Reliability of hiv duo antigen/antibody test

I am a single mum with two kids. I recently (6 weeks ago)had vaginal intercourse with a man i was seeing with a condom but it came off inside me.  I think most of the sperm was inside it when i got it out straight after intercourse.  I straight away panicked bout hiv.  You read so much about it and it creates fear.  I got tested by the duo test at 2 weeks, 4 weeks and 6 weeks.  All came back negative.  I cannot stop my anxiety attacks and the man has now shunned me and said i am deranged.  He said he got tested at 9 weeks after his last intercourse with a female and that he has been told he is in the clear.  "Can anyone help me to see things rationally and help with facts about the reliability of these tests.  I am getting sicker each day with regret and anxiety.  It is such a shame that we can't nowadays feel save to have a relationship whether with a male or female because of all the conflicting information on window periods. Please help as my poor kids are suffering because of an anxious overwraght mother.

[Teak]

3 months and your test will be conclusive.

[anxatt1]

Thanks for responding
Teak.  I know that the 3 month window period is conclusive but i was wondering if these tests give me a good indication. I feel like i am going crazy with no one to talk to and my anxiety med doesn't seem to help.  Are they a good indication that i might be okay.

[Teak]

Any time you get a negative test it's good. You just need your conclusive test.

[anxatt1]

So in other words the test means nothing untl 3 months.  I don't think i can get thru this.  For everyone out there worried i totally feel your anxiety and for everyone on the site that helps people like me and tolerates my questions.  I thank you.  You are all very special people and for those of you who are hiv+ out there and help others you are wonderful.  I welcome feedback from everyone and thank you Teak for your help.  I just wish someone could wave a magic wand and take the window period to 6 weeks!

[Teak]

No, it means at that time you don't have any detectable antibodies which is always good.

[anxatt1]

Can you give me some information about the duo test.  I need to talk with people who understand this awful waiting period.  Would a test at 8 weeks be more conclusive

[LIZZIE LOU]

"Would a test at 8 weeks be more conclusive?"    
as you were told...3 months is when you can obtain a CONCLUSIVE test result.

[mike_no]

I'll post about how duo works in some time, when i can access my computer. It's elaborate and can't type from pda now.

[mike_no]

IV gen antibody test, indeed is a valid and approved test in India, Australia and the UK. The combo test detects antibodies and P24 antigen simultaneously.

The working mechanism of this test is very intelligent, a IV gen antibody test is at it's optimum 28 days post exposure.

Now let's understand how it works - The AB detection of the test is a normal III gen antibody test. For a person who has acquired the virus sero-converts 7-14 days post exposure. 7 days post sero-conversion a normal individual would almost always test positive. Meaning - Should test positive by the next 7 days, the calculation comes to 21 days, factoring in a buffer of 7 more days the total calculation comes to 28 days, hence a negative AB on the 28th day is very encouraging.

Now on the other hand, the AG detection of the test looks for the P24 antigen in the body. For a person who has acquired the virus is sero-converting or has already sero converted however, the detectable amount of antibody has not yet been formed, the P24 antigen has a good chance of being detected. During the formation of detectable amount of antibodies, P24 antigen is present in detectable quantity and once the detectable amount of antibody is formed, the P24 antigen fades away.

In India and Australia, the testing window period for a conclusive result with a IV gen test is 6 weeks post exposure.

Hence, to sum up, you can only expect a negative at the 12th week even if there is a minute amongst of risk associated. BTW - if you ask me personally, I didn't see much risk associated with the whole incident though.

[anxatt1]

Thank you for your feedback Mike.  It is very encouraging.  I just don't understand why the doctors tell me they can't be sure until 3 months.  I am finding the anxiety of that window period terrifying.  Is it because they are scared to tell people they are ok at six weeks in case there is the odd person that tests positive later.  The guy i was seeing said he tested negative 9 weeks after his last exposure previous to me.  Is that a good sign as well (on the assumption he is telling the truth as he won't even talk to me now).  Because of my anxiety i want to keep testing every two weeks till i get to 12.  Everyone thinks i am nuts but i feel that each test being negative will help reduce anxiety.  

[LIZZIE LOU]

you stated that the condom was left behind...was it hanging out of you or was it pushed up inside your vagina?

[anxatt1]

It was inside me and when i pulled it out the sperm was inside it

[LIZZIE LOU]

since his ejaculate was in the condom...it sounds like it came off during withdrawal.  this would mean that you were protected.

from everything that you have described in your previous posts...i think you can RELAX.  

[anxatt1]

Thanks Lizzie Lou.  I will try to relax but gee i am a stressor!!  Wish i wasn't as this has really affected by daily life and my kids are wondering why i am so upset all the time.  But I know i have to try and believe everything will be okay for their sake.  

You guys do a wonderful job on this site and just being able to communicate with you is helping me heaps.

[LIZZIE LOU]

word of advice...dont let this site or sitting on the computer researching hiv become an obsession and control your life.

it is unlikely that this guy had hiv
sounds like you were protected
you have a 6 weeks test that is a good indication of your status

enjoy life and your kids...staying on the computer will do NOTHING but add fuel to the fire of your anxiety.

[anxatt1]

Thanks.  Taking your advice and off to sit and watch a movie now. Kids are at sleepovers so time to relax.  Take care

[jmgarcia]

A DUO HIV test Ab / Ag 4th generation, at 4 weeks is 99,89% reliable, the final 6 weeks.
You do not have HIV.

[Louis87270]

"In India and Australia, the testing window period for a conclusive result with a IV gen test is 6 weeks post exposure. "

Hi Mike, does your explanation works for all the subtypes of HIV? Can AG/AB tests find all the subtypes of HIV-1 (also subtype AE) in between that 6 week-period reliably?
Thank u

[Teak]

Duo tests are conclusive at 3 months.

[Louis87270]

Yes I know that. But I asked Mike if duo tests in India and Australia are conclusive at 6 weeks for all subtypes.

[jmgarcia]

The doctors of international HIV Medhelp consider HIV testing DUO 4th generation 99,89% conclusive at 4 weeks.
The recommendations of France, considered conclusive, these same tests at 6 weeks.
These tests are inconclusive at six weeks.

[Teak]

A conclusive negative test is 3 months. The only small benefit a DUO test has is in detecting HIV one week earlier than a 3rd generation test.

[Teak]

http://www.health.vic.gov.au/__data/assets/pdf_file/0007/19978/hiv_your_questions_answered.pdf

If the test detects no HIV antibodies, the person is said to be HIV negative (sometimes the term antibody-negative is used). Howeverthe body sometimes takes up to three months to produce antibodies after infection occurs, so a repeat test may be necessary, depending on how recently the possible exposure to HIV took place.

[jay251]

http://www.youtube.com/watch?v=m0n2VZdV1L0

"The guidelines around testing at 3 months after a exposure are really because of the fact the early HIV tests we used were not as sensitive". Dont want to cause any conflict just think this is very interesting. Do you agree with this??

[LIZZIE LOU]

A GUIDELINE IS A GUIDELINE and until that guideline is changed...3 months post exposure is when one can obtain a conclusive test result.

[Teak]

No I don't agree. The first guidelines were a year, then as the test got better it was reduced to 6 months and in 2004 when the tests became more sensitive it was changed to 3 months where it is today.

[jay251]

okey dokey teak. Are the US and UK guidelines the same?? It seems that freedomhealth in the UK dismiss patients 28 days post exposure with a negative HIV 4th generation test. If they was wrong wouldn't they be legally sued by now and shut down? I know and i do agree with waiting 3 months to capture 100% hiv infection but i find it interesting how doctors like Dr.Handsfield and Dr. Cummings believe in shorter window periods.

[Teak]

Yes, the UK and the US have the same guidelines.  
UK - http://www.bhiva.org/documents/Guidelines/Testing/GlinesHIVTest08.pdf
Post-test discussion for individuals who test HIV negative

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.


US - http://www.cdc.gov/nchstp/od/gap/pmtct/Trainer%20Manual/Adobe/Module_6TM.pdf

Page 11
Number 4

[nursegirl6572]

First, you have to understand how Dr HHH and Dr. Hook come up with their risk assessments.  A big part of their assessments include looking at the actual risk, where on this forum, IF there was a risk at all, no matter how big or small, we recommend testing out to 3 months, because that is what the OFFICIAL guidelines are, and until they are changed, that will be our advice.  It is just a slightly different approach to risk assessment.

Yes, the reaily is that a VERY LARGE majority of newly infected people test POS quite rapidly, usually by 6-8 weeks after exposure.  This is also why we say that a NEG at this timeframe is very reassuring.  HOWEVER, there still is a minute possibility that some people will not develop detectable antibodies until after that period, which is why it is better to play it safe.  Certainly the advancement of the sensitivities of testing is a big reason why it is becoming more rare for people to test POS after the 8-ish week mark.  Rare, but not impossible, hence the reason for our advice and the reason for the guidelines.

Read the quote that teak posted abouve, it sums this issue up nicely.  The CDC and testing manufacturer's guidelines, IMO, are a bit conservative, but also, when dealing with something like ruling out HIV infection...it is better to err on the side of caution to be sure.

To sum it all up...IF a person had a true risk (which most do not)...testing at 6-8 weeks is a good idea to help minimize anxiety, or to confirm infection as early as possible.  Then, a follow up test must be performed at 3 months for a conclusive result.

[jay251]

Kooollll, i get what your saying :) bascially testing 6-8 weeks good indicator, 3 months conclusive in other words no ******* chance! I knew all that already all i said was its interesting how medical experts like Dr.Sean Cummings state 28 days is conclusive it says so on their site too. But i whole heartly agree when you say 3 months to rule out every aspect of HIV infection. I just find it interesting thats all how a medical expert like Dr.Sean Cummings says 28 days is conclusive. Anyways thanks for your input tke care and everyone else in the window period stay well and you'll get through :) xxx

[anxatt1]

I have just read all the recent posts on my question.  I take it that the majority of the population would test negative within 6-8 weeks.  What would cause a person to take longer to serocovert and show up on a test after 8 weeks.  Is it because they have a weak immune system and what defines a weak immune system.  I am going for my 8 week test on Monday.  What percentage of people would take longer to seroconvert and why.  

[Teak]

Reread the guidelines for testing in the abouve posts.

[Addell79]

I had unprotected sex but he didn't ejaculate inside me. he couldn't ejaculate as he was drunk..what are the chances of contracting HIV?

[anxatt1]

Hi Mike

Having read your posts above i did some more research on the internet and i can't find anything that says Australia has 6 week conclusive for IV generation test.  Everything i read says 12 weeks.  To help relieve my anxiety can to tell me where this guidelline comes from.  I am going for 8 week test tomorrow and it would really help me put my mind to rest to know where you got that info.  I know that the everyday person cannot access some medical journals.  Is this where you got the guidelines.  I am not doubting you but just want to know where as my doctor says it is still 12 weeks

Thanks

[deezie757]

need 2 ask u this
guess i know some info abt the rna tests

i had the test hiv-1 rna (qualitative) by pcr after 24 days of unprotacted vaginal receptive with a girl
i dunno nothin abt her hiv status,
the result was

hiv-1 rna not detected. specimen is presumptive negative for hiv-1 rna


and 7 days later = 31 days a had another test called hiv rna viral load by real time pcr
the result was

NO HIV RNA COPIES WERE DETECTED


and 15 days later= 46 days i had the normal antibodies test
the result was
negative
and 12 days later= 58 days again the normal antibodies test
negative

are these tests enough?
should i be sure that am 100% not infected??

[deezie757]

guess u know*

[Teak]

3 months is when you can obtain a conclusive test result.

[deezie757]

How long after a possible exposure should I wait to get tested for HIV?

Most HIV tests are antibody tests that measure the antibodies your body makes against HIV. It can take some time for the immune system to produce enough antibodies for the antibody test to detect, and this time period can vary from person to person. This time period is commonly referred to as the “window period.” Most people will develop detectable antibodies within 2 to 8 weeks (the average is 25 days). Even so, there is a chance that some individuals will take longer to develop detectable antibodies. Therefore, if the initial negative HIV test was conducted within the first 3 months after possible exposure, repeat testing should be considered >3 months after the exposure occurred to account for the possibility of a false-negative result. Ninety-seven percent of persons will develop antibodies in the first 3 months following the time of their infection. In very rare cases, it can take up to 6 months to develop antibodies to HIV.

Another type of test is an RNA test, which detects the HIV virus directly. The time between HIV infection and RNA detection is 9–11 days. These tests, which are more costly and used less often than antibody tests, are used in some parts of the United States


BY CDC

could be wrong?!!

[Teak]

Wrong. What it says is that the PCR-RNA test is a  supplemental test in helping diagnose. It's not a stand alone test and has to be used in conjunction with an Antibody test.

[deezie757]

they didnt type what u just wrote!!
i just had a 10 weeks test 2day....
z that enough?!!!

[raj576]

hi Teak,
i had high risk exosure on 30 jan2011, at 6 , 9 and 11 week my duo test came  neg. are there any chances of getting hiv +ve after even 3 months, i have immume dissorder(my cd4 % were 28 at 9 week), can this be a reason for not detecting the antibodies at 11 week? i still feel my immume power is low..
please help..