your opinion pls - I'm really really worried

[mikeward]

Hi Dr,

•I had sex with a CSW in Thailand on December 1st at 1.00am
•After I ejaculated, I realized that the condom was broken

I went to have a HIV PCR exactly 9 days and 10 hours after the exposure. The results of the test are:

Specimen: EDTA Plasma
HIV PCR: Negative by Nested PCR

The doctor told me that:

•HIV Risk  from a single unprotected sex is 0.3%
•The HIV PCR can have false positive and false negative, so need to do a DUO at 28 days and antibody at 3 months

I have the following questions:

1.The doctor told me the test was PCR RNA but it doesn’t mention any “RNA” in my results. What do you think?
2.A Dr from an other forum said to test 10 days after exposure. The doctor I saw said that the test should be done after 10-14. I did it 9 days and 10 hours after exposure. Do you think it is an issue?
3.I’m confused with the HIV PCR accuracy. The doctor told me that it is not a conclusive test and the methodology/process of this test can differ from one country to another, so that’s why we need to get the DUO at 28 days and antibody at 3 months. But I see in some your post that you have very high accuracy of PCR after 7 days. Honestly, I’m mixed and don’t know how to interpret this negative PCR result. Some says it is good. Some not. Have you ever heard of false negative PCR? I got the PCR results in less than 24hrs.
Is it possible to have such quick TAT? I'm in Thailand and it seems that even in the west, it takes much longer than that to have PCR results. Is it true that PCR accurcy depends a lot about the quality of the lab perfoming the test?
4.The doctor told me that even after the DUO, I need an antibody after 3 months to have conclusive and final result. What do you think?
5.Do you think this doctor is very conservative?  
6.Can I have sex with my wife now?
7.The most important question: With all the above, what is your opinion of my current situation?

[Edward W Hook, MD]

Last answer.  The earliest recommended test for determination of HIV is performance of a DUO test at 28 days.  EWH

[mikeward]

That's why I'm still worried Dr. I'm not sure I can rely on the PCR I did. I'm panicking.

Any test I can do before 28 days post exposure?

help me Dr please and sorry to ask again!

[Edward W Hook, MD]

I have no information in one way or another about this.  As I said, PCR is not a recommended test for HIV diagnosis - there are many kits and some labs even make their own assays.  My answers above were based on my knowledge of the good PCR tests approved by the FDA in the U.S. which we regularly use for following treatment response in persons with HIV.  EWH

[mikeward]

Hi Dr,

Sorry, it's me again. A friend told me that PCR RNA test are maybe less
reliable in Bangkok compared to the west as here they may use a less
developed technology. Do you have any opinion?

Thanks

[mikeward]

Thanks Dr! I appreciate your help :)

[Edward W Hook, MD]

No, just a standard DUO test.  EWH

[mikeward]

Hi Dr,

Sorry to ask an additional question.

When I'll do my DUO at 28 days, is there a specific method this test should be done?

Thanks for help and support

[Edward W Hook, MD]

I very sincerely doubt that you acquired HIV from the encounter you describe and if I were you I would not test however, if you want to be 100% sure for your peace of mind, then a 28 day DUO test is appropriate.  EWH

[mikeward]

Thanks Dr. I appreciate your help.

I know I'm overposting on these forums. It's the first time I'm facing such situation and I read so many different opinions, but you're right: there's no need to look after difference sources.

One more question: in my current situation (and considering the PCR I already had), do you recommend me to have this DUO at 28 days?

Thanks Dr.

[Edward W Hook, MD]

.Welcome to the Forum.  Your over 30 posts in the past 10 days indicates that you are having trouble getting past the assurances you've received both on the International HIV Forum and on our HIV Prevention Community site.  I'll add my comments but the bottom line is that this  was a very low risk exposure to begin with and the testing you have had provides further strong evidence that you were not infected.  Asking the same questions over and over again will not change the answers but you may get different estimates of risk, when to tests, etc. depending on just how conservative the person you are talking to is.  This can’t be changed- there is lots of information out there which while mostly in agreement has slight differences form source to source.   If you are going to persist in going from source to source, you'll have to live with it.


In answer to your specific questions, using the same number that you used above:
1. Why would the doctor lie. If he said it was a PCR, it most probably was.  The result you report above sounds like a PCR results.  

2. Advice about precisely when you can count on PCR tests for HIV diagnosis varies, in part because there are no studies and partially because these tests are not recommended for routine HIV diagnosis.  That said, a negative PCR result is strong evidence that you did not get HIV- how strong is hard to judge.  In your situation, I would urge you to believe the results you have.

3.. As I said above, people are using the PCR for diagnosis which is not a task the test is designed for.  False negatives are rare, particularly after 10-14 days.  False positives occur regularly and that, along with expense is part of the reason we do not recommend them.  

A PCR can certainly be done in less than 24 hours. The TAT is a function of not only how long it takes the test to be done but also the time for transport to and from the lab, when the test is performed, etc.  

4.  I think this is overly conservative.  A negative DUO test at 28 days will provide you with definitive information.

5.  See above- redundant question.

6.  I would not be worried about unprotected sex with your wife at this time.

7.  Another redundant question- there are no hidden answers.  EWH