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Is it Conclusive
Hello Doctors,
First let me say thank you for your great service. I have been reviewing threads on this site for a few weeks now and have found it very helpful. Based on what I've read on this site I had what you would deem to be a no risk/low risk encounter. After reading that I felt better but eventually the "what if" fear got the best of me. At the same time the Internet telling me everything could be a symptom didn't help either. I went and saw my PCP on the 19th day after the encounter and he said I had nothing to worry about but did a HIV 1/2 antibody test just to put me at ease. This came back negative. I read however that this test is not conclusive until 6 weeks, but really 3 months. Again I felt better but after reading that had fear again. I then read about a very expensive "early detection test". I decided that my peace of mind was worth the $299 cost so I had it done at 32 days past my encounter. The test was a PCR DNA and HIV 1/2 Antibody Test. These 3 results all came back negative. My questions for you are as follows:
1.) Is the PCR DNA and HIV 1/2 Antibody Test 100% Conclusive/Accurate at 32 days?
2.) Is this test as conclusive/accurate as a 6 week or 90 day ELISA test? Is it more accurate? Why?
3.) In the free forum on this site there is someone who says the test is not FDA/CDC approved and is not for diagnostic purposes and that I need to wait 3 months and have an antibody test in order to be conclusive. Is that correct? Why or Why not?
I thank you for your time, your service, and your attention to my concern.
First let me say thank you for your great service. I have been reviewing threads on this site for a few weeks now and have found it very helpful. Based on what I've read on this site I had what you would deem to be a no risk/low risk encounter. After reading that I felt better but eventually the "what if" fear got the best of me. At the same time the Internet telling me everything could be a symptom didn't help either. I went and saw my PCP on the 19th day after the encounter and he said I had nothing to worry about but did a HIV 1/2 antibody test just to put me at ease. This came back negative. I read however that this test is not conclusive until 6 weeks, but really 3 months. Again I felt better but after reading that had fear again. I then read about a very expensive "early detection test". I decided that my peace of mind was worth the $299 cost so I had it done at 32 days past my encounter. The test was a PCR DNA and HIV 1/2 Antibody Test. These 3 results all came back negative. My questions for you are as follows:
1.) Is the PCR DNA and HIV 1/2 Antibody Test 100% Conclusive/Accurate at 32 days?
2.) Is this test as conclusive/accurate as a 6 week or 90 day ELISA test? Is it more accurate? Why?
3.) In the free forum on this site there is someone who says the test is not FDA/CDC approved and is not for diagnostic purposes and that I need to wait 3 months and have an antibody test in order to be conclusive. Is that correct? Why or Why not?
I thank you for your time, your service, and your attention to my concern.
A related discussion, Does HIV DNA PCR test detects both HIV1 & HIV2 was started.
MEDICAL PROFESSIONAL
Brief Replies:
1.). At day 25 past exposure I started to have pain in the left side of my jaw. It then swelled a little bit over the next few days. I looked this up online while I was in panic mode and saw parotid gland swelling can be associated with early HIV. This through me into a panic.
A.). If this was parotid swelling due to HIV would my PCR DNA and HIV 1/2 test at 32 days past exposure been positive even though the symptom had only been there for 6-7 days?
B.). Is there a period/window around 32 days where neither PCR DNA nor HIV 1/2 antibody test would be positive and you could still be infected?
A. If your swelling we due to HIV (which I am confident it is not) your PCR would probably be positive. Again, the test is not designed or approved for HIV diagnosis.
B. Re-read my earlier answers please. This sort of "what if" question is a bit repetitive
2.). I saw a post on here where Dr. HHH stated that the combination of a negative PCR DNA and an antibody test past 4 weeks is 100% proof that someone did not get HIV. He also said this was not his/your opinion, rather scientific fact. Is this accurate?
Another redundant question.
3.). Based on my negative PCR DNA and HIV 1/2 antibody tests being negative, does that mean that there is no way I aquired HIV? Is any further testing necessary?
Can I be 100% sure- no, just as I cannot promise you that you will not be struck by a meteorite today. On the other hand, I am confident, obth the you do not have HIV and that you will not be struch by a meteorite.
My sense is that your anxiety is getting the best of you. Relax. EWH
1.). At day 25 past exposure I started to have pain in the left side of my jaw. It then swelled a little bit over the next few days. I looked this up online while I was in panic mode and saw parotid gland swelling can be associated with early HIV. This through me into a panic.
A.). If this was parotid swelling due to HIV would my PCR DNA and HIV 1/2 test at 32 days past exposure been positive even though the symptom had only been there for 6-7 days?
B.). Is there a period/window around 32 days where neither PCR DNA nor HIV 1/2 antibody test would be positive and you could still be infected?
A. If your swelling we due to HIV (which I am confident it is not) your PCR would probably be positive. Again, the test is not designed or approved for HIV diagnosis.
B. Re-read my earlier answers please. This sort of "what if" question is a bit repetitive
2.). I saw a post on here where Dr. HHH stated that the combination of a negative PCR DNA and an antibody test past 4 weeks is 100% proof that someone did not get HIV. He also said this was not his/your opinion, rather scientific fact. Is this accurate?
Another redundant question.
3.). Based on my negative PCR DNA and HIV 1/2 antibody tests being negative, does that mean that there is no way I aquired HIV? Is any further testing necessary?
Can I be 100% sure- no, just as I cannot promise you that you will not be struck by a meteorite today. On the other hand, I am confident, obth the you do not have HIV and that you will not be struch by a meteorite.
My sense is that your anxiety is getting the best of you. Relax. EWH
Thank you for taking the time to provide such detail in your response, it is truly appreciated and show that you care more then just a few word response would. I do have a few follow up questions, if you could answer those I would really appreciate it.
1.). At day 25 past exposure I started to have pain in the left side of my jaw. It then swelled a little bit over the next few days. I looked this up online while I was in panic mode and saw parotid gland swelling can be associated with early HIV. This through me into a panic.
A.). If this was parotid swelling due to HIV would my PCR DNA and HIV 1/2 test at 32 days past exposure been positive even though the symptom had only been there for 6-7 days?
B.). Is there a period/window around 32 days where neither PCR DNA nor HIV 1/2 antibody test would be positive and you could still be infected?
2.). I saw a post on here where Dr. HHH stated that the combination of a negative PCR DNA and an antibody test past 4 weeks is 100% proof that someone did not get HIV. He also said this was not his/your opinion, rather scientific fact. Is this accurate?
3.). Based on my negative PCR DNA and HIV 1/2 antibody tests being negative, does that mean that there is no way I aquired HIV? Is any further testing necessary?
Thank you for your time and knowledge Doctor. I truly, truly appreciate it.
Thank you.
1.). At day 25 past exposure I started to have pain in the left side of my jaw. It then swelled a little bit over the next few days. I looked this up online while I was in panic mode and saw parotid gland swelling can be associated with early HIV. This through me into a panic.
A.). If this was parotid swelling due to HIV would my PCR DNA and HIV 1/2 test at 32 days past exposure been positive even though the symptom had only been there for 6-7 days?
B.). Is there a period/window around 32 days where neither PCR DNA nor HIV 1/2 antibody test would be positive and you could still be infected?
2.). I saw a post on here where Dr. HHH stated that the combination of a negative PCR DNA and an antibody test past 4 weeks is 100% proof that someone did not get HIV. He also said this was not his/your opinion, rather scientific fact. Is this accurate?
3.). Based on my negative PCR DNA and HIV 1/2 antibody tests being negative, does that mean that there is no way I aquired HIV? Is any further testing necessary?
Thank you for your time and knowledge Doctor. I truly, truly appreciate it.
Thank you.
MEDICAL PROFESSIONAL
Welcome to the Forum. I will try to help but my suspicion is that your major battle is with your own anxieties and, perhaps, guilt. You say nothing about your exposure other than it was "no/low risk" and thus I suspect it was. Thus the testing you are pursuing is mostly to quell your anxieties. Here is what is going on and the source of your concerns and the internet conflict.
The FDA has VERY strict, high standards for approving a test for any purpose, including HIV diagnosis. These standards require evaluation of tens of thousands of persons with and without HIV from a variety of settings and situations. As a result, there results are very, very good but also quite conservative. Further, as tests improve and as use of tests expands, there is little financial incentive for companies to spend the tens of millions of dollars required to modify their approvals. This is the source of the confusion.
When people get HIV, if untreated, they will always have the virus present in their blood. thus, from this perspective PCR tests should be VERY good tests for diagnosing HIV. The problem with the PCR tests however are two-fold. First, they have not gone through the FDA evaluation process and second, they have ha far (10- to 100-fold) higher rate of false positive results than the approved antibody tests. Thus for you a negative PCR is good evidence that you do not have HIV. We do not recommend them for diagnosis on this site both because of the problem with false positives and because they are so expensive. On the other hand, if you have a negative PCR test it is very, very strong evidence that you did not acquire HIV.
Comparing PCR and antibody tests is comparing apples and oranges. Both are good tests which have been designed for different purposes. They also become positive at different times The PCR test is designed for following the response to therapy in persons with HIV while the antibody tests are designed to diagnosed infection. PCRs do however become positive very early in the course of infection (with a few weeks). Antibodies take longer to form than the virus does to appear in the blood, thus antibody tests take longer to become positive. Currently available antibody tests, despite more conservative recommendation, give completely reliable results 8 weeks after and exposure. When a test for antibodies is combined with a test for the virus results are reliable sooner and provide totally reliable results just 4 weeks after exposure (these are the so-called “combo” tests which use a test for the p24 antigen to test for the virus).
The results of your three tests at 32 days are equivalent to the results of the so-called "combo" tests for HIV which test for the virus as the p24 antigen and for antibody. when these tests are negative at any time beyond 4 weeks, the results are definitive. thus you can be sure you do not have HIV.
I hope these comments are helpful. EWH
The FDA has VERY strict, high standards for approving a test for any purpose, including HIV diagnosis. These standards require evaluation of tens of thousands of persons with and without HIV from a variety of settings and situations. As a result, there results are very, very good but also quite conservative. Further, as tests improve and as use of tests expands, there is little financial incentive for companies to spend the tens of millions of dollars required to modify their approvals. This is the source of the confusion.
When people get HIV, if untreated, they will always have the virus present in their blood. thus, from this perspective PCR tests should be VERY good tests for diagnosing HIV. The problem with the PCR tests however are two-fold. First, they have not gone through the FDA evaluation process and second, they have ha far (10- to 100-fold) higher rate of false positive results than the approved antibody tests. Thus for you a negative PCR is good evidence that you do not have HIV. We do not recommend them for diagnosis on this site both because of the problem with false positives and because they are so expensive. On the other hand, if you have a negative PCR test it is very, very strong evidence that you did not acquire HIV.
Comparing PCR and antibody tests is comparing apples and oranges. Both are good tests which have been designed for different purposes. They also become positive at different times The PCR test is designed for following the response to therapy in persons with HIV while the antibody tests are designed to diagnosed infection. PCRs do however become positive very early in the course of infection (with a few weeks). Antibodies take longer to form than the virus does to appear in the blood, thus antibody tests take longer to become positive. Currently available antibody tests, despite more conservative recommendation, give completely reliable results 8 weeks after and exposure. When a test for antibodies is combined with a test for the virus results are reliable sooner and provide totally reliable results just 4 weeks after exposure (these are the so-called “combo” tests which use a test for the p24 antigen to test for the virus).
The results of your three tests at 32 days are equivalent to the results of the so-called "combo" tests for HIV which test for the virus as the p24 antigen and for antibody. when these tests are negative at any time beyond 4 weeks, the results are definitive. thus you can be sure you do not have HIV.
I hope these comments are helpful. EWH
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