HIV test confirmation

[Verryworried1973]

Dear Doctor,

I had a serious exposure 5 weeks ago. I have been with a female sex worker and had unprotected vaginal and anal sex with her. When I finished I found blood on my penis and it wasn't mine.

I obviously freaked out and started taking tests. First, I did the Oraquick test at 2 weeks and it was negative. On the 22nd day I did antibody test in lab (don't know which generation and came negative) and PCR RNA (came undetectable for less than 500 copies/ML), and yesterday (32 days post exposure) I did the Oraquick again and it came negative.

I need to know how accurate are these tests? and do I need more test to confirm these results?

Many thanks

[Edward W Hook, MD]

Welcome to our Forum. I will be pleased to comment.  First let me point out, as I do to most persons with questions such as yours, that most commercial sex workers do not have HIV or other STIs.  Even if your partner did, the fact is that most exposures do not lead to infection.  With this as background a few more comments.

The development of positive antibody of antigen tests is a time-dependent process.  Over time the likelihood of having a positive test, if you have been infected increases.  The time that it takes for this process to occur depends on the test used and the infection being looked for.  In your specific case, after an unprotected exposure in which your risk for getting any of these is infection is less than 1% BEFORE you test at 22 days:

1.  The test for HIV antibodies would have detected nearly 90% of recent infections.
2.  The test for hepatitis B and C would have detected many but not all infections (the numbers are less precise for these infections than most) at 21 days.
3.  You can get conclusive results on your HIV status by either having a test for HIV antigen and antibody (i.e. a COMBO test or the combination of an HIV PCR and an antibody test taken at the same time) 4 weeks after exposure or a test for HIV antibodies taken at 8 weeks after the event.
4.  Recommendations that Hepatitis B or C can be ruled out only by testing at 3 months are a bit conservative and nearly all such infections can be detected by testing at 1 month (30 days) after infection.

I hope this information is helpful.  In the future, I suggest that you use condoms for encounters of the sort you describe. EWH

[Verryworried1973]

Dear Doctor, I am in a country where HIV tests aren't anonymous and a positive result will result in automatic deportation. However, I managed to get an Oraquick test kit and tested at 47 days after exposure. The result was positive. Is this test as accurate as the ones you recommended at this stage? Or should I get additional tests whenever possible?

Thank you!

[Verryworried1973]

I am not debating and I am sorry you got offended.

http://www.medhelp.org/posts/show/1891685

[Edward W Hook, MD]

Dr. Handsfield and I do not disagree.  The fact is that PCR is not approved for the purpose of HIV diagnosis. Early negative results are strong evidence that you are not infected but there are no data that they are definitve until 4 weeks.

This is not a debate.  You wanted an answer and got it.  I'll have nothing more to say to your anxiety-driven "what if" quesitons. EWH

[Verryworried1973]

Dear doctor, there seems to be a great difference between the way you look at PCR tests and the way your colleague Dr. Handsfield look at them. I find this difference in opinion on a scientific matter a bit confusing. To a similar question to mine, his answer was more positive towards PRC RNA results even at an earlier time than mine. What's the reason behind this difference? Is it based on cases you encountered during your professional experience, or more as matter of adherence to FDA rules?

I am sorry if I had to ask this question.

Bes

[Edward W Hook, MD]

Correct. EWH

[Verryworried1973]

Thank you for your the additional information that was very useful to me at this stage. I haven't noticed that you answered a similar question earlier.

I will see if we have the combination HIV P24 test over here and go for it. And that test should be conclusive at this stage, 38 days post exposure.

Many thanks

[Edward W Hook, MD]

This question has been answered many times.  Despite what the people who profit from selling them say, PCR tests are NOT recommended for HIV diagnosis.  Research has shown however that the combination of a PCR test AND an HIV antibody test taken at the same time, 4 or more weeks after exposure, like the far less expensive combination HIV p24 antigen/HIV antibody tests that ARE FDA approved for this purpose, give a conclusive result regarding HIV infection status.  Results at 22 days, while strong evidence that you were not infected are not conclusive and there are no good data to inform you of what proportion of persons with infection would have positve tests at tthis time.  EWH

[Verryworried1973]

Many thanks for your feedback Dr.Hook, much appreciated. What about the HIV PCR RNA test that I have done on the 22nd day of exposure. Doesn't it rule out the possibility of HIV-1 infection?

Again, thank you for your feedback.

Best,

[Verryworried1973]

Many thanks for your feedback Dr.Hook, much appreciated. What about the HIV PCR RNA test that I have done on the 22nd day of exposure. Doesn't it rule out the possibility of HIV-1 infection?

Again, thank you for your feedback.

Best,

[Verryworried1973]

I also did the following tests on the 22nd day and they all came negative. Are they conclusive or I need to test for them again at later stage:
1 - Antigen Australia (HBsAg)
2 - Anti HCV ab
3 - VDRL

[Verryworried1973]

To clarify: The PCR RNA viral load test was also made on the 22nd day post exposure and the result reads: undetectable <500 HIV-1 Copies /ML