Ultra conservative information or fact?

[vs7829]

Hi Doctor,



It never ceases to amaze me the different advice people give in regards to HIV. Just today I went for an HIV Oraquick rapid test at the local clinic and was told that this specific test can only give a result conclusively after 6 months. I told her my understanding was that 3 months was conclusive and that at 6 weeks it’s almost 100%. She told me that was irresponsible information as she has seen many cases where a person was negative at 3 months but subsequently found to be positive at 6 months. I just don’t know what the hell is going on.



Here is my situation to refresh your memory– had protected sex with a stripper – whilst withdrawing condom slipped off – may have been exposed. Tested negative with PCR for HIV DNA 13 days after exposure and tested negative today (5 and half weeks after exposure) an Orasure or Oraquick blood rapid test.



My questions if you would be so kind answer



(1)Is the Oraquick or Orasure rapid test as good as the third generation of ELISA tests which can be as accurate as 95 to 100% after 6 weeks?

(2)Would my negative result on that test today at 5 and half weeks on this test be a significant result?

(3)Would my result today (at 5 and a half weeks after exposure) coupled with my 13 day PCR for HIV DNA test be a very indication that I did not get infected?



I will also test at 12 weeks but I think all this inaccurate or ultra conservative information out there is troubling for people like myself as we do not know who to believe. Also I was felling pretty good about the 13 day PCR test I had until I read Mackia’s postings which made me feel pretty anxious and so this drove me to get the antibody test today.



Thanks

[H. Hunter Handsfield, M.D.]

I'll try to help, but I can't enlarge on all the information and opinions I have about interpreting HIV results, which you seem to be aware of.  And of course I'm not going to change that advice based on the testimony of a single clinician whose expertise likely is pretty inferior to mine (intended as a statement of probable fact, not ego).  My guess is she is simply following the party line of the medical director of the clinic.  She is simply wrong.  But I do not believe there is a conspiracy, ultraconcervative or otherwise, to transmit false information to the public.



As I probably told you in your original thread, the exposure you describe sounds very low risk; I'm not sure you needed testing at all.  But, to answer your questions:



1) Oraquick and Orasure are not "as good" as standard testing, but the reason is they give more false-positives.  To my knowledge they become positive as fast as standard tests.



2) See many previous threads (search "time to positive HIV test") to see one of my many mathematical calculations.  Your negative result probably means the chance you have HIV from the exposure you describe is under 1 in a million.



3) Yes.  But I would be over 99.9% sure of that even if you weren't tested.  But another test at 12 weeks will meet all experts' criteria for certainty.



For a variety of reasons, I do not believe Mackia is HIV infected.  Don't let his distorted perspective spook you.



Good luck--  HHH, MD

[vs7829]

Just a quick comment doctor



My second question should be "Would my negative test result today on the Oraquick or Orasure blood rapid test be a significant result?"



My thrid question should read "very good indication....."



Sorry for the confusion

[mrtibbs]

Just to give more evidence of the Doctor's accuracy on this site.  I went to an expert in the the state of Colorado who travels all over the region and tests policeman who have been stuck with dirty needles, medical people, convicts etc... Basically every situation you can think of.  She has practical experience using the modern HIV tests.  She agreed with the doctor on this forum and stated by 30 days almost everyone will test positive if infected.

[scaredstraight68]

Funny you should say that.. Today I went back after a 6 week test for my 12-13 week test and the lab lady told me to come back in 6 months then a year after this one and I was like.. HUH,,,  I cant do this paranoia thing for a solid year.  I informed her about 6 weeks in massachussetts being cosidered in the clear and it was like the first time she had ever heard that.

[Imdumb]

3 years ago I went to westover heights in Portland.  Maybe one of the top 5 STD/herpes clinics in the nation.  I was 6 weeks post expousre.  They tested for everything (including HIV and HSV) and said that my exposure was low risk and that I MIGHT want another test for HSV after 3 months.  They said I was cool on everything else and that sometimes people can get HSV even with a condom and sometimes the symtoms are not really overt.  But they said it was up to me and that my test at 6 weeks was pretty reliable in the absence of sores.  I went back at 12 weeks for the HSV and was negative again.  The bottom line is they were more than confident in my negative HIV result and said I could have all the unprotetced MONOGOMOUS sex I wanted without fear of infecting my wife.

[JohnnyV]

Do a Google on "CDC" and "OraQuick" and you'll find a webpage where the CDC itself indicates 12 weeks as the outer limit for that test.



Also, you can refer her to this webpage:



http://www.hivguidelines.org/public_html/center/clinical-education/q-and-a/update.htm



That's New York State's clear statement that TWELVE WEEKS is the threshold for the reliability of an HIV test, INCLUDING ORAQUICK. NOT 13 WEEKS, NOT 6 MONTHS, NOT A YEAR. 30 days, 6 weeks, and 2 months are other figures that circulate from time to time, but I like following New York's guidelines, because NY has the longest tradition of dealing with AIDs.



You have to remember that people who do rapid testing are not only not doctors; they're often people who took non-profit jobs just out of college, volunteers they picked up who knows where, or someone with a certificate from a local associates program -- not to disrespect any of those qualifications, but it's often possible to be doing rapid tests without knowing that much about the scientific part of it, including the serology of an infection window. Sometimes there's a manual that the whole clinic has to obey, and some aging crony with ties in the public health department is the boss who won't let anybody say anything different. A crew of CBO lifers train folks in the revolving door of testing counselors... you get the idea. An urban legend takes hold about a handful of people who tested negative at 3 months & pos at 6 months, which leads to every front-line testing counselor claiming he saw it with his own eyes. A million reasons could explain this woman's obviously incorrect statement.



Testing counselors who do rapid tests also have to sit there and walk as many as 30-50 people a day through the long path from the anxiety-ridden entry after hours of waiting in a crowded room (just read the stress in all the postings here) to the gut-wrenching 20 minutes waiting for the stick to turn colors, to the emotional outpouring after the results come in. They get jaded, they turn sour, they quit a lot. Someone else comes in who's only been in the testing racket for a few weeks... and you get stuck with someone who doesn't know what she's talking about and doesn't want to listen to you. It's natural and you have to sympathize with them.



J

[rickyme]

I agree with you doctor,I think Mackia is faking it.After following your forum for quite some time,I realised that some of his statements are inconsistent with ARS.He is probably mad at you or something.

[mrtibbs]

I am curious about one thing.  I read the New York Health testing limits and it is 12 weeks, however it states for occupational accidents the timelines are still 6 weeks, 3 months and 6 months.  Why is that?

[JohnnyV]

Hi,



Someone told me that was because needle stick injuries, for some reason, result in an infection window different from sexual exposure or IV drug use... but this may be an urban legend too. My guess is that they still do the 6 month test for occupational exposure because it's a legal liability question; the health care worker is an employee protected by the responsibilities of his/her employer, so there have to be heightened formalities. Another possibility is that the risk is generally higher for exposure to blood on the job. For instance, if you ***** yourself with a needle containing HIV+ blood, the virus is moving directly from blood to blood, and the likelihood of HIV is higher; therefore, they take the extra safety net of the 6-month test because the chance of infection is so high. Otherwise, you're right, it does not make that much sense.



Also, keep in mind that the earlier figure that was the gold standard for so long -- namely, "95% of people infected test positive in 6 months" -- was based on a study of people with occupational exposure. So even though the test advancements have rendered that old standard antiquated, still, there is an extra cautiousness about occupational exposure.



J

[mrtibbs]

Thanks for the info.  I think it being for liability reasons might be right.  I read on an earlier post from June that Doctor HH stated there is no difference to the best of his knowledge in the route of transimssion to the time it takes to test positive.