French and Italian guideline

[emmanuel85]

Good day to all

I am a young man from Milano in the north of Italy (sorry for possibility of mistakes)
I want to say two things to the people have to go to test:
1)Here in Europe, the “Haute Autorité de santé” (French National Authority for Health) had published the new guideline for HIV testing in time 10/22/2008, beneath the link (French):
http***www.has-sante.fr/portail/jcms/c_704683/la-realisation-des-tests-de-depistage-de-linfection-par-le-vih-evolue .
This cut the windows period, for adult and infant +18 mth, to six week (only with the blood 4th Gen HIV combo test) and in absence of PEP therapy. In that case the six week start to the end of prophylaxis.
2)I had a test at 11 weeks (4th Gen HIV 1/2 ab/ag ) in the best public STD clinic in Milan. They say 4 weeks test is very reliable and 6 weeks after exposure is conclusive, don’t need to test again, period. This despite public health authorities in Italy is conservative and says 3 months.
If a state like France says this, and after doctors assurance I’m convincing myself to be safe.

And I have to two questions for the Doc
1)I read about cases about persistently seronegative but infected persons, of course I know this is an extremely rare eventuality, but it is a little scary thinking about the test are unable to detect all the people who have infected. I think in that case the people should be positive for p24 and then combo test should be able to detect the infection. Is it so?
2) Can new or unknown subtypes do not be showed by the test? Can take more time?

[JeanClaude]

- That timeline ( if correct) stands for France only. I will inquire further with some of my peers on this matter.
- We on this board are bound by the US -CDC guidelines which state that only an ANTIBODY TEST at 3 months is conclusive, likewise we can only advise accordingly. Some of us are very familiar with international testing policies and can only offer advice relevent to the National residence of the individual asking the inquiry.

[emmanuel85]

I report this fact just because I know windows period could be an horrible time and carry some sort of support

[emmanuel85]

I reread what HAS press agency said:
Une personne peut être considérée comme non infectée par le VIH si le test de dépistage Elisa combiné est négatif six semaines après l’exposition supposée au VIH, et non plus trois mois comme auparavant.
TRANSLATION:
A person can be consider as not infected with HIV if the Elisa combined test is negative six weeks after suspected exposure to HIV, and not three months as before.

[JeanClaude]

- What you present as the "FRENCH GOVERNMENT'S Position concerning the conclusivity of an HIV test is inconsistent with what I know to be protocol in FRANCE. I suggest you reread your referenced article. Take into account the specific tests( Antibody assay, Western Blot, as these are the ONLY accepted tests for HIV) used and their ability to detect ANTIBODIES.  Take note that clinical suspicion and DIAGNOSTIC PROTCOL are NOT always cordant.

- Please keep in mind that after approx 3-4 post infection, the ANTIGEN component of a DUO test is NOT relied on as there would be no ANTIGEN detectability. By this point, the body would BEGIN producing ANTIBODIES. It is the body which dictates the rate at which these antibodies are produced. Most MODERN assays ( GEN 3/4) have the same sensitivity to HIV antibodies. After 3-4 weeks, the GEN 3 and GEN 4 tests have the SAME sensitivity. The possibility DOES exist ( per extensive research) that it MAY take up to 3 months for the body to produce ENOUGH  HIV antibodies to meet the test's SENTITIVITY THRESHOLD. We WILL NOT play the percentage game with seroconverters at each week up to 3 months. A CONCLUSIVE HIV TEST IS OBTAINED AT 3 MONTHS.

[Teak]

No that is not so and if you would have looked up the DUO tests it states a conclusive negative test is 3 months post exposure.