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DNA PCR Validity
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DNA PCR Validity

Dear Doctor,

I hope you can evaluate my question as one that while common, the circumstances surrounding why I am asking is clearly not. Laboratory testing recently revealed that my IGA was low, and a battery of tests have been ordered to determine if I have CVID. My hope is, based on a relatively healthy life thus far, I will ultimately be diagnosed with just select IGA deficiency (it was not absent, just quite low - 36).

Thankfully (I know this test is not FDA approved for diagnosis) I had a PCR done 20 days after a potential low risk exposure (Insertive Oral). While I have had antibody testing out to the 5 Month mark (Rapid Testing done today), the DNA PCR is the only test was not dependent on an immune response that I have taken to date. My questions are as follows:

1) Is it possible to have HIV with a negative PCR at 20 days? If yes, what is the accuracy rating of the PCR at 20 Days.
2) Should these tests come back less than favorable do I need to retest, and if so, do you recommend the DNA or RNA test or does it make no difference?
3) Is there a point with which everyone produces antibodies (i.e. even those with a slight deficiency?)
4) Would an immune deficiency (or a significant one) all but ensure a very noticeable seroconversion?
5) I have tested positive for HSV-1 IGG Antibodies, is this a good sign that the IGG portion of my immune system is doing it's job properly?

I have tried to come up with my answers via the forum, and from what I can see, the reccomendation is that the PCR testing is not used for routine testing. My hope is since the recommended testing mechanism for immunodifficent folks is in fact non antibody testing that you can shed some light on the validity of the PCR I had done. My first preference would be to stop testing, but I would also like to have the peace of mind of knowing that I am 100% in the clear. My doctors call regarding low iga / cvid was a bit of a curve ball.  

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Returning to the Forum to ask questions you have already asked is not going to change my answer.  As I have told you repeatedly, your likelihood of having HIV is effectively zero and no amount of "what if..." or "has it ever..." questioning is going to change this.

As I have said on the Forum before- " In general we do not recommend HIV PCR testing for diagnosis is HIV infection for several reasons.  While the PCR is likely to become positive more quickly than other antibody detection tests (i.e. usual blood tests), at the present time the blood tests are becoming more and more sensitive and detecting infection earlier and earlier so that the time difference in detection between PCR test and antibody detection tests is becoming smaller and smaller and at present is, in general only a week or two.  In addition the time course over which the PCR tests become positive is less well described than for the blood tests and, as a result, it is difficult to make a definitive statement on what a negative PCR test means at any time within a few weeks of exposure to a HIV infected or possibly infected partner.  PCR tests are also more expensive than regular antibody tests.  Finally and most importantly, the false positive rate for PCR tests (i.e. a positive result in persons who do not have HIV) is higher than for blood tests.  Each of this on this Forum have seen a number of people who were worried needlessly because of false positive tests. For all of these reasons, we rarely recommend testing for HIV diagnosis using PCR. "

Relevant to your questions:
1.  You do not know you have immune deficiency.  I suspect you do not or if you do, you have selective IgA deficiency which has nothing to do with HIV.
2.  No one can tell you the time course by which HIV tests become positive for HIV because they have not, and will not be studied for this purpose.  Most and possibly all people with recently acquired HIV would have a positive PCR test at 20 day- no one knows however what proportion of persons woul not.  
3. Antibody tests are reliable after 8 weeks- you should believe your 15 week result.
4.  You do not need re-testing.
5. Yes, your positive HSV IgG is an indication that you would develop antibodies if you had HIV.

Bottom line, you do not have HIV. Believe the tests. Stop worrying.  You need to move forward.  

Finally, I will remind you that clients are allowed to post only twice in any 6 month period in order to allow others with access to the site.  No further questions please. EWH  
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H. Hunter Handsfield, M.D.Blank
University of Washington
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Edward W Hook, MDBlank
University of Alabama at Birmingham
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