HIV DUO Testing at 4 Weeks - Question "Only" for DR HHH

Dear Dr HHH

Congratulations for this wonderful service!!!

I have read numerous posts on the expert forum regarding HIV testing, Early HIV testing etc and cutting the long story short and without wasting much of your time will straight away get to the point. But please care to explain in detail.

You have been saying that " HIV duo test gives "virtually" 100% reliable results at 4 weeks" is there a disclaimer in the word "virtually" meaning its is not definitive or conclusive as compared to a 6 to 8 weeks normal antibody test??

Personally i feel the combined antigen and antibody is far more greater assurance than a simple antibody test.

I also know from your posts that 3 months is old news and soon 4 weeks combo test would be approved as a definitive test.

1) Do you mention "virtually" or "almost" only due to legal reasons?

2) Have you ever heard of any instance across the globe when some has tested positive after a 4 week Negative HIV duo test?

Appreciate your time & insight Dr.

[Edward W Hook, MD]

Sorry, you do not get to choose.  Dr. Handsfield and I share the forum.  You got me.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.  Further, we regularly review we watch others responses and despite thousands of replies on the Forums each year, still have yet to disagree.

Regarding the word "virtually", let me clarify an important point.  As a generalization for both you and other readers, you must realize that we VERY frequently get questions asking if different types of exposures or prevention measures are 100% effective.  The answer to that is that this is scientifically impossible.  For a variety of mathematical reasons far too complex to go into here, all one can do with well conducted scientific studies is estimate probabilities.  By definition, any estimate, cannot ever be 100% certain because of the incredibly low possibility that someone will get HIV through a previously undescribed mechanism tomorrow.  On the other hand, when Dr. Handsfield or I say that something is virtually zero, very close to no risk, or of minimal risk, or use any other term to indicate a very small risk, that means "close to zero" in a world where zero cannot be attained.  In science there is no such thing as never since the exception could happen or be discovered the next time someone looks.

I am confident that somewhere, somehow there is someone with a DUO negative at 4 weeks which subsequently was positive.  It is however, as said on this forum again and again and again exceedingly and vanishingly rare.  When it has happened, the risks and circumstances are typically elucidating such as when persons have tried unsuccessfully to prevent HIV by taking preventative therapy after a high risk exposure.  

I hope this helps. EWH

[confusedworried81]

Thankyou Dr Hook

For the clarification and I understand what you mean.

Can I also have a comment by Dr HHH since I have read numerous of his posts assuring the client he doesn't have HIV after a 4 week Negative HIV duo test which is 100% reliable.

Correct me if I am wrong Dr that in the absence of someone taking a preventive therapy like a PEP may be relaxed and assured he/she is negative after a Negative HIV duo test at 4 weeks?

[Edward W Hook, MD]

Yes, I agree with your assumption.  I would tell virtually anyone (using the caveatsmentioned above) that if their DUO was negative a 4 weeks they should be confident that they don't have HIV and do not need further testing.  EWH

[confusedworried81]

Dr Hook

By the statement "(using the caveats mentioned above)" you mean PEP, chemotherapy, autoimmune disorders etc?

Why I am asking this is because i took a HIV Duo test IV generation at 33 days after a low risk exposure with a girl i know (possible initial dipping & protected vaginal sex) condom was intact. The result was NEGATIVE. I am healthy male with no illnesses, no symptoms, no disorders with a normal immune system.

1) Can I Move On? Or Do i need to test further?

2) Your response about you being confident "that somewhere, somehow there is someone with a DUO negative at 4 weeks which subsequently was positive" has scared me slightly.?

[confusedworried81]

The possible initial dipping was unprotected followed by a protected vaginal sex.

[Edward W Hook, MD]

1.  Yes you should move on.  Believe the results  

2.  Get over it.  You did not get HIV from the exposure you described.

There in nothing more to say-the thread is over.EWH