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HIV duo CMIA method
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HIV duo CMIA method

i did 2 HIV  1/2 DUO by CMIA

39 days non reactive 0.34
44 days non reactive 0.16
50 days non reactive 0.38

I know this is not conclusive.However what are these index values..last one was the highest.Does that mean i am seroconverting .
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Avatar_m_tn
why these values are changing...something really wired.
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Avatar_m_tn
Also to say the cutoff value for 'reactive' is above 1
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Avatar_m_tn
What was your exposure?
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Avatar_m_tn
i had sex with a csw.Is something wrong with figures?they are fluctuating.
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Avatar_m_tn
They will always fluctuate. You can test multiple tiimes in one day and they will all be different. All you need to be concerned with is the cut off is 1.
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Avatar_m_tn
Ok so fluctuations are nothing to be worried about.So 0.16 is not more negative than 0.38 and 0.34.
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Avatar_m_tn
Correct.
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Avatar_m_tn
Is this wrong info..

"The HIV p24 antigen is a core HIV viral protein which becomes detectable at approximately 10 days post exposure, peaks at 16 days or so and then remains at high level for 8 to 10 weeks post exposure. "
..........................................
"From the Freedomhealth point of view, using as described above the combined knowledge and experience of the team we regard the HIV DUO test as a conclusive HIV test at 28 days or beyond in almost all circumstances. In situations where a patient has had an exceptionally high level of HIV exposure and has symptoms which we might in our expert opinion regard as suggestive of an acute HIV infection, we will encourage the patient to re-test at an appropriate interval which we will decide with the patient. However, it is almost always the case that a negative HIV DUO test at 28 days or more will be conclusive and will not need repeating."

Dr Sean and Dr Jos'e  is a part of this forum too

source:
http://www.freedomhealth.co.uk/sexual-health/hiv-test-hiv-testing-london/125/

sorry for asking too many questions.I am very tensed.
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Avatar_m_tn
That information is 100% correct and they are 2 excellent expert doctors.Freedomhealth has an excellent reputation and their advice on testing is totally accurate.
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Avatar_m_tn
What do you say about my status till now.I had hell lot of ARS symptoms like Fever,headache ...even weight loss.in 4 weeks...What is my likely hood to stay negative?
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Avatar_m_tn
Is it possible or have any doc have seen that 50 days negative becoming 12/13 week positive with HIV duo...
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Avatar_m_tn
Yes,you will stay negative because you have had 3 negative DUO tests.Test at 12 weeks just to make it official.
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Avatar_m_tn
NO,it is not possible.It hasn't happened ever with DUO tests.
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Avatar_m_tn
What is your source.
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Avatar_m_tn
I know 3 months is conclusive.However have u ever seen 6 - 7 weeks HIV DUO turning positive in 12/13 weeks.You are the most learned person here.I will surly test on 12 and 13 week.
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Avatar_m_tn
DUO tests have only been used in the US for a little over a year and most places don't offer the testing.

1. If you do test postive there isn't any advantage because you aren't going to start treatment to begin with.
2. If you had an exposure, you need to be wearing a condom until you receive your conclusive test result
3. It is a waste of money taking and paying for two test when one would do it.
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Avatar_m_tn
I have heard that DUO test is reduced to 3rd gen after 6 weeks because of lack of antigen.Your points are correct.However my doubt is how likely it is for a 50 days negative to become positive by 12 weeks.Have you seen such cases.
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Avatar_m_tn
It is the same after 4 weeks. Antigen testing is only good after week 1 to week 4.
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Avatar_m_tn
Thing are very confusing..Like this post and advice by Dr Jose

Hello Doctor, I am male from Lebanon and I was engaged in unprotected vaginal sex with a cws. 15 days After the exposure my symptoms started, I had bad chills with great headache and high fever 39-40 °C  that lasted for 1 week.  

4 weeks After the exposure I had a rapid HIV test the result was negative. In Addition 5 weeks and 4 days after the exposure I took another test ( i don't know if it is a 4th generation test)  the result was also negative and on the result paper it is mentioned that the search for HIV antibodies and p24 Ag using MEIA technique is negative. Therefore can you please doctor assess my situation if I need to go for further testing

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Dr. Jose Gonzalez-Garcia, MD, MBBS, LMS, MRCP(UK), MRCGP, PhDBlank

Nov 18, 2011
To: georges81
Hello,
Thank you for your post.
The fact that your second HIV test included the p24 antigen, that makes it 4th generation, equivalent to our HIV Duo test.  This test was performed at 5 weeks and was negative.  You can consider that to be conclusive, confirming that you have not been infected.  There is no need for you to have any further tests.
Best wishes,
Dr José
http://www.medhelp.org/posts/HIV---International/HIV-ARS-symptoms/show/1631129

This person had a high risk exposure.Even he had fever a typical ARS symptom i.e fever.However Dr Jose stated his 5 weeks and 4 days as conclusive.Don't you feel this is a wrong advice by doctor or does negative DUO results reduces probability of HIV infection to a very great extent.It almost gives a accurate and near to conclusive (but not conclusive) results by 6 weeks.
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Avatar_m_tn
http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/PremarketApprovalsPMAs/ucm264723.htm
Package Insert - GS HIV Combo Ag/Ab EIA
GS HIV Combo Ag/Ab EIA
Manufacturer: Bio-Rad Laboratories
GS HIV Combo Ag/Ab EIA
13 - LIMITATIONS OF THE PROCEDURE
4.
A negative test result at any point in the investigation of individual subjects does not preclude the possibility of exposure to or infection with HIV-1 and/or HIV-2.
5.
Negative results can occur if the quantity of marker present in the sample is too low for the detection limits of the assay, or if the marker which is detected is not present during the stage of disease in which a sample is collected.
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Avatar_m_tn
Current methods for the detection of HIV may not detect all infected individuals. An ARCHITECT HIV Ag/Ab Combo test result that is nonreactive does not exclude the possibility of exposure to or infection with HIV-1 and/or HIV-2. Nonreactive results in this assay for individuals with prior exposure to HIV-1 and/or HIV-2 may be due to antigen and antibody levels below the limit of detection of this assay.

.
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Avatar_m_tn
But why Docs.Everywhere in medhelp to freedomhealth.uk ..except thebody are very pro 4 weeks-6weeks HIV duo.may be they are doing it for popularity or some personal interest .Even if they do for some personal interests they have to take same calculated risks before giving advices.

I know you are talking about standards.However my questions is does the chances of getting infected goes down by a negative 6 week  and above results.
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Avatar_m_tn
Not every site does. 4th generation tests can detect HIV infections earlier than 3rd generation test but when it comes to a conclusive negative test result they are both 3 months post exposure.
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Avatar_m_tn
So can I consider my results encouraging ...I just want to ask you the same question.Have you seen any one with 50 day negative turning positive on  12/13 week.My symptoms started on 29 days and I took my last HIV duo after the completion of 50 days.I know you are adhering towards standards .However do u consider this a good sign ....I will surly test on 12/13 weeks.Can you give me a specific answer regarding 6 week negative turning positive on 12/13 week.Have u seen such cases.
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Avatar_m_tn
Any negative test is encouraging but the conclusive test is final.
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Avatar_m_tn
last question Have u seen any one with 50 day negative turning positive on 12 week...please answer this I am tensed and in any case I will adhere to 12 week guidelines.
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Avatar_m_tn
Concern yourself with your conclusive test result and not of others.
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Avatar_m_tn
certainly dear..I am concerned about my results.However have u seen anyone with 6 week negative turning positive later.
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Avatar_m_tn
Yes, but what does that have to do with you?
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Avatar_m_tn
Ok so it does happen frequently..I just wanted to know that..
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Avatar_m_tn
I think these docs must be sued for giving wrong advices to the clients.They are putting people life on risk..someone in United states and UK have to take up this issue.Discoursing people not to follow window period is not ethical.These can lead to serious health issue and gives public false assurance. about their health.
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Avatar_m_tn
It happens, just look at Dr. Conrad C. Murray court case.
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Avatar_m_tn
Very little humanity is left now.I think we should write to health department about this issue.What do u think.something must be done I am really serious now.

Teak if I have HIV would I would be able to live a normal life and full life span?I am from a very poor family and only son who have take care of parents and a sister.
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Avatar_m_tn
Your life would not be normal as you see it today. You would more than likely live a normal life span if you stay adherent to the medications and don't have any adverse side effects to the ARVs.  
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Avatar_m_tn
OMG what I have done.Please give me a one and last chance.
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Avatar_m_tn
I always had side effects to even normal antibiotics..forget AVRs
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Avatar_m_tn
My source is the expert doctors here at medhelp.Freedomhealth and the Hiv specialists in sydney and melbourne.You have to remember that the DUO test has been avaliable alot longer in the UK and AUS then it has been in the US.
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Avatar_m_tn
Stick to the the approvals. No one can change the approvals except the manufacture with the approval of the licensing body inwhich it is the FDA.  
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Avatar_m_tn
UK Fourth Generation  Testing

http://www.bhiva.org/documents/Guidelines/Testing/GlinesHIVTest08.pdf
Post testing
Page 11
The need for a repeat HIV test if still within the window period after a specific exposure should be discussed. Although fourth generation tests shorten the time from exposure to seroconversion a repeat test at three months is still recommended to definitively exclude HIV infection.
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Avatar_m_tn
What is the window period in Australia for Fourth generation  test or HIV DUO tests? I have heard that it is 6 weeks, is that true?
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Yes,In some clinics in Sydney and melbourne they won't test you again if you have received a negative result with a DUO at 6 weeks.Look,the simple fact is who you want to believe because there are different opinions.Many Hiv specialists say the DUO is extremely reliable at 4 weeks,others will say test out to 12 weeks.I'm sure that DR Sean Cummings knows more about Hiv testing then anyone on this forum.
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Avatar_m_tn
Dr. Jose Gonzalez-Garcia, MD, MBBS, LMS, MRCP(UK), MRCGP, PhD
Dec 06, 2011 To: jjllmm
Hello,
Thank you very much for your post and welcome to our forum.  I am afraid that it is going to be me answering your question, and not my colleague, Dr Sean.
It is certainly quite unfortunate that you had contracted herpes type 2 in this unprotected sexual encounter.  The negative test that you had at 8 weeks is certainly highly reassuring and a very good indication as it is possible to detect the HIV antibodies already at that stage.  However current "UK guidelines still recommend to have a final test at 12 weeks for it to be considered final and fully conclusive."  Having said all that, and speaking out of my own clinical experience, I have never come across anyone testing negative at 8 weeks and then positive at 12 weeks.  Therefore I am very confident that you are HIV negative.
Best wishes,
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Avatar_m_tn
I think we all know that A DUO is highly reliable at 4 weeks and then a final test a 12 weeks just to make it all official.
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Avatar_m_tn
I have read BHIVA guidelines it says this

source:
http://www.bhiva.org/documents/Guidelines/Testing/GlinesHIVTest08.pdf

page 13

"Although with fourth generation tests infection can be detected much earlier than previously(see section on primary screening assays), in very recent infection – when patients may be most symptomatic – the test may be negative. In this scenario, if PHI is suspected, either urgent referral to specialist services (GU clinic or HIV service) or a repeat test in seven days is recommended. HIV viral load testing can be used in this clinical setting, but it is recommended that this is only performed with specialist input."

Even freedomhealth.uk says this thing
"From the Freedomhealth point of view, using as described above the combined knowledge and experience of the team we regard the HIV DUO test as a conclusive HIV test at 28 days or beyond in almost all circumstances. In situations where a patient has had an exceptionally high level of HIV exposure and has symptoms which we might in our expert opinion regard as suggestive of an acute HIV infection, we will encourage the patient to re-test at an appropriate interval which we will decide with the patient. However, it is almost always the case that a negative HIV DUO test at 28 days or more will be conclusive and will not need repeating."

getitright my symptoms started on 29 days..nearly all symptoms,fever,night sweats ,headache,weightless...I tested again on Day 50 .My question is that is it enough days for the production of antibodies or I have tested  early.
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Avatar_m_tn
Yes,by 50 days almost all people will have detectable antibodies.Did you read the last sentence.It is almost always the case that a negative HIV DUO test at 28 days or more will be conclusive and not need repeating.Freedomhealth is one of the best STD and HIV clinics in the world.
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Avatar_m_tn
3 months post exposure is conclusive.

Dr. Jose Gonzalez-Garcia, MD, MBBS, LMS, MRCP(UK), MRCGP, PhD

However current "UK guidelines still recommend to have a final test at 12 weeks for it to be considered final and fully conclusive."  
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Avatar_m_tn
What should I know about HIV testing?

When thinking of getting tested for HIV, there are a few important things to consider:

    Window Period: The HIV test is looking for antibodies, which are the body’s response to having HIV in it. For most people, it takes 6 weeks for the body to produce enough antibodies for a standard HIV antibody test to be accurate. Some people call this the "window period". The Massachusetts Department of Public Health recommends waiting 6 weeks between an individual's possible HIV exposure and the time they get tested, providing there are no risks within that time period. For a conclusive test result, it’s recommended to wait 3 months before getting tested.
    Anonymous vs. Confidential Tests: An anonymous test does not require an individual to provide their name at the time of testing, while a confidential test does require a name. In either case, written consent from the patient is the only way the results will be released, and otherwise will be kept private. Doctor's offices use confidential testing while some private clinics and testing sites will still do anonymous HIV testing, although it is becoming increasingly difficult to find.

    Standard vs. Rapid Testing: A standard HIV test refers to a blood draw, typically done at a doctor's office. Results are usually received within 5 to 10 business days. Rapid tests (sometimes referred to as OraQuick, OraQuick Advance, or Unigold) involve either a finger prick or a mouth swab. Results are given in about 30 minutes. See below for descriptions of different types of HIV-Antibody tests.

    Cost: Depending on where you get tested, either insurance will cover the cost, pricing may be based on a sliding-scale which will depend on your income, or you may be able to get a free test.

For more information about testing, please call the AIDS Action Hotline at 800-235-2331.

Why do some sources advise waiting longer than 6 weeks for HIV testing?

Most people will test accurately for HIV after 6 weeks have passed since their last risk. In some cases where a person has a highly compromised immune system, such as those in which a person has recently undergone chemotherapy or an organ transplant, it may take 3-6 months for their body to develop enough antibodies to test positive.

These are very extreme situations, however, and other more common conditions such as colds or the flu, diabetes, asthma, and many others, will not affect the body's development of HIV antibodies in that way. Those who suggest window periods longer than 6 weeks are trying to account for all those who may also have compromised immune systems. The CDC (Centers for Disease Control and Prevention) recommends waiting 3 months for a conclusive test result.

Source:http://www.aac.org/site/PageServer?pagename=basics_home


Teak and getitright I feel you both are correct from your point of view.However I feel getitright 4 weeks is too early I fell you should advise a 6 week for first test. and then followup on 12/13 weeks.No doubt 12/13 weeks is compulsory and conclusive.However 6-7 week gives a fairly accurate results for most of the people.
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Avatar_m_tn
That's not true.A duo at 4 weeks is most accurate not at 6 weeks.The p24 antigen will peak at 4 weeks like I told you.An antibody test at 6 weeks is good,I agree with you there,but at the end of the day a 12 week test result is gold.This is just my opinion on how one should test.They take the DUO at 4 weeks and then the antibody at 12 weeks.Perfect testing timeline.
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Avatar_m_tn
duo at 6 weeks is OFFICIALLY considered conclusive in France. This means that you do not have to wait 3 months for a conclusive test but only 6 weeks.
in Denmark, 8 weeks is the OFFICIAL window period.

i know that other countries in Europe have also shorter OFFICIAL window periods than 3 months but i don't have the link to the official guidelines.

Majority of the countries, including US, have 3 months.

Does this mean that 3 months is a better estimate? I don't think so because countries with advanced hiv research are moving towards cutting the official window period.
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Avatar_m_tn
You are wrong.Accuracy of any test increases as time passes.Theoretically 6 week DUO would be more effective than 4 weeks.
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Avatar_m_tn
is it really so that p24 becomes undetectable (using duo/combo) tests after 4 weeks?
i've read different information that states that it will remain detectable up to 6 months...
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Avatar_m_tn
I have read the same information from freedomhealth in the UK and they have an excellent reputation.For some reason there are websites stating that the p24 antigen will become undetectable after say 5 weeks.Personally i don't believe this myself as studies have been done where it has clearly show that p24 antigen remains detectable for months.Not as high as in the first 4 weeks but still detectable.
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Avatar_m_tn
It is you who is wrong.The most effective timeline for a DUO test is 4 weeks because that is when the p24 antigen is at it's peak,at 6 weeks the antibody part of the test become reliable and very accurate.P24 will still be detectable but not as easily as it would be at 4 weeks.The window period for a DUO is 4 weeks.
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Avatar_m_tn
Most places don't offer duo test because they don't have the equipment to offer the test and findthat there isn't that much difference in the time line for receiving a positive result. Studies show that the duo test may detect one week earlier than a 3rd generation test.
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Avatar_m_tn
Practice has shown that the Duo test does not tend to change if it is done 4-6 weeks after exposure. I agree with many of your statements, and I agree that there are some guidelines to follow, but again this is the fact and it is true. I would say that the test COMBO test is very advanced test that is performed with the minimum requirements, so there is no place for mistakes.
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Avatar_m_tn
The guidelines for a conclusive negative test is 3 months post exposure, it does not matter what type of test it is.
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Avatar_m_tn
CDC does not give the approvals for HIV tests.
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Avatar_m_tn
No incident HIV infections among MSM who practice exclusively oral sex.
Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WePpC2072)??Balls JE, Evans JL, Dilley J, Osmond D, Shiboski S, Shiboski C, Klausner J, McFarland W, Greenspan D, Page-Shafer K?University of California, San Francisco, San Francisco, United States

Oral transmission of HIV, reality or fiction? An update
J Campo1, MA Perea1, J del Romero2, J Cano1, V Hernando2, A Bascones1
Oral Diseases (2006) 12, 219–228

AIDS: Volume 16(17) 22 November 2002 pp 2350-2352
Risk of HIV infection attributable to oral sex among men who have sex with men and in the population of men who have sex with men

Page-Shafer, Kimberlya,b; Shiboski, Caroline Hb; Osmond, Dennis Hc; Dilley, Jamesd; McFarland, Willie; Shiboski, Steve Cc; Klausner, Jeffrey De; Balls, Joycea; Greenspan, Deborahb; Greenspan
Page-Shafer K, Veugelers PJ, Moss AR, Strathdee S, Kaldor JM, van Griensven GJ. Sexual risk behavior and risk factors for HIV-1 seroconversion in homosexual men participating in the Tricontinental Seroconverter Study, 1982-1994 [published erratum appears in Am J Epidemiol 1997 15 Dec; 146(12):1076]. Am J Epidemiol 1997, 146:531-542.

Studies which show the fallacy of relying on anecdotal evidence as opposed to carefully controlled study insofar as HIV transmission risk is concerned:

Jenicek M. "Clinical Case Reporting" in Evidence-Based Medicine. Oxford: Butterworth–Heinemann; 1999:117
Saltzman SP, Stoddard AM, McCusker J, Moon MW, Mayer KH. Reliability of self-reported sexual behavior risk factors for HIV infection in homosexual men. Public Health Rep. 1987 102(6):692–697.Nov–Dec;

Catania JA, Gibson DR, Chitwood DD, Coates TJ. Methodological problems in AIDS behavioral research: influences on measurement error and participation bias in studies of sexual behavior. Psychol Bull. 1990 Nov;108(3):339–362.

There is no debate (among experts) about the HIV risks associated with oral sex. The risk is so low that almost nobody who cares for HIV infected patients has ever had a patient believed to have been infected that way. Among experts, it's a semantic issue about using terms like "no risk" and "very low risk". There is no difference between my or Dr. Hook's use of "low risk" and other experts' "no risk".
DR. HANSFIELD

"And oral sex is basically safe sex -- completely safe with respect to HIV and although not zero risk for other STDs, the chance of infection is far lower than for unprotected vaginal or anal sex. Please educate yourself about the real risks. If you stick with oral sex and condom-protected vaginal or anal sex, you have no HIV worries and very little worry about other STDs. " DR HANSFIELD

"I am sure you can find lots of people who believe that HIV is transmitted by oral sex, but you will not find scientific data to support this unrealistic concern..." DR HOOK

"HIV is not spread by touching, masturbation, oral sex or condom protected sex."- DR. HOOK

in the public HIV Prevention forum of MedHelp, TEAK and the other moderators maintain that oral sex in all forms is a zero risk activity. Would you agree with this assessment?
I TOTALLY AGREE / DR GARCIA
"HIV is not spread by masturbation, through oral sex, through kissing or other casual contact." Dr. Hook
"The observation on thousands and thousands of observations is that HIV is not spread by oral sex (of any sort)." DR HOOK
"I would not say your risk ,if he had HIV is "slim to none"- that's too high.  I would say they are effectively zero.  How much of his ejaculate or other genital  secretions you may have swallowed makes no difference.  EWH "
"As far as HIV is concerned, there is no known risk of getting HIV from performing oral sex on an infected partner, even if that person's genital secretions get into your eyes or if you swallow." Dr.Hook
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Avatar_m_tn
http://www.cdc.gov/globalaids/Resources/pmtct-care/docs/TM/Module_6TM.pdf
Page 11
#4
  In an adult, a positive HIV antibody test result means that the person is infected, a person with a negative or inconclusive result may be in the “window for 4 to 6 weeks but occasionally up to 3 months after HIV exposure. Persons at high risk who initially test negative should be retested 3 months after exposure to confirm results

UK Fourth Generation  Testing
http://www.bhiva.org/documents/Guidelines/Testing/GlinesHIVTest08.pdf
Post testing
Page 11
The need for a repeat HIV test if still within the window period after a specific exposure should be discussed. Although fourth generation tests shorten the time from exposure to seroconversion a repeat test at three months is still recommended to definitively exclude HIV infection.
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Avatar_m_tn

http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/PremarketApprovalsPMAs/ucm264723.htm
Package Insert - GS HIV Combo Ag/Ab EIA
GS HIV Combo Ag/Ab EIA
Manufacturer: Bio-Rad Laboratories
GS HIV Combo Ag/Ab EIA
13 - LIMITATIONS OF THE PROCEDURE
4.
A negative test result at any point in the investigation of individual subjects does not preclude the possibility of exposure to or infection with HIV-1 and/or HIV-2.
5.
Negative results can occur if the quantity of marker present in the sample is too low for the detection limits of the assay, or if the marker which is detected is not present during the stage of disease in which a sample is collected.
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Avatar_m_tn
in this document (http://www.bhiva.org/documents/Guidelines/Testing/ConsultComments.pdf), they discuss several things related to testing guidelines.
I think one of the important comments is the one made by John White about window period etc.


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Avatar_m_tn
Dr. Jose Gonzalez-Garcia, MD, MBBS, LMS, MRCP(UK), MRCGP, PhD

However current "UK guidelines still recommend to have a final test at 12 weeks for it to be considered final and fully conclusive."  
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Avatar_n_tn
plz help all experts here....

How about p24antigen combo test (CMIA).....after 4 days the start of ARS...???
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Avatar_m_tn
Do not pull up old threads and post.
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3147776_tn?1349200103
Please start a new thread for your question rather than posting on another member's thread.  Click the "back to community" link at the top of this page and you will see a "post a question" button.
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