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RNA and oraquick swab test
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This forum is limited to prevention of HIV and to safe sex in general. All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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RNA and oraquick swab test

I am a male of 27 yrs old and fairly healthy condition, I was involved in a incident with a women of unknown status  in a diffrent state we had unprotected vaginal and anal sex.  Of course she claimed that she was clean and there is nothing to worry about.  Following my return  home I had a 11 day hiv rna test conducted by quest labs which came back as undectable, followed by a two week oraquick swab test and a five week oraquick swab test that both came back negative.  I would like to know where do i stand now at this point in regards to being negative.  I asked this question on another forum which you prob heard about The Body and really didnt not get a solid answer.  Should i continue testing or am i cleared from this point on. I am confused and scared from all the conflicting info online.  Thanks
239123_tn?1267651214
Welcome to the forum.

As you heard on the community forum, official advice from test manufacturers and most public health agencies is that the results of HIV antibody testing are not completely reliable until 3 months after exposure.  However, the available data indicate that in fact such tests are virtually 100% reliable much earlier than that, probably around 6-8 weeks.  The reason for the persisting 3 month advice is regulatory in nature, not scientific.

Second, an HIV RNA test at 10-11 days is almost 100% reliable all by itself.  Such a test is a keystone of testing all donated blood, and central to the absence of transfusion-related HIV in the United States at the present time -- a testament to how accurate the test is.

Third, for those reasons, combinations of test results are even more secure.  Your combination of a negative RNA test at 10 days and negative antibody test at 5 weeks amounts to 100% proof you weren't infected.  The need for waiting for 3 months for definitive testing strictly applies only whe only antibody testing is done.

Therefore, you don't need any more testing.  At a personal level, if I somehow found myself in your circumstance, I would have no other tests and I would be continuing unprotected sex with my wife with no fear of ifnecting her. Of course you are free to be tested again if you would feel better adhering to the official advice for another antibody test at 3 months.  But truly there is no need.

For more discussion of these issues, see the thread linked below:

http://www.medhelp.org/posts/show/1704700

Best wishes--  HHH, MD
8 Comments
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Avatar_m_tn
thanks for your very detailed and specific information.   From my understanding if a person is infected they would have enough copies of the virus within there blood to show up on the rna test but heard conflicting info that possibly the virus has not spread enough to be detectable and if the body would have converted already by then antibodies would have been present within the swab test at 5 weeks.  Also if your body is in a healthy state  I assume it would fight the virus in the earlier stages rather then later if a person is somewhat compromised from some other ailment then antibodies would show post 3 months like some type of cancer for example.  Is my train of thought correct because my personal doctor told the stronger your body is the longer it would take to show symptoms or antibodies which I believe is totally false and the opposite is correct that if healthy your body would react quickly to the virus
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239123_tn?1267651214
Sorry, but your "train of thought" is mistaken (and your doctor's -- although I have to wonder whether you're the one who first raised the idea and he found it easier to agree than argue).

Don't overthink it.  There is no known difference between outwardly healthy people with "strong" immune systems or those who are unhealthy or have "weak" immune systems in how quickly the HIV tests become positive.  The direct viral tests such as HIV RNA always become positive at around 5-10 days, and the antibody tests always become positive at 2-6 weeks (usually 2-4 weeks).

The other aspect of your situation is that you imply your potential exposure was very low risk.  In the US or other industrialized countries, it is statistically unlikely your partner had HIV (probably around 1 chance in 1,000, no matter her sexual lifestyle); and even if she did, the average transmission risk for an episode of unprotected vaginal sex is around 1 in 1,000.  So even before you had an HIV test, the chance you were infected probably was somewhere in the range of one in a million.

So my reply above stands.  You can safely go on with your life without giving any of this another thought.
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Avatar_m_tn
Thank you dr for your explanation I hope one day the medical field can get on the same page about information because honestly its scary with all the contradicting info out there thank you and best of health.  
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Avatar_m_tn
there are alot of articles that state rna should not be  used as a stand alone, is that because of false positive. And i took another oraquick at 7 weeks which was negative i can be reassured that i am negtaive and no loner need testing. thanks
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239123_tn?1267651214
I don't see a question.  I agree that RNA testing should never be used as a standalone test.  But you didn't use it that way, so I don't understand why it's on your mind.  I have no other comment. That will end this thread.
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Avatar_m_tn
I apologize for the wording I was at work  this will be my last question. Why is that rna testing is not stand alone and antibody testing needs to be used to be conclusive.  And does oraquick have the same efficiency as blood testing  
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239123_tn?1267651214
RNA theoretically carries the possibility that someone is infected but with too low a viral load for detection.  This is rare in early HIV infection, but could happen.  All experts are in agreement that a negative RNA test is highly reliable but never stands alone as 100% certain.

Recent research shows that the oral fluids rapid tests have a somwehat longer window period than blood tests, but not enough to change my opinions and advice as discussed above.  

That's definitely the end of this thread.  You can't expect to keep returning with every additional minor quesiton that comes to mind.
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H. Hunter Handsfield, M.D.Blank
University of Washington
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