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Testing Confusion

Dr

I have searched numerous posts on this site and others and am confused.  I had a high risk exposure with an HIV positive person (unprocted anal and I was insertive). I developed lymph node swelling 2 weeks later but no other symptoms that I am aware of.  I am not sure why there is so many different answers on testing timeframes and type of tests but it is confusing. The HIV community forum on here and on other sites says 3 months before conclusive but the doctors forum on Medhhelp says something different and you dont have to wait as long. After all of this I have abstained from unprotected sex with my partner.  I had a 4th generation test done at 5 weeks which was negative.  I then read about a 2nd window period after 4 weeks and that the 4th generation test may not be accurate after 4 weeks so I went and got a lab based EIA test at 6 weeks (43 days) and it was negative.  

1) Why the confusion about window periods and type of test?

2) Am I conclusive negative?

3) Should I re-test and if so, when and what type of test?

4) Can I have unprotected sex with my partner now or should I wait for more test?

Thanks
4 Responses
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Avatar universal
Thanks so much for your comments Doctor.  My anxiety and fear is pretty high right now as some could imagine. I just want to ask a few follow ups

1) you said the 4th generation test is accurate after 5 weeks.  If for some reason that test was flawed or not performed right, would the 6 week EIA lab antibody test have picked up an infection if there had been one?  Is it as accurate as the 4th generation?

2) you said I dont need another test but I could have one if I wanted to.  Just want to make sure I am not reading something into that that you think maybe I need one more just to absolutely sure.

I just dont want to put anyone at all at risk.  

Thanks again
Helpful - 1
239123 tn?1267647614
MEDICAL PROFESSIONAL
1) These tests are pretty much foolproof.  The lab didn't screw it up.  You can rely on the result.  But the answer is yes -- the EIA at 6 weeks would have picked it up if somehow the first test missed it.

2) There were no hidden messages in my reply or advice. I truly believe you do not have HIV and should resume sex with your regular partner without fear.
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
I've decided to make this thread the one I will regularly refer to in answering similar questions in the future.  Therefore, I'm adding three more threads that also discuss HIV test science, interpretation of results, window period, and the regulatory reasons why official advice still includes testing at 3 months despite scientific evidence to the contrary.  Although they go back as long as 5 years, I have confirmed that the information in them is still valid.

http://www.medhelp.org/posts/show/764623
http://www.medhelp.org/posts/show/1579458
http://www.medhelp.org/posts/show/1704700

In some of these 6 threads, important information is in the follow-up comments as well as the initial replies.
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your questions.  I'll go directly to them.

1) There are no official moderators or experts on MedHelp's HIV community form. Everyone participates because of their personal interest in the topic.  Many of the regulars are very knowledgeable and usually have excellent advice. I believe some are or have been HIV prevention counselors, but most are not medical professionals and it is appropriate that they stick to official advice about HIV testing. CDC and many other agencies do not consider negative tests to be conclusive until an antibody test has been done at 3+ months after the last possile exposure.  In contrast, Dr. Hook and I are experts in this area, and we have the freedom to give advice based on the best science.

Below I have provided links to other threads that go into these issues in more detail.

2-4) Negative 4th generation ("duo" or "combi") tests are conclusive any time 4 weeks or more after the last exposure. There is no second window period; that's an urban myth (see the third thread linked below, in particular the follow-up comments December 25).  Your negative result at 5 weeks proves without doubt you do not have HIV and you do not need further testing. You can safely have sex with your partner.  However, if you would like the additional reassurance of a negative result at the official interval, feel free to have another test at 3 months.  Personally, I wouldn't do it and I don't recommend this to my own patients.

http://www.medhelp.org/posts/show/1855891
http://www.medhelp.org/posts/show/1891685
http://www.medhelp.org/posts/show/2064508

I hope these comments have helped clear up your confusion on these issues.  Best wishes and stay safe--

HHH, MD
Helpful - 0

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