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Understanding Various Test Results within Window Period
Hi Drs.,
I recently had a high risk exposure to HIV:
1) Had anal sex with a partner, used condom and lube for initial intercourse, but then my condom came off and we continued unprotected (including more anal penetration).
2) He recently came forward saying he was in fact HIV Pos. He said he is on medication and is "undetectable", and therefore "its every unlikely to transmit HIV while bottoming". (he was bottom, I was top).
3) The event happened 5 weeks ago.
Recently I had a sore throat and was achy, so I thought something might be up. I've currently completed the following tests:
1) Oraquick at home (35 days post exposure) = Negative
2) Lab HIV 1/2 EIA Ab Screen w/ reflexes (36 days post exposure) = Negative (PS. how can you tell what generation test this is?)
3) Clearview Complete HIV 1/2 Rapid test (37 days post exposure) = Negative.
4) Requested doctor to perform a viral load test, as I understand that this has a much shorter window period, results pending.
As you can probably tell from the number of tests I've taken in such a short period, I'm rather concerned that I am in fact infected. My questions to you are as follows:
1) Given the short time since exposure, what value, if any is there in the above tests?
2) How can I find a treatment center in NYC which has rapid combo tests?
3) How can I tell what the generation is / window period is of the lab tests? All i know is the test name and that they were performed using an "Advia Centaur XP HIV 1/O/2 Enhanced immunoassay.
4) Is what he saying true about a lower risk of infection if he is "undetectable"?
I recently had a high risk exposure to HIV:
1) Had anal sex with a partner, used condom and lube for initial intercourse, but then my condom came off and we continued unprotected (including more anal penetration).
2) He recently came forward saying he was in fact HIV Pos. He said he is on medication and is "undetectable", and therefore "its every unlikely to transmit HIV while bottoming". (he was bottom, I was top).
3) The event happened 5 weeks ago.
Recently I had a sore throat and was achy, so I thought something might be up. I've currently completed the following tests:
1) Oraquick at home (35 days post exposure) = Negative
2) Lab HIV 1/2 EIA Ab Screen w/ reflexes (36 days post exposure) = Negative (PS. how can you tell what generation test this is?)
3) Clearview Complete HIV 1/2 Rapid test (37 days post exposure) = Negative.
4) Requested doctor to perform a viral load test, as I understand that this has a much shorter window period, results pending.
As you can probably tell from the number of tests I've taken in such a short period, I'm rather concerned that I am in fact infected. My questions to you are as follows:
1) Given the short time since exposure, what value, if any is there in the above tests?
2) How can I find a treatment center in NYC which has rapid combo tests?
3) How can I tell what the generation is / window period is of the lab tests? All i know is the test name and that they were performed using an "Advia Centaur XP HIV 1/O/2 Enhanced immunoassay.
4) Is what he saying true about a lower risk of infection if he is "undetectable"?
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question. You had basically accurate replies on the community forum, but I'm happy to expand on the issues you raise.
To answer the overriding question, as posed in the title of your question: depending on the specific test done, or combination of tests, HIV testing is definitive at 4-8 weeks after the last possible exposure. Here is a link to a thread that discusses this in more detail, includng the reasons why official advice often remains to test at 3 months -- as usually recommended by frequent participants on MedHelp's HIV prevention community forum -- even though the scientific evidence indicates conclusive, reliable results at earlier times: http://www.medhelp.org/posts/show/1704700
To your specific issues: This was a zero risk exposure for all practical purposes. Your HIV positive partner is exactly right: being on HIV therapy with an undetectable viral load makes him non-infectious. If there is any risk at all, it is extremely low.
As for the tests you have had, all are antibody tests, i.e. "3rd generation". At the times you had them, the results are 95+% reliable, probably closer to 99% for the tests at 36 and 37 days. And once you have tested negative on your viral load test (and you can be sure it WILL be negative), that combination -- a negative test for the virus itself plus the negative antibody tests -- that combination of results will be 100% conclusive (as discussed in the thread linked above). To your specific questions:
1,4) Answered above.
2) To my knowledge, in the US there is no approved rapid combo test. But you don't need it. The combination of your RNA/DNA test ("viral load") plus antibody is the equivalent of the combo test -- in fact, even better.
3) All your tests were 3rd generation. Only the combo tests are 4th gen -- in fact, that's the definition of 4th generation.
So no worries at all. Had I somehow been in your situation, I would not have felt a need to be tested at all -- your risk was that low. When your curently pending viral load test returns and is negative, your results will be conclusive and you can stop worrying.
Best wishes-- HHH, MD
To answer the overriding question, as posed in the title of your question: depending on the specific test done, or combination of tests, HIV testing is definitive at 4-8 weeks after the last possible exposure. Here is a link to a thread that discusses this in more detail, includng the reasons why official advice often remains to test at 3 months -- as usually recommended by frequent participants on MedHelp's HIV prevention community forum -- even though the scientific evidence indicates conclusive, reliable results at earlier times: http://www.medhelp.org/posts/show/1704700
To your specific issues: This was a zero risk exposure for all practical purposes. Your HIV positive partner is exactly right: being on HIV therapy with an undetectable viral load makes him non-infectious. If there is any risk at all, it is extremely low.
As for the tests you have had, all are antibody tests, i.e. "3rd generation". At the times you had them, the results are 95+% reliable, probably closer to 99% for the tests at 36 and 37 days. And once you have tested negative on your viral load test (and you can be sure it WILL be negative), that combination -- a negative test for the virus itself plus the negative antibody tests -- that combination of results will be 100% conclusive (as discussed in the thread linked above). To your specific questions:
1,4) Answered above.
2) To my knowledge, in the US there is no approved rapid combo test. But you don't need it. The combination of your RNA/DNA test ("viral load") plus antibody is the equivalent of the combo test -- in fact, even better.
3) All your tests were 3rd generation. Only the combo tests are 4th gen -- in fact, that's the definition of 4th generation.
So no worries at all. Had I somehow been in your situation, I would not have felt a need to be tested at all -- your risk was that low. When your curently pending viral load test returns and is negative, your results will be conclusive and you can stop worrying.
Best wishes-- HHH, MD
MEDICAL PROFESSIONAL
The "generation" definitions are not official -- different experts use different definitions. But most important, the differences between 2nd and 3rd generation tests are irrelvant to your situation. Third tends to become positive earlier than second. ("First generation" tests are no longer in use.) But that difference is pretty much gone by 5 weeks, so your test results are equally valid whether you consider them second or third generation.
Based on your exposure history, even without testing, you shouldn't be at all worried. And once your pending RNA/DNA test result is available -- and is negative as expected -- you can move on without giving any of this another thought.
Finally, you can pass this message on to your HIV positive partner: He still has an absolute ethical obligation to inform all partners of his HIV status, before having sex with them. Even though the transmission risk is zero or close to it, and even if he is a consisent condom user, it is inappropriate and unethical to put partners through the worries you have experienced yourself. In other words, he is scietifically right but, from a moral standpoint, behaving very inappropriately. I hope you'll tell him I said so.
Based on your exposure history, even without testing, you shouldn't be at all worried. And once your pending RNA/DNA test result is available -- and is negative as expected -- you can move on without giving any of this another thought.
Finally, you can pass this message on to your HIV positive partner: He still has an absolute ethical obligation to inform all partners of his HIV status, before having sex with them. Even though the transmission risk is zero or close to it, and even if he is a consisent condom user, it is inappropriate and unethical to put partners through the worries you have experienced yourself. In other words, he is scietifically right but, from a moral standpoint, behaving very inappropriately. I hope you'll tell him I said so.
Dr. Handsfield,
Thank you so much for the quick reply. Your words are very comforting. I've spent the weekend googling every possible thing I can think of on the matter (I know this can usually do nothing but raise anxieties.). I just have one lingering question: I'm still really confused on understanding and identifying 2nd gen vs. 3rd gen. vs. 4th gen tests. I came across a document below which said the both the Clearview and Oraquick were 2nd generation tests. Is there something i'm misreading or not understanding?
Much Thanks!
(http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCkQFjAA&url=http%3A%2F%2Fwww.cdc.gov%2Fhiv%2Fpdf%2Ftesting_Advantages%26Disadvantages.pdf&ei=kgBCU8-TJaOTyQHf_IDgDg&usg=AFQjCNG509nNsxqog4VpzirSMcsmzTokuw&sig2=hCOEWw5Y2AWyIfcG-cAwXg&bvm=bv.64125504,d.aWc)
Thank you so much for the quick reply. Your words are very comforting. I've spent the weekend googling every possible thing I can think of on the matter (I know this can usually do nothing but raise anxieties.). I just have one lingering question: I'm still really confused on understanding and identifying 2nd gen vs. 3rd gen. vs. 4th gen tests. I came across a document below which said the both the Clearview and Oraquick were 2nd generation tests. Is there something i'm misreading or not understanding?
Much Thanks!
(http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCkQFjAA&url=http%3A%2F%2Fwww.cdc.gov%2Fhiv%2Fpdf%2Ftesting_Advantages%26Disadvantages.pdf&ei=kgBCU8-TJaOTyQHf_IDgDg&usg=AFQjCNG509nNsxqog4VpzirSMcsmzTokuw&sig2=hCOEWw5Y2AWyIfcG-cAwXg&bvm=bv.64125504,d.aWc)
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