Sorry Test at 4-6 weeks is conclusif

Hello Doctor,
I d unprotected vaginal sex with a sex worker/prostitute in Tunisia.I'm male never toke drugs or have a sex with a man.
I've done a test in a local lab in Tunisia after 30 days post exposure:

HIV Combo: Anti body HIV1,2,0 and p24 : -ve (Axsym-Abbott Automate )  .i've asked the nurse and she told me it 's a 3th generation of ELISA and it's 99.9 accurate at 1 month! I 've read all post of Dr HHH , Teak and Lizzie You and some French Forum like atoute.org and doctissimo.com and seems that the nurse is right (depiste of the official/Legal window period of 3 month) i ve also call my doctor and he told me i'don't have HIV.

Teak and Lizzio would say : NO its' 3 month or nothing :) but the vast of majority of labs and doctors in France , UK , Suisse are sure that 4 to 6 weeks IS CONCLUSIF and the 3 month is just legal.
I think it's time to be honnest and say 4 to 6 week is almost conclusif.
Dr HHH (usa guru) and Dr Dupagne (france guru) says never seen a negatif test at 4 weeks become +ve at 12 !!

I've search for 30 days information ,presentation , reports from various Health care provider , labs, CDC ,HCS,... and 4- 6 weeks is conclusif IF we are sure that we take a risk at this time.

Rakech from Tunisia/US (NY)

[wonderstd]

Dear AIDSWorries,

HIV DUO Test is 4th Generation test which tests both antigen and antibody simulaneously.

FreedomHealth, a special clinic in UK, claims that HIV DUO is conclusive if taken after one month of exposure.

State Mass. and Australia claims 6th week tests are conclusive.

Although legal seroconversion in France is 3 months with 3rd gen. hiv tests, many docs in France say 6th week is conclusive with 4th gen. tests. Same approach in many European contries.

In USA, 4th gen tests have not yet been approved. And Legal duration is 13 week with approved 3rd gen hiv tests. (Even more CDC mentions
that seroconversion may happen up to 6 month in VERY RARE cases.

I live in Turkey, and many STD Doctors believe 6th week is conclusive with 4th gen Hiv tests. But official seroconversion declared by health ministery is 12 week if 4th gen is used. Health Ministery also advices the people to take 6th month 3rd gen. test if any 4th gen test has not been used. Effects of CDC :)
General approach in Turkey, 21st day Hiv DUO and then 90th day
Hiv Ab Tests.

In Medhelp, Hiv Prevention Community Forum, it is declared that 13 week is conclusive as being inline with CDC Guidelines. To the contrary of CDC guidelines, nobody believes 6 month testing necessity in this forum.

[samsamsam204]

what do you mean by 4th generation???
is it raid test by test ing the blood tests and antibodies

[Teak]

You're right, it is three months because that is what is stated on the paper work that comes with the tests and that is what the FDA gave approval on.

[MoroccoMan]

4- 6 week  is conclusif even with 3th generation . 99% of people will develop antibd as soon as 3 week ( average of 22 days)  from 6 To 38 days no more !  You should only test at 3 month if u do not get tested 4 To 6 week. Aidsworries u are -ve for sure. Move on and don't forgot using condom next time

[AIDSWorries]

I hope so ... i 'll do a test on 6 week and i hope it ll be -ve.
Teak plz, have u ever seen a 4 week  -ve result become +ve on 6 or 12 weeks?
need you experience on that...

[Teak]

http://www.bhiva.org/files/file1031097.pdf   Now move on.

[wonderstd]

Dear AIDSWorries,

Be happy, according to BHIVA you are HIGHLY negative.

BHIVA's guideline says that seroconversion time for  4th Gen Tests is 1 month.
But They still advices 12 week 3rd Gen Antibody tests to DEFINETELY Exclude
the HIV Risk.

Just get a 4th Gen. HIV DUO at 6th week then return to your normal life.
If you encounter still anxiety abaout HIV (Just like myself), Then get a final 12 week test
(Then it does not matter whether 3rd gen or 4th Gen Test)

If you would like to have more info about 4th Gen. HIV DUO test, you can start from this
link;
"http://www.freedomhealth.co.uk/sexual-health/hiv-testing/125/"

I'm also copy+pasting important part of UK's HIV Testing Guidelines.

Be well my friend

Blood tests
The recommended first-line assay is one which tests for HIV antibody AND p24 antigen simultaneously.
These are termed fourth generation assays, and have the advantage of reducing the time between infection and testing HIV positive to one month which is one to two weeks earlier than with sensitive third generation (antibody only detection) assays [22]. It is reasonable to expect universal provision of these assays, although they are not offered by all primary screening laboratories.

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 DEFINETELY EXCLUDE HIV infection.

[Teak]

The only conclusive negative test is one done at 3 months post exposure.

[wonderstd]

I agree with Teak,

According to almost all countries' HIV testing guidelines, 12 week (or 13 week for USA Only) is the seroconversion time.

Countries have to be a bit conservative to change their guidelines.
On the other hand, for the last 5 years, many seroconversion data has been
collected and these data encourages the pioneer countries (Australia and MAss.state), to updated their guidelines to 6 week.

I believe that, In year 2010 or 2011, even CDC will update window period to 6 week.

[AIDSWorries]

I've done a 4 th generation test at exactely 8 weeks
HIV Combo: Anti body HIV1,2,0 and p24 : -ve (Axsym-Abbott Automate )

I hope i'm free now :)

[Teak]

When you obtain your conclusive test then you can consider yourself free.

[solosaram]

bro u said it by urself it's 99.99% conclusive .then it's not 100% conclusive.and 00.01% is still a risk.thats why teak and lizze keep say 3 months

what if u r this 00.01%?? would u love to transmassion it then to ur wife or ur g.f or ur familly???^_~
no one want to be mistaken bro thats why u can do the test 4-6 weeks.then confirm the result at 3 months

[Teak]

MOVE ON.

[AIDSWorries]

Thkx for your replies but i'm folowing the french recommandation of HAS :

Six Week with 4th generation ELISA (antibody HIV 1,2 and antigen P24) is conclusif.
The ONLY case (according to the HAS) when it is required to take 3 month test is when you take a chimiotherapy or you have taken  the prevention traitement after a recent risque(after 48 hours):

http://www.has-sante.fr/portail/jcms/c_704683/la-realisation-des-tests-de-depistage-de-linfection-par-le-vih-evolue

I don't think the HAS (Haute Autorité de Santé) are playing with words...

[Teak]

There are no tests approved to give a conclusive test result earlier than 3 months. It doesn't matter if it's French, British, German or the US.

[AIDSWorries]

My doctor give me the folowing link :
http://www.biomerieux.fr/upload/HIVDUO_ULTRA.pdf

Take a look to page 3 .

[Teak]

The use of combined ELISA tests called “4th generation” tests,
which simultaneously detect HIV antibodies and the HIV1 p24
antigen, enables for more effective early detection of infections which
are very often asymptomatic. In most cases, 4th generation tests used
in the absence of treatment can reduce the serological window
for the detection of HIV-1 by approximately one week when
compared to 3rd generation tests (antibodies alone).

There it is.. http://www.biomerieux-diagnostics.com/upload/Livret_HIV_GB.pdf
Now move on.

[LIZZIE LOU]

just test at 3 months for a conclusive test result.

[Teak]

The US uses 3rd generation.

[AfraidMistake]

Is FDA approval more important than biology or virology? If in fact some people take longer to seroconvert why does it matter what a piece of paper says or does not say or who approved what?

[Teak]

Did you leave out the most important information? It's what the testing data that the manufactures of the tests have done and summitted to the FDA which also redoes their testings and see if the results are the same. Now who knows more about what their tests can and cannot do than the manufactures of the tests? NOW MOVE ON.

[nursegirl6572]

You are blatantly ignoring the information that is out there.  Re-read the UK guidelines quote above, just for one example.....

"Although fourth generation tests shorten the time from exposure to seroconversion a repeat test at three months is still recommended to DEFINETELY EXCLUDE HIV infection. "

A NEG at 6-8 weeks is a good sign (4 weeks is too early, period)...but you MUST obtain a test at 3 months if you want to get a conclusive result to 100% rule out infection.  While extremely rare, seroconversion DOES occur after 6 weeks.

Its your health, do the smart thing.

Also, had you simply worn a condom, you wouldn't be in this position to begin with.

[cansam81]

Does Hep B vaccine after one month incident(sex exposure) disturb the result?

[wonderstd]

I just want to add a probability calculatoin for 4th Gen (DUO) Hiv Test.

I believe that "conclusive" is the key word.

A 3rd gen test at 13th week is 99.99x accurate and this is called conclusive.

4th gen tests test both antigen and antibody.
A test at 6 week for will be more conclusive  than a 3rd Gen test at 6 week for sure.

It's simply calculation of 6th week DUO Test like that;
For Antigen testing it is %10 of probility that test misses real infection.
For Antibody testing it is %1 of probability that test misses real infection.

If you multiply 0.1 and 0.01 it is 0,001. That means, by 6 week, it is
%99.9 that test will identify the infection either from antigen testing or from antibody testing.  This probability is almost the same probability of a 3rd gen test at 10-12 weeks.
Even many docs in Europe say that one DUO test at 21st day (Where the Antigen is at its peak) and one DUO test at 42nd day (Where anti body reaches at almost peak)
is %100 conclusive.

So accumulated data on HIV testings has taught the docs that 6 week
4th Gen Hiv DUO tests are as conclusive as 3rd gen test at 12 week.

On the other hand, Detecting ONE/TWO week earlier than 3rd Gen Hiv Ab tests does not definetely mean that conclusive time for 4th gen test is 13 -1 = 12 weeks.
It is just to say while 3rd gen Hiv test CAN identify infection by 3weeks onwards,
4th gen CAN identify the infection ONE week earlier which means by 14 days.

4th Gen Tests are getting used widely day by day all over the world except USA.
I hope FDA will approve them and they are used widely in USA as well. Then I believe, according to accumulated data, CDC will update its recommendations accordingly.

[wonderstd]

Here is the Dr. Hunsfields response in the Expert Forum, regarding with reliability of the DUO Tests at 4 and 6 weeks.

http://www.medhelp.org/posts/HIV-Prevention/HIV1--HIV2-Antibodies--Combo-Test-Includes-p24-Antigen/show/1004810

The combo test, which detects both HIV antibody and p24 antigen, is considered virtually 100% reliable at 4 weeks.  Still, some experts recommend a final antibody-only test as late as 3 months, although 6-8 weeks really is sufficient.  As things stand now, based on the combination of all information (low chance your partner had HIV, low chance of transmission even if she was infected, plus the test results), the chance you have HIV is zero for all practical purposes.  It is up to you whether you need the additional reassurance of additional tests despite this reassurance.

[wonderstd]

Since Saudi Arabia is a rich country, tests must be either 3rd or 4th generation.

If the name of test does not include Ab/Ag  or P24 words, it must be 3rd gen.
Pls ask this question where you had the test.

If it is 4th gen DUO test, a negative at 8 weeks is conclusive according to many places
(not USA).

If it is 3rd gen Hiv 1/2 Antibody only test, 8 week is really reassuring and unlikely to
change. Bu t you need a 3 month test again to be definitive.

Be well....

[Teak]

DUO tests are not conclusive any earlier than any other test. Move on.

[wonderstd]

Duo test is %99.8 conclusive at 4 weeks and at least (and more than ) %99.9
at 6 weeks.

On the other hand a 3rd Gen Hiv Test is %99.99 conclusive at 12 weeks. (That's why
CDC still claims 6 month elisa test to be EXTRA Certain)

So, 4th Gen DUO test is widely accepted as conclusive in europe since it has no diffrerent reliability than a 3rd Gen Tests at 12 week.

But since 4th Gen Tests are not approved by FDA, It will not be legally correct to
say 4th Gen Tests are conclusive in USA.

[Teak]

Move on that information is incorrect. Three months is conclusive in the US and the UK. There are no tests approved or marketed to give a conclusive negative test earlier than three months.

[sweety7]

guys test at 6 weeks is totally conclusive

[nomore11]

To conclude these test data what is actually being major. Im wondering are these actuallyy based on situations where someone is tested after having some kind of real exposure vaginal/anal with someone that is known HIV positive. Otherwise the probability of negative tests will always seem high for all others because most people are not positive

[kenzorio]

Right on - what the percentages describe is the number of _infected_ people that could be picked up x weeks post exposure. The tests are done on blood samples that were drawn in the weeks immediately following exposure. Such blood samples are made available to manufacturers in the form of so-called "seroconversion panels". The source for those panels are usually blood donors who gave blood regularly and who happened to become infected while giving blood (not infected from giving blood!).

So again, these numbers apply to people who are infected. For an uninfected person, a negative result is accurate at day 1, since it is not going to change due to the person being uninfected.

So what does this mean to a person that have a risk and wants to know if he is infected? This is what HIV tests are for anyway ;) Well, if the risk was in 1 in 1,000 to begin with, and the person had a negative DUO result at 4 wks which would be associated with an sensitivity of 98%, then the person's risk of having HIV is no longer 1 in 1,000 but rather 1 in 1,000 x (100/(100-98)) = 1,000 x 50 = 50,000. A risk of 1 in 50,000 is extremely low - consider that the mortality risk for a young person is around 1 in 1,200 per year!

[Healthadvisory]

Teak is 100 percent correct. 3 months is conclusive, a negative result at 6 weeks will not likely change.

[nomore11]

Spoke to someone in CDC, and the 4-6 weeks antibody test is for sure over 50-60% but would not mention if its around 90%. Im also told to consider my doctors advise in which he stated that my 4 weeks test is near conclusive considering that i have a healthy immune system. the Doctors in this forum are also saying the same thing.

[peace12345]

It is a fact that both cdc in USA & HPA in UK has a 12 weeks window period for a leagally conclusive test altough it is not also 100 percent it is 99.96% this is a fact but remember then they also consider oral sex even receiving and fingering a risk for HIV transmission, if you dont believe then check out their websites.So what drives me nuts is that experts on this forum dont believe these activities to be no risk and quote experts opinions but clearly ignore their advice and opinion on tests reliability. In the USA duo tests were recently approved but still they are not widely used and they dont have clinical experience of them in USA. If duo test was also approved for 3 months then what was the purpose of it the manufacturer of duo test claims more than 99 percent accuracy at 4 weeks. In Uk france experts consider 4-6 weeks duo as conclusive Period. altough as a legal disclaimer they put 3 months recommended. Here in UK private clinics are regulated by Healthcare commission and they advise healthcare professionals to do a 4 week duo test and then if there are still concerns repeat the test after 2 weeks (6 weeks). This is what they call HPA algorithm for health professionals.
here is the quote from NHS
HIV antibody/antigen test (DUO test)

This test looks for HIV itself (p24 antigen) as well as the immune system’s reaction to infection (antibody). This means it detects HIV much sooner after infection than older tests. It can sometimes detect it as early as 2 weeks. By 4 weeks the test will pick up nearly everyone.
http://www.chelwest.nhs.uk/jhc/aids-hiv-testing.html
The Health Protection Agency are the UK’s leading experts in the performance of HIV tests. They advise that there is no test available guaranteed to pick up 100% of HIV infections before 3 months. As per UK guidelines, an additional HIV test should be offered to all persons at 3 months (12 weeks) to definitively exclude HIV infection.
There are case reports in the literature of people taking a long time to seroconvert. However, these reports are old and relate to old, poorly performing tests. The HIV 200 Diagnostic Survey published by the association of american public health laboratories makes the very good point that "since the development of the first HIV testing algorith, HIV testing technology has changed significantly with the introduction of new immunoassays, point of care rapid tests and molecular detection techniques. It goes on to say updating the HIV testing guidelines is a priority for the APHL and the CDC.
That remains the case - whilst the CDC etc are updating their statements then there will continue to be confusing information. The UK's Health Protection Agency though is content with its algorithm - an HIV DUO test at 28 days and if needed a further test at 1 to 2 weeks later.
Its up to you guys what you want to believe.

[juandos1980]

http://www.*************.org/forum/helpline/testing

[Teak]

3 months is conclusive.

[confuseddotcom17]

http://www.medhelp.org/posts/HIV---International/What-is-the-truth/show/1483114#post_6742642