Test results

[Fabfizzler]

Hello Dr Hunter

Hope all is well. I had sent you a question some months ago regarding an exposure which you answered. That exposure was probably about 8 months ago now. Since then I also had another low risk exposure. I got several hiv tests done based on these exposures. Because the second exposure happen only 19 days before the test the dr said that the best test to do would be the PCR RNA test as it would  show for both exposures if virus was present in blood sample.

So in brief the tests I had which all came back negative were

PCR RNA qualitative HIV 1
P24 Antigen hiv 1 neg
Antibody HIV 2

From what I have read it appears that the pcr and p24 test should be taken on their own as evidence of no infection. As such I would need to take a dual antibody test now ( 4 weeks from last exposure) and even this would not be conclusive and would have to test again at 3 months! I'm a bit confused on the tests now especially as the pcr was very expensive. So my question is if I have 1 more dual antibody test, considering the above test results could I expect it to likely negative again?

Thanks in advance

Fabfizzler

[H. Hunter Handsfield, M.D.]

Depends on the sex worker and the duration of unprotected exposure. In most of the US and industrialized countries, under 1% of female sex workers have HIV, usually under one in 1000. Brothel workers and bar pickups generally are higher risk, expensive escorts often very low risk.  African Americans generally much higher risk than whites or Asians, Latinas intermediate. Brief exposure, e.g. immediate withdrawal after breakage, probably carries little risk.

Thanks for the thanks. Best wishes and stay safe.

[Fabfizzler]

Hi Doctor

Is a condom failure with a CSW high risk? Thanks for the feedback and I'll take your comments with me in the future. Once again you guys are providing a great service. Best wishes for the future.

Fabfizzler.

[H. Hunter Handsfield, M.D.]

Based on your statement that your latest exposure was "low risk", your current results (a duo test at 3 weeks) can be considered conclusive.  But if you want a 100% conclusvie result based only on testing, you'll need another antibody test (with or without p24 antigen) at 4+ weeks.

I would also advise you to stop testing after individual exposures.  People who are sexually active outside monogamous relationships should be HIV tested from time to time, like once a year, but should ignore all individual exposures as a trigger for testing unless especially high risk, e.g. known positive partner, unprotected sex with an especially high risk partner, etc.

Finally, if and when you are tested, it will be cheaper to see a doctor or clinic and then follow the testing advice they give.  Assuming you are testing at labs on your own, this current round of tests probably will end up costing a lot more than the price of a doctor visit plus proper testing based on knowledgeable medical advice.  This for sure is the case if you visit a public health STD clinic (or its equivalent if you're not in the US).

[Fabfizzler]

Hi Dr Hunter

Yes it appears I made a mistake , the tests I had were the pcr RNA, which I understand now to be early detection test for the hiv 1 . The other test was ELSA test which was for  hiv 1 and 2 antibodies and the P24 was hiv 1. I think that makes more sense now? But as the antibody was at 3 weeks I should do 1 more at 4 weeks?

Regards

Fabfizzler

[H. Hunter Handsfield, M.D.]

Welcome back to the forum.

I'm not sure I understand why you had a p24 antigen test without antibody.  Nobody recommends that such testing be done except in combination.  I'm also puzzled about your report of an antibody test for HIV-2, apparently without HIV-1 antibody testing.  Are you sure it wasn't for both HIV types?

Anyway, the combination of either a negative PCR or negative p24 antigen, plus antibody at 4 weeks or more after exposure, is conclusive.  In other words, having a duo test at 4 weeks or more after exposure would prove you don't have HIV.  Here are a couple of threads that go into this in more detail, including an explanation why official agencies still advise antibody testing at 3 months -- which, in fact, is rarely necessary.

http://www.medhelp.org/posts/show/1704700
http://www.medhelp.org/posts/show/1891685

You might also note that on MedHelp's community forum, there are no official moderators.  Everyone who participates, including the post knowledgeable, are non-professional volunteers with no official link with MedHelp.  As such, they are correct to adhere to the official advice, such as that from CDC.

Best wishes--  HHH, MD