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4th Generation Test
Hi Docs, I have read through your site and feel it is by far the best place for informtion regarding HIV on the web. I have always been a person that is conscious regarding HIV so I always come to this site when I a question any experiences I have.
My question today is your thoughts on a new testing algorithm. I know 4th generation testing has been around for a while and that your stance has been that these tests are conclusive at 28 days. Just recently I went to get tested in Massachusetts a month after my last sexual experience. As I know the duo test they perform would be conclusive at that point. While speaking with a counselor they had mentioned that the 4th generation test here in Mass is now considered conclusive after 2 weeks. This testing site i was at is run by the Mass Dept of Health. I was surprised to hear that so I decided to look up some information on it. I spoke with counselors at two HIV testing sites. AAC and Fenway Health who both have been around for a long time and get their training from the Mass Dept of Health. They both confirmed that this new 2 week window for the 4th generation was considered conclusive now. I also found the below links which reference these tests.
http://www.mass.gov/eohhs/gov/newsroom/press-releases/dph/new-community-hiv-testing.html
http://www.fenwayhealth.org/site/PageServer?pagename=FCHC_srv_services_testing
http://www.hivguidelines.org/clinical-education/hiv-qa-fact-sheets/window-period-for-hiv-infection/
https://custom.cvent.com/ADE0EB81B3184D618E2FB8340F1EC28E/files/a9ffc0d52d20484f9c24cb513d44c3c1.pdf
Ill save you through reading more links but I have seen that Colorado, New York and Idaho have taken to this new testing window as well. Also, on the CDC site it says it is about to announce a new algorithm so I assume this may be it?
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6224a2.htm
Keep up the great work.
I look forward to here your thoughts.
My question today is your thoughts on a new testing algorithm. I know 4th generation testing has been around for a while and that your stance has been that these tests are conclusive at 28 days. Just recently I went to get tested in Massachusetts a month after my last sexual experience. As I know the duo test they perform would be conclusive at that point. While speaking with a counselor they had mentioned that the 4th generation test here in Mass is now considered conclusive after 2 weeks. This testing site i was at is run by the Mass Dept of Health. I was surprised to hear that so I decided to look up some information on it. I spoke with counselors at two HIV testing sites. AAC and Fenway Health who both have been around for a long time and get their training from the Mass Dept of Health. They both confirmed that this new 2 week window for the 4th generation was considered conclusive now. I also found the below links which reference these tests.
http://www.mass.gov/eohhs/gov/newsroom/press-releases/dph/new-community-hiv-testing.html
http://www.fenwayhealth.org/site/PageServer?pagename=FCHC_srv_services_testing
http://www.hivguidelines.org/clinical-education/hiv-qa-fact-sheets/window-period-for-hiv-infection/
https://custom.cvent.com/ADE0EB81B3184D618E2FB8340F1EC28E/files/a9ffc0d52d20484f9c24cb513d44c3c1.pdf
Ill save you through reading more links but I have seen that Colorado, New York and Idaho have taken to this new testing window as well. Also, on the CDC site it says it is about to announce a new algorithm so I assume this may be it?
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6224a2.htm
Keep up the great work.
I look forward to here your thoughts.
MEDICAL PROFESSIONAL
For now, our advice on this forum is for a 4th generation test (same thing as duo test) at 4 weeks for definitive result.
A related discussion, Testing Window for NYC was started.
MEDICAL PROFESSIONAL
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I agree with you (that a DUO test @ 4 weeks is definitive). I wish you could get the HIV Prevention on board with that so there is consistency.
Thanks again Doctor.
Yeah, I plan to do that anyway for peace of mind.
Likely he'll state that the 28 day test is definitive. Especially if it is a DUO ab/ag test. No less you are using condoms for vaginal/anal sex.
Thank you for your response. It's great to see you have worked with the CDC on these matters, which makes me that much more happy I came to you with this question.
As a quick follow up. In your opinion. Should I stick with a 28 day post exposure fourth generation testing until those formal recommendations come out? I'm a heterosexual male. Use condoms for vaginal sex but not for oral.
As a quick follow up. In your opinion. Should I stick with a 28 day post exposure fourth generation testing until those formal recommendations come out? I'm a heterosexual male. Use condoms for vaginal sex but not for oral.
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question and for the opportunity to comment on potential evolving recommendations on HIV testing. This is an area I know something about; take a look at the author list on CDC's current (2006) national recommendations for HIV screening:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm
It is correct that CDC is soon expected to officially role out a "new algorithm" for HIV testing policies and procedures, and the July MMWR report (the last of the URLs you have listed) goes into some detail about what to expect. Thanks for letting me know that the Massachusetts health department is already citing evidence in favor of earlier definitive results for HIV testing; I was unaware of it.
That said, the CDC algorithm probably will not be a one-size-fits-all recommenation. The whole point of an algorithm is to provide decision points that branch in different ways, depending on the clinical situation, prior risk, results of initial testing, and the like. For example, the approach may end up being different following an especially high risk exposure, or when symptoms suggest ARS in someone at high risk, compared with general screening when someone is at risk but there is no concern about any particular exposure (which is how most HIV testing is done, i.e. not because of a specific exposure).
We will all need to patiently wait until CDC officially comes out with its new recommendations and algorithm(s). However, I suspect they will include testing beyond 2 weeks in some patients with negative duo tests at that time. Another issue is that labs in the United States have been slow to transition to the duo for routine testing. Perhaps new algorithm(s) and/or guidelines will speed that process, but it won't happen overnight.
Best regards-- HHH, MD
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm
It is correct that CDC is soon expected to officially role out a "new algorithm" for HIV testing policies and procedures, and the July MMWR report (the last of the URLs you have listed) goes into some detail about what to expect. Thanks for letting me know that the Massachusetts health department is already citing evidence in favor of earlier definitive results for HIV testing; I was unaware of it.
That said, the CDC algorithm probably will not be a one-size-fits-all recommenation. The whole point of an algorithm is to provide decision points that branch in different ways, depending on the clinical situation, prior risk, results of initial testing, and the like. For example, the approach may end up being different following an especially high risk exposure, or when symptoms suggest ARS in someone at high risk, compared with general screening when someone is at risk but there is no concern about any particular exposure (which is how most HIV testing is done, i.e. not because of a specific exposure).
We will all need to patiently wait until CDC officially comes out with its new recommendations and algorithm(s). However, I suspect they will include testing beyond 2 weeks in some patients with negative duo tests at that time. Another issue is that labs in the United States have been slow to transition to the duo for routine testing. Perhaps new algorithm(s) and/or guidelines will speed that process, but it won't happen overnight.
Best regards-- HHH, MD
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