Official recommendation for HIV testing

[Joan123]

Dr HHH,

I have some questions that I hope you could answer. What is the official recommendation for HIV testing after sexual assault(healthy person)? What is the window period for most STD tests in this case? Would Hep C interfere with HIV test results? I know you are a busy man and you may not answer my questions, but I'd like to thank you for all the work you do here and for all the useful information about HIV transmission and prevention. Than you very much!

[H. Hunter Handsfield, M.D.]

OK, folks, that's enough.  Over to the HIV Support forum if you want to continue the discussion.

HHH, MD

[dipwad2007]

OK, I'm new on here but I am going to chime in and rant because this is really bugging me..

Joan123, I kind of agree with you - it's not confusing but, to me, some of Dr. Handsfield's comments and stances throughout this board (I've read quite a lot of it) and the others who repeat them in this forum and the support forum are very hard come to terms with.  To me, my personal view, the issue about risk versus when to stop testing/accept your negative test is nonsense.

There is quite often mention of testing "windows" as it related to risk.  Now the doc and anyone else can get out their calculator and come up with whatever they want to but I cannot fathom how it relates.  Even with the often stated ratios and multipliers I have no clue how anyone can say that a person might possibly test positive at a later date (assuming they acquired the virus) because they were involved higher risk activity.  To me, that is saying that someone who, by bad luck/whatever, who did a low/lower risk thing and actualy got the virus will seroconvert and test positive earlier than someone who did a high risk thing (e.g. unprotected anal).  I cannot view that as anything other nonsense...  If the subject is ratios and multiplers as it relate to risk only then fine but risk versus how far out to test - no way.

If you get the virus, then your body will attempt to deal with it - start seroconverting and make antibodies.  Great, everyone gets that.  However how that hell can the risk of the behavior that caused you to get the virus determine when your antibodies will show on a test?  There is no reasonable way to quantify that with the statistics and ratios given.  It could be quantified by known/accepted/proven physiological conditions, situations, and known data.  It is that type of information that causes various agencies, asscociations, doctors, whatever to now say 6 weeks is good.

I accept the notion that modern testing will detect HIV antibodies earlier and more definitivly than before.  I also accept that over the two decades or so this has raged within our world that a lot of science concludes that almost most (whatever the hell "most" means) people's status can be determined in 6 weeks.  However, saying that someone might have detectable antibodies later than that because of the type of activity they did to get it has no needs clinical data to back it up.  If there is then Dr. H should state that - not ratios and multipliers.

I personally accept the 6 weeks testing concept and I consider Dr. H as strong person to publically state that.  I accept that if a person is indeed having ARS symptoms that most people will have detectable antibodies within a couple of weeks - I have read quite a few medical papers showing/stating that.  However, it is just a fact that there a many others, including STD/infectious disease specialists who do not believe that (or at least will not say it to a patient or in public).  I also accept that certain activities might not merit worrying about testing windows at all.  But, to me, it makes no sense to say that dectectable antibodies will be found later (therefore one should test later) based on he act of how one might have got the virus.

For whatever it's worth, I'm on this board because I did a stupid, considered very low risk thing (unprotect oral on prostitute of unknown status) but like many I am very concerned about it (my mouth was not in the greatest shape at he time).  I've also spent a great amount of time learning as much as I can so I can take the best approach to this very, very scary thing.  I am trying to deal with and accept all the info I have encountered - but I have found most of it is over generalized ****.  Dr. Handsfield's forum is great and I like most of what Dr. Handsfield has written, stated, whatever - just not the notion being passed that a person will seroconvert later because they did something known to pass the virus more so than some other "low risk" activity that could cause you to get it.

My apologies if I have offended anyone's sensibilities here and maybe I am too dense to "get it" but it seems simple enought either accept 6 weeks testing as valid or don't based on clinical science not stuff based.

[Joan123]

Dr. HHH have explain this millions of times here.
It is not confusing. If someone had  none or almost no risk of acquiring HIV, a 6-8 week test if fine. If you had a high risk exposure like anal sex, sexual assault and such, Dr. HHH always recommends a 3 month test. What's so confusing? Of course , if you are not satisfied with you 6-8 negative result after a low risk exposure, you can always retest.

[H. Hunter Handsfield, M.D.]

bemyown234 has it exactly right.

amiscrewed: Before you go questioning my expertise or motives, better search this forum for a hundred other discussions on these issues. I don't take it personally, but I do insist that people have their facts straight and to be familiar with prior discussions on the same subject before posting on this forum.

[bemyown234]

Nothing in diagnosting testsing is 100% or 0 % .
ok, lets assume that the assaulter had a 10%( 0.1) chance of having HIV( this is actually a very high rate). The risk for transmission for a single act of vaginal intercourse is 1 in 2000.Lets double that risk and make it 1 in 1000 , viz 0.001.

So even before testing , the chance of getting HIV was 0.1 x 0.001=0.0001.

Now coming to testing . Dr H says 5 weeks is almost 100% reliable. CDC says 3 months is 100% reliable. Assume that there is no clear data , and that Dr H is wrong in it being 100%. Almost all reasources say that "most people" are positive by 6 weeks. Lets make it 95% instead of 100 % at 6 weeks. so if test is negative there is still a 5 % (0.05) chance that it is false negative.
At this point, chances of having HIV despite a negative test at 6 weeks is 0.0001 x 0.05 = 0.000005 or 1 in 200000.

So sure, its POSSIBLE, but look at the odds.
Of course this is assuming the worst possible case scenario, and assuming wrongly that the accuracy is only 95% at 6 weeks and assuming that an HIV expert of Dr HHHs calibre does not know what he is talking about.  In reality, the actual risk is probably much much less, so low as to be close to 0.

[xworriedx]

You are out of your mind, you will listen to what Teak in the support forum like he is the bible on HIV but you wont listen to a REAL DR has to say about testing.

Give your head a shake

[amiscrewed]

sorry, no offense to you doctor and I am not questionning your expertise but after reading in the hiv support forum where one girl tested negative at 6 week and positive later, so im very confused about this, and went to the cdc and the body.com and other sites they recommend 3 month to be conclusive. After many research online, yes most people seroconvert after 4weeks, therefore i would assume an accurate test by 6 weeks, but there are cases that 6 week may have a false negative and this could mean false reassurance and put others at risk. I also call the hiv department at my school(medical school) they also suggest a 3 month test and 6 week is not definitive. so i get many different answers and a bit confused.

[asymptomaddict]

The Dr. has indicated repeatedly in the past that he means the latter.  

[amiscrewed]

I dont think 6 week is conclusive as he metions I really dont know why he is advising this, because on the hiv forum support, this girls"helpme21" tested negative at 6 weeks after being raped but later tested positive and confirmed it with a western blot, I dont see why someone would joke like that, and that is why the CDC and other reputable site and testing manufacturer such as thebody.com are advising a 3 month test to be definitive and conclusive not 6 weeks. And almost every lab in the US use the standart elisa for routine hiv testing. So i dont know why drhhh said that others are behind on testing, I would assume this is a false reassuarance.

[Jepp]

Just wanted to ask, when you say
"Most of those that advise 3 months are behind the times with modern HIV testing" Do you mean that their tests are different and because of this there is a 3 months window period on these tests ? Or the test is the same and they just dont know that its now considered a 6 week window period?

Thanks

[H. Hunter Handsfield, M.D.]

There is no 'official' recommendation.  Different health agencies have different advice and there are no laws or regulations about it.  Some agencies say 6 weeks (e.g., the Massachusetts health department) and others say 3 months.  Most of those that advise 3 months are behind the times with modern HIV testing, or they are following their lawyers' advice instead of science.  For other STDs, a week is fine for gonorrhea and chlamydia, 6 weeks for syphilis, and 3 months if herpes testing is done.

Thanks for the thanks.  Best wishes--

HHH, MD