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HIV Prevention (Expert Forum)
Further testing required?
by ttn12221984, Jun 21, 2008 12:44PM
Dear Dr. HHH, i have several questions i hope you can answer. I recently went to the STD clinic at Harborview Medical Center in Seattle, WA to have a blood test. For some reason, i was offered the RNA HIV as well as the Oral rapid tests. The two tests were done 30 days after my last exposure. Two weeks after, i went back to get the result and was told by the clinician that the result for the RNA test is 100% and that there is no better test than this and i do not need to have further testing. However, the health adviser that i talked to a few days earlier says that i need to come back in 3 months to have another antibody test to confirm the results. Here are the questions i hope you can answer.
- Should i follow the advice of the clinician and trust that the result for the RNA test is 100%
-I see that you work at the UW, thus i was wondering if you have any experience working with the folks at the STD clinic at Harborview. Are they very knowledgeable with HIV because i am getting different responses from the two people that i listed above.
- I was told that the RNA test is done at the UW Virology lab so i was wondering if you know whether the test is the recently FDA-approved Aptima test for diagnosing HIV. I asked the clinician and was told that although RNA tests are not approved for diagnosing HIV in the general population, it is approved to them (King County Public Health). Her response seems rather strange to me so i just want to know if you know anything about the RNA test that they do.
-. The blood draw at Harborview was done using butterfly needles. For some strange reason, the clinician who performed the blood draw couldn't get any blood out using both arms. She had to call in another lady who couldn't get any blood out of the median cubital either and had to use my hand. Do you have any idea why this is. When the first lady pulled out the needle, i noticed blood flowing from the tube back to the needle.
Thank you.
- Should i follow the advice of the clinician and trust that the result for the RNA test is 100%
-I see that you work at the UW, thus i was wondering if you have any experience working with the folks at the STD clinic at Harborview. Are they very knowledgeable with HIV because i am getting different responses from the two people that i listed above.
- I was told that the RNA test is done at the UW Virology lab so i was wondering if you know whether the test is the recently FDA-approved Aptima test for diagnosing HIV. I asked the clinician and was told that although RNA tests are not approved for diagnosing HIV in the general population, it is approved to them (King County Public Health). Her response seems rather strange to me so i just want to know if you know anything about the RNA test that they do.
-. The blood draw at Harborview was done using butterfly needles. For some strange reason, the clinician who performed the blood draw couldn't get any blood out using both arms. She had to call in another lady who couldn't get any blood out of the median cubital either and had to use my hand. Do you have any idea why this is. When the first lady pulled out the needle, i noticed blood flowing from the tube back to the needle.
Thank you.
Doctor's Answer
by H. Hunter Handsfield, M.D., Jun 21, 2008 04:08PM
, Jun 21, 2008 04:08PM
Most people who ask "Do I need further testing?" have already been tested at least 6 weeks, and usually 3 months or more, after the last possible HIV exposure, with negative results. After seeing the title you selected for this question, I anticipated seeing the same thing again. It was a pleasant surprise to see an important question that will be of interest to many forum users.
To answer part of your question, yes I have just a bit of experience at the Harborview STD clinic. For 25 years, until 3 years ago, I was clinic director. Some of the research behind the current approach to combined antibody and RNA testing for HIV was done by the current clinic leadership, and I have followed that program very closely.
The principle is this: HIV appears in the blood before antibody develops. Thus, testing for the virus in people with negative blood tests can pick up HIV infections earlier than antibody testing alone. However, this has not been done routinely in most public health settings, because RNA testing for HIV is too expensive. (It is done for all donations to blood and tissue banks, however.) The approach by Public Health - Seattle & King County, which runs the Harborview STD Clinic, is one that is increasingly done but still not routine in most settings -- specifically, for all HIV testing in men who have sex with men, both HIV RNA and standard antibody tests are done. (In other settings, this approach could be done for other high risk groups, or even for all patients -- but in Seattle, MSM still account for almost all new HIV infections, and Dr. Golden has determined that this approach wouldn't work well for groups other than MSM.)
A side note: to save costs, the way this is actually done is that several patients' blood specimens are mixed together and the HIV RNA test is done on this pooled specimen. If the result is negative, it shows that nobody in the pool had HIV in their blood. If positive, then the individual blood samples are tested to find the person with the positive result.
To your specific questions:
1) You can trust the clinician's advice on this. Still, the conservative approach -- since the RNA testing program is new and research on this program still continues -- is to have a final antibody test. Even though 3 months is the official time, 6 weeks probably would be enough. In other words, the clinician was correct, but the counselor was just following standard policy. Also, most MSM who attend STD clinics -- not all, by any means -- don't have just one or two risky exposures, but are potentially at risk for HIV on an ongoing basis. Such men ought to have HIV testing about every 3 months anyway. This might apply to you; if you weren't at particularly high risk for HIV, you probably would have been advised to phone instead of returning in person. But feel free to phone the counselor and ask him or her these same questions. You'll get straight answers. (Most of the clinicians and advisors I knew still work at the clinic. Say hello for me -- or tell them they might be interested in looking at this thread.)
2) I don't know exactly which RNA assay is now being done in this program. But even the non-FDA approved tests of this sort are highly reliable.
3) Sounds like your veins are somewhat difficult to access veins, which is fairly common (and especially common in people who are, or have been, injection drug users). There is nothing more to read into the difficulty in successfully drawing blood.
I hope this helps. Best wishes-- HHH, MD
To answer part of your question, yes I have just a bit of experience at the Harborview STD clinic. For 25 years, until 3 years ago, I was clinic director. Some of the research behind the current approach to combined antibody and RNA testing for HIV was done by the current clinic leadership, and I have followed that program very closely.
The principle is this: HIV appears in the blood before antibody develops. Thus, testing for the virus in people with negative blood tests can pick up HIV infections earlier than antibody testing alone. However, this has not been done routinely in most public health settings, because RNA testing for HIV is too expensive. (It is done for all donations to blood and tissue banks, however.) The approach by Public Health - Seattle & King County, which runs the Harborview STD Clinic, is one that is increasingly done but still not routine in most settings -- specifically, for all HIV testing in men who have sex with men, both HIV RNA and standard antibody tests are done. (In other settings, this approach could be done for other high risk groups, or even for all patients -- but in Seattle, MSM still account for almost all new HIV infections, and Dr. Golden has determined that this approach wouldn't work well for groups other than MSM.)
A side note: to save costs, the way this is actually done is that several patients' blood specimens are mixed together and the HIV RNA test is done on this pooled specimen. If the result is negative, it shows that nobody in the pool had HIV in their blood. If positive, then the individual blood samples are tested to find the person with the positive result.
To your specific questions:
1) You can trust the clinician's advice on this. Still, the conservative approach -- since the RNA testing program is new and research on this program still continues -- is to have a final antibody test. Even though 3 months is the official time, 6 weeks probably would be enough. In other words, the clinician was correct, but the counselor was just following standard policy. Also, most MSM who attend STD clinics -- not all, by any means -- don't have just one or two risky exposures, but are potentially at risk for HIV on an ongoing basis. Such men ought to have HIV testing about every 3 months anyway. This might apply to you; if you weren't at particularly high risk for HIV, you probably would have been advised to phone instead of returning in person. But feel free to phone the counselor and ask him or her these same questions. You'll get straight answers. (Most of the clinicians and advisors I knew still work at the clinic. Say hello for me -- or tell them they might be interested in looking at this thread.)
2) I don't know exactly which RNA assay is now being done in this program. But even the non-FDA approved tests of this sort are highly reliable.
3) Sounds like your veins are somewhat difficult to access veins, which is fairly common (and especially common in people who are, or have been, injection drug users). There is nothing more to read into the difficulty in successfully drawing blood.
I hope this helps. Best wishes-- HHH, MD
