confused about HIV test types and results

[jspenader]

Hi, I had a condom failure that was unnoticed during vaginal intercourse with a woman of unknown status on February 26. Asking about her history after the fact (really smart, I know) she claims to have tested negative within the past 6 months and says she had no sexual partners in that time.

It's hard to know when people are telling the truth or not and my anxiety sent me to a lab for an early detection test at 14 days. This was an antibody test and a pcr dna test. Both came back negative.

Yesterday, at 23 days I have developed a mild fever (99.1) and a dry, irritating cough and diarrhea today. I'm still have very bad anxiety over this and am trying to get the woman to go with me for testing (that would be ideal).

So, the questions are: is the 14 day dna test meaningful at all? And is it worth repeating the early detection dna test next week after 28 days? I know I should get an elisa test at 12 weeks as well. Just not sure I can survive that long. Thanks for you insight...

[jspenader]

Thank you Dr. Hook. This illness has been getting worse as the cough became productive on Friday and the headaches and bowel issues persist. Still no fever or obvious swollen glands. I do need to get tested to find out what's going on and I appreciate your counsel on this very much. Maybe I'll wait until Tuesday just to be sure.

[Edward W Hook, MD]

The data from studies is for data collected after 28 days however 27 days is effectively the same.  I would consider 27 day test results defintive for you. EWH

[jspenader]

One more quick question if I may: If I test on Monday (at day 27) would that still be definitive? That would be the easiest day for me to make it to the lab next week.

Thanks again for all your help, Dr. Hook. I really appreciate it.

[Edward W Hook, MD]

Correct, testing as you describe at day 28 would be defintive.  EWH

[jspenader]

Dr. Hook, thank you for your reply. I appreciate your insight. Trying to research these things is difficult as there is a vast and vastly varied amount of conflicting information on window periods and the different types of tests.  I am sure that the economic (and other) considerations that affect official policy from places like CDC don't help any. I did find it interesting that I found reference to blood donation screening using pooled NAAT where the window period was listed as 11 days (a CDC document) and 10 to 12 days (a Canadian source). All of this makes your head swim when you are just trying to figure out what your own results may mean. It also told me it was time to stop trying to sort through the mess on my own and ask a professional.

Anyway, it sounds like I can buy some peace of mind if I choose to retest with another antibody/dna test on or after Tuesday next week (which will be the 28th day) since you mentioned that would be definitive. Thanks again for your help.

[Edward W Hook, MD]

Welcome to the Forum.  The exposure you mention was low risk for HIV.  Few heterosexual women who are not IV drug users have HIV (less than 1 in 10,000) and the risk for getting HIV through any unprotected sexual exposure is less than 1 infection per 1000 exposures.  Thus statistics are very much on your side.

Your tests are helpful but not definitive. There are no precise estimates of how accurate a PCR test is for detection of HIV 2 weeks after an exposure (despite what those selling them say) but certainly the majority of infections would be detected at this time, particularly when the test is done in conjunction with an antibody test as you did. the combination of negative PCR and an antibody tests at 28 days is, on the other hand would be definitive, although expensive, way to rule out HIV.

I hope this is helpful.  Based on the history you have provided and your test results the chance that you have HIV is vanishingly rare.  I suspect your symptoms are unrelated to the exposure that you mention. EWH