Clinical Confusion

Dear Doctor H,

Can I clarify a testing question. I received a

[H. Hunter Handsfield, M.D.]

I cannot explain why some clinics or providers give varying advice, except to say that differing experts have different interpretations of the data; and differing clinics have different philosophies about medicolegal issues, i.e. how much margin of safety they retain in advising patients.  The bottom line, though, is that with a low risk exposure and a negativ duo test at 4 weeks, you are home free.

This is never going to change.  Ten years from now, there still will not a single approach or identical messages from all clinics and providers on these issues.  It's the nature of medicine, science, and clinical practice.

Best wishes--  HHH, MD

[jplee]

I am with you on this and had the same experience.  Even at 6 weeks negative the doctor says "Your clear" BUT I would do another at 12.  OK so I am not clear then?  Well it really depends if you want to take that chance he tells me.  Hmmm I am not the expert here YOU ARE.  Ok off the record I would say your clear but if you wanted me to sign something then of course I would not and recommend another test at 12 weeks.

All in all this has to be cleared up.  If the tests today are that good and enough data has been collected then new figures must be published.  If not then why test at all before 3 months?

I suspect you and I are in the same boat now.  Retest at 3 months and say goodbye to another

[worstnightmereever]

hello doc..
what do u think of the eclipse period of hiv??
the virus spreads (or stuck) in the lymphatics n hasn't reached the blood yet
so tests for antibodies, P24 n pcr would be negative
i found articles that says it can be up to 6 months or even more.

[Rob73!]

Hey guys,

Was in the exact same position as you two about 3 months ago. Can I ask what clinic you used? In my case I went to Freedomhealth in Wimpole Street London. And was pretty much told the same thing.

The average time to develop detectable HIV antibodies is in the region of 25 days.

As the good Dr has pointed out on this forum testing @ 4-6 weeks is pretty much a conclusive result. Many health professionals in the developed world are now moving towards a window period of between 4-6 weeks. this has come about due to greater understanding of the immune system and HIV. Also the newer tests are more sensitive than those of just 5 years ago. And while any generation of test will be bang on the money at 12 weeks, the newer one's (referred to as 4th generation) can pick up HIV infection sooner. You also have to bear in mind that HIV research is one of the fastest moving fields of medicine - so things change quickly and some Dr's will not be armed with the latest findings and guidelines.

I can only advise from my own experience - I had the DUO test done @ 28 days. And had a follow up rapid test done at the three month mark, mainly for piece of mind. Another poster on this forum (can't remember the handle tho') also made a valid point of saying that the Dr who handled his HIV test stated that the biggest problem was in getting people to accept a negative test result. Hence the constant treadmill of re-testing. Remember just  beacuse the Worried Well's are trawling the net for answers to confirm their status it's the dr's who know what they are talking about. IF they say it's neg and no further testing is warranted then ask yourself why they are saying that! I would recommend that you stick you research efforts to this site and thebody.com.

Jplee, symptoms are NEVER, NEVER, EVER an indicator of HIV infection. You have to test. But your symptoms are exactly the same as mine were. Trust me it's stress. And it takes time to recover. So don't expect it all to go away overnight. I would suggest seeking professional help to deal with your anxiety. Again, this is something that I did and it did help.

Good luck guys!

[Josh1968]

Thanks for your reply and comments, it was indeed Freedom Health and the service they provided was outstanding.

The biggest problem as you say is

[skerdstraght68]

nothing in this world is 100% not even the test. You can rely on a 6 week test.

[jplee]

Sorry but you don't help with statments like the above that you made........

[Rob73!]

Partially agree with you Skerd. The only thing that's 100% stick on in this life is income tax and death. Everything else is guesswork. But take that comment as it's meant. 99.8% or 99.9% that's pretty much conclusive.

Worriedclive, yes, the Doc's @ freedomhealth are superb and know their stuff, don't forget they specialise in sexual health. When I had the 12 week rapid test - the Doc said their was no real need for me to have it - save that of piece of mind.

Look at it this way - why would thay disseminate information that they knew was or might be misleading? There is no reason to do that - there's no benefit to them in anyway. Also, I guess most doc's would be pretty upset that their professional comptence would be called into question, especially by a random nigel nonothing.

[scared...]

I think i had a 4th generation test but the doctors didnt know the generation exactly..only that the test was combined with an antigen.can anyone tell me how much did he pay for this test?i would like to know if there is a difference,i am from Europe.
Thanks

[Rob73!]

Dude,

the generation question re tests is getting pretty obsolete. If you are in western europe, then the test was probably an Ag\Ab test, also known as the duo.

Price has nothing to do with the test as it varies from place to place.

What else did your doc say when you tested?

[scared...]

I did the test at one private clinic..i asked about the generation but they didnt know,they just told me that the test is new and replaced by the old one.
The test wrote hiv ag/ab.,so i guess this may be also a 3rd generation..the cost was 42 euro..it is so confusing..the biochemical told me that 4 and 6 weeks is o.k and 3 months was with the older tests but other doctors didnt know exactly and told me..for sure is only 3 months!thats why i am here..

[Rob73!]

All I can suggest is check the archives on this site. You will see that the Dr will recommend testing @ 4-6 weeks to get a reliable result.

Hope this helps.

[scared...]

the test was at 6 1/5 weeks.Thanks anyway

[anotherdummy]

I wish the medical community would establish this "window" period a little better to be honest.  This is where the extreme fear seen here comes from because nobody knows what to believe.  I live in Canada and I have been told we use latest testing technology.  What that means I don't know, I would assume 4th generation.  Then you hear conversion averages ~25 days for detectable antibodies and up to 35 days on the high end.  If this is the case, and Massachusettes is recommending 6 week tests for example, then what the he** is the 3+ months testing still mentioned for?

Here in Canada, they could save a ton of cash on testing (Government health care system so our test costs are covered) people multiple times due to this lack of conformity.

The Dr. here has repeatedly said, if asked along with other experts, most would agree that 4-6 week testing is conclusive.  If this is the case, then why is this not the norm?  In the beginning it was 6 months, then 3 months was "approved" due to testing technology and better conversion data.  Why the reluctance to move to say 6 weeks?  

That is the most frustrating part of this.  I tested negative at 8 weeks and was told that is good enough but while I am trying to accept this, it is certainly tough to do when continuously hearing 3+months.  It is fine for the Dr. to say 6 weeks, for the US, but does that apply in Canada?  

sorry for the endless rant. :)

[Rob73!]

Totally agree with you; 4 weeks, 6 weeks, 3 months, 6 months. Another poster to this esteemed forum was told 10 years before you could get an accurate result!!

Anyway, I think the best thing to do is listen to what Dr H has to say on the matter - after all with 30 years field experience on STI's and HIV, he knows his stuff. Also, i guess all the Worried Wells should be made to stay away from less reputable sites and stick with this one and the body.com

That said, I think the "window period" is nothing more than a catch all period, even though the usual time to detectable antibodies is 25 days. I guess the more conserveitive elements of the medical community wish to keep it at 3 months, to avoid any repercussions if one person was to slip through the testing net.

[anotherdummy]

Yes, a person can and should easily listen to Dr. H's recommendations without a doubt.  My only real concern is my geographic location and the tests we use.  Sure, in the US most if not all labs use up to date tests, but do we really here in Canada?  Canada had a hard time accepting HSV testing for some reason so it makes me wonder if we accept "newer" HIV testing technologies and I am not really sure on how I could find out.

The whole thing is tiring, I can only imagine how the doc feels here.

[Need help UK]

Seeing as there are a couple of people from the UK around...does anyone know if the routine HIV screens are for HIV-2 as well as HIV-1. The guidelines recommend it, but I am not overly sure.

Gotta love Wimpole Street! Went to the Regent Park clinic myself!

[Rob73!]

Dude, AFAIK and again, speaking from my personal experience and the tests i had DUO @ 28 days and Abbot Determine @ 87 - both of them tested for HIV1&2. Though to be fair HIV2 is pretty rare int he UK. That said there are plenty of people living in the UK and especially London from Africa and the Indian sub-continent, where HIV2 is found. So i guess that makes sense.