HIV duo CMIA method

[cs28]

i did 2 HIV  1/2 DUO by CMIA

39 days non reactive 0.34
44 days non reactive 0.16
50 days non reactive 0.38

I know this is not conclusive.However what are these index values..last one was the highest.Does that mean i am seroconverting .

[Kirstie_MHModerator]

Please start a new thread for your question rather than posting on another member's thread.  Click the "back to community" link at the top of this page and you will see a "post a question" button.

[Teak]

Do not pull up old threads and post.

[curiousboy114]

plz help all experts here....

How about p24antigen combo test (CMIA).....after 4 days the start of ARS...???

[Teak]

Dr. Jose Gonzalez-Garcia, MD, MBBS, LMS, MRCP(UK), MRCGP, PhD

However current "UK guidelines still recommend to have a final test at 12 weeks for it to be considered final and fully conclusive."  

[peterSlm]

in this document (http://www.bhiva.org/documents/Guidelines/Testing/ConsultComments.pdf), they discuss several things related to testing guidelines.
I think one of the important comments is the one made by John White about window period etc.

[Teak]

http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/PremarketApprovalsPMAs/ucm264723.htm
Package Insert - GS HIV Combo Ag/Ab EIA
GS HIV Combo Ag/Ab EIA
Manufacturer: Bio-Rad Laboratories
GS HIV Combo Ag/Ab EIA
13 - LIMITATIONS OF THE PROCEDURE
4.
A negative test result at any point in the investigation of individual subjects does not preclude the possibility of exposure to or infection with HIV-1 and/or HIV-2.
5.
Negative results can occur if the quantity of marker present in the sample is too low for the detection limits of the assay, or if the marker which is detected is not present during the stage of disease in which a sample is collected.

[Teak]

http://www.cdc.gov/globalaids/Resources/pmtct-care/docs/TM/Module_6TM.pdf
Page 11
#4
  In an adult, a positive HIV antibody test result means that the person is infected, a person with a negative or inconclusive result may be in the “window for 4 to 6 weeks but occasionally up to 3 months after HIV exposure. Persons at high risk who initially test negative should be retested 3 months after exposure to confirm results

UK Fourth Generation  Testing
http://www.bhiva.org/documents/Guidelines/Testing/GlinesHIVTest08.pdf
Post testing
Page 11
The need for a repeat HIV test if still within the window period after a specific exposure should be discussed. Although fourth generation tests shorten the time from exposure to seroconversion a repeat test at three months is still recommended to definitively exclude HIV infection.

[Teak]

No incident HIV infections among MSM who practice exclusively oral sex.
Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WePpC2072)??Balls JE, Evans JL, Dilley J, Osmond D, Shiboski S, Shiboski C, Klausner J, McFarland W, Greenspan D, Page-Shafer K?University of California, San Francisco, San Francisco, United States

Oral transmission of HIV, reality or fiction? An update
J Campo1, MA Perea1, J del Romero2, J Cano1, V Hernando2, A Bascones1
Oral Diseases (2006) 12, 219–228

AIDS: Volume 16(17) 22 November 2002 pp 2350-2352
Risk of HIV infection attributable to oral sex among men who have sex with men and in the population of men who have sex with men

Page-Shafer, Kimberlya,b; Shiboski, Caroline Hb; Osmond, Dennis Hc; Dilley, Jamesd; McFarland, Willie; Shiboski, Steve Cc; Klausner, Jeffrey De; Balls, Joycea; Greenspan, Deborahb; Greenspan
Page-Shafer K, Veugelers PJ, Moss AR, Strathdee S, Kaldor JM, van Griensven GJ. Sexual risk behavior and risk factors for HIV-1 seroconversion in homosexual men participating in the Tricontinental Seroconverter Study, 1982-1994 [published erratum appears in Am J Epidemiol 1997 15 Dec; 146(12):1076]. Am J Epidemiol 1997, 146:531-542.

Studies which show the fallacy of relying on anecdotal evidence as opposed to carefully controlled study insofar as HIV transmission risk is concerned:

Jenicek M. "Clinical Case Reporting" in Evidence-Based Medicine. Oxford: Butterworth–Heinemann; 1999:117
Saltzman SP, Stoddard AM, McCusker J, Moon MW, Mayer KH. Reliability of self-reported sexual behavior risk factors for HIV infection in homosexual men. Public Health Rep. 1987 102(6):692–697.Nov–Dec;

Catania JA, Gibson DR, Chitwood DD, Coates TJ. Methodological problems in AIDS behavioral research: influences on measurement error and participation bias in studies of sexual behavior. Psychol Bull. 1990 Nov;108(3):339–362.

There is no debate (among experts) about the HIV risks associated with oral sex. The risk is so low that almost nobody who cares for HIV infected patients has ever had a patient believed to have been infected that way. Among experts, it's a semantic issue about using terms like "no risk" and "very low risk". There is no difference between my or Dr. Hook's use of "low risk" and other experts' "no risk".
DR. HANSFIELD

"And oral sex is basically safe sex -- completely safe with respect to HIV and although not zero risk for other STDs, the chance of infection is far lower than for unprotected vaginal or anal sex. Please educate yourself about the real risks. If you stick with oral sex and condom-protected vaginal or anal sex, you have no HIV worries and very little worry about other STDs. " DR HANSFIELD

"I am sure you can find lots of people who believe that HIV is transmitted by oral sex, but you will not find scientific data to support this unrealistic concern..." DR HOOK

"HIV is not spread by touching, masturbation, oral sex or condom protected sex."- DR. HOOK

in the public HIV Prevention forum of MedHelp, TEAK and the other moderators maintain that oral sex in all forms is a zero risk activity. Would you agree with this assessment?
I TOTALLY AGREE / DR GARCIA
"HIV is not spread by masturbation, through oral sex, through kissing or other casual contact." Dr. Hook
"The observation on thousands and thousands of observations is that HIV is not spread by oral sex (of any sort)." DR HOOK
"I would not say your risk ,if he had HIV is "slim to none"- that's too high.  I would say they are effectively zero.  How much of his ejaculate or other genital  secretions you may have swallowed makes no difference.  EWH "
"As far as HIV is concerned, there is no known risk of getting HIV from performing oral sex on an infected partner, even if that person's genital secretions get into your eyes or if you swallow." Dr.Hook

[Teak]

CDC does not give the approvals for HIV tests.

[Teak]

The guidelines for a conclusive negative test is 3 months post exposure, it does not matter what type of test it is.

[gumm_BIH]

Practice has shown that the Duo test does not tend to change if it is done 4-6 weeks after exposure. I agree with many of your statements, and I agree that there are some guidelines to follow, but again this is the fact and it is true. I would say that the test COMBO test is very advanced test that is performed with the minimum requirements, so there is no place for mistakes.

[Teak]

Most places don't offer duo test because they don't have the equipment to offer the test and findthat there isn't that much difference in the time line for receiving a positive result. Studies show that the duo test may detect one week earlier than a 3rd generation test.

[RainLover71]

It is you who is wrong.The most effective timeline for a DUO test is 4 weeks because that is when the p24 antigen is at it's peak,at 6 weeks the antibody part of the test become reliable and very accurate.P24 will still be detectable but not as easily as it would be at 4 weeks.The window period for a DUO is 4 weeks.

[RainLover71]

I have read the same information from freedomhealth in the UK and they have an excellent reputation.For some reason there are websites stating that the p24 antigen will become undetectable after say 5 weeks.Personally i don't believe this myself as studies have been done where it has clearly show that p24 antigen remains detectable for months.Not as high as in the first 4 weeks but still detectable.

[peterSlm]

is it really so that p24 becomes undetectable (using duo/combo) tests after 4 weeks?
i've read different information that states that it will remain detectable up to 6 months...

[cs28]

You are wrong.Accuracy of any test increases as time passes.Theoretically 6 week DUO would be more effective than 4 weeks.

[peterSlm]

duo at 6 weeks is OFFICIALLY considered conclusive in France. This means that you do not have to wait 3 months for a conclusive test but only 6 weeks.
in Denmark, 8 weeks is the OFFICIAL window period.

i know that other countries in Europe have also shorter OFFICIAL window periods than 3 months but i don't have the link to the official guidelines.

Majority of the countries, including US, have 3 months.

Does this mean that 3 months is a better estimate? I don't think so because countries with advanced hiv research are moving towards cutting the official window period.

[RainLover71]

That's not true.A duo at 4 weeks is most accurate not at 6 weeks.The p24 antigen will peak at 4 weeks like I told you.An antibody test at 6 weeks is good,I agree with you there,but at the end of the day a 12 week test result is gold.This is just my opinion on how one should test.They take the DUO at 4 weeks and then the antibody at 12 weeks.Perfect testing timeline.

[cs28]

What should I know about HIV testing?

When thinking of getting tested for HIV, there are a few important things to consider:

    Window Period: The HIV test is looking for antibodies, which are the body’s response to having HIV in it. For most people, it takes 6 weeks for the body to produce enough antibodies for a standard HIV antibody test to be accurate. Some people call this the "window period". The Massachusetts Department of Public Health recommends waiting 6 weeks between an individual's possible HIV exposure and the time they get tested, providing there are no risks within that time period. For a conclusive test result, it’s recommended to wait 3 months before getting tested.
    Anonymous vs. Confidential Tests: An anonymous test does not require an individual to provide their name at the time of testing, while a confidential test does require a name. In either case, written consent from the patient is the only way the results will be released, and otherwise will be kept private. Doctor's offices use confidential testing while some private clinics and testing sites will still do anonymous HIV testing, although it is becoming increasingly difficult to find.

    Standard vs. Rapid Testing: A standard HIV test refers to a blood draw, typically done at a doctor's office. Results are usually received within 5 to 10 business days. Rapid tests (sometimes referred to as OraQuick, OraQuick Advance, or Unigold) involve either a finger prick or a mouth swab. Results are given in about 30 minutes. See below for descriptions of different types of HIV-Antibody tests.

    Cost: Depending on where you get tested, either insurance will cover the cost, pricing may be based on a sliding-scale which will depend on your income, or you may be able to get a free test.

For more information about testing, please call the AIDS Action Hotline at 800-235-2331.

Why do some sources advise waiting longer than 6 weeks for HIV testing?

Most people will test accurately for HIV after 6 weeks have passed since their last risk. In some cases where a person has a highly compromised immune system, such as those in which a person has recently undergone chemotherapy or an organ transplant, it may take 3-6 months for their body to develop enough antibodies to test positive.

These are very extreme situations, however, and other more common conditions such as colds or the flu, diabetes, asthma, and many others, will not affect the body's development of HIV antibodies in that way. Those who suggest window periods longer than 6 weeks are trying to account for all those who may also have compromised immune systems. The CDC (Centers for Disease Control and Prevention) recommends waiting 3 months for a conclusive test result.

Source:http://www.aac.org/site/PageServer?pagename=basics_home


Teak and getitright I feel you both are correct from your point of view.However I feel getitright 4 weeks is too early I fell you should advise a 6 week for first test. and then followup on 12/13 weeks.No doubt 12/13 weeks is compulsory and conclusive.However 6-7 week gives a fairly accurate results for most of the people.

[Teak]

3 months post exposure is conclusive.

Dr. Jose Gonzalez-Garcia, MD, MBBS, LMS, MRCP(UK), MRCGP, PhD

However current "UK guidelines still recommend to have a final test at 12 weeks for it to be considered final and fully conclusive."  

[RainLover71]

Yes,by 50 days almost all people will have detectable antibodies.Did you read the last sentence.It is almost always the case that a negative HIV DUO test at 28 days or more will be conclusive and not need repeating.Freedomhealth is one of the best STD and HIV clinics in the world.

[cs28]

I have read BHIVA guidelines it says this

source:
http://www.bhiva.org/documents/Guidelines/Testing/GlinesHIVTest08.pdf

page 13

"Although with fourth generation tests infection can be detected much earlier than previously(see section on primary screening assays), in very recent infection – when patients may be most symptomatic – the test may be negative. In this scenario, if PHI is suspected, either urgent referral to specialist services (GU clinic or HIV service) or a repeat test in seven days is recommended. HIV viral load testing can be used in this clinical setting, but it is recommended that this is only performed with specialist input."

Even freedomhealth.uk says this thing
"From the Freedomhealth point of view, using as described above the combined knowledge and experience of the team we regard the HIV DUO test as a conclusive HIV test at 28 days or beyond in almost all circumstances. In situations where a patient has had an exceptionally high level of HIV exposure and has symptoms which we might in our expert opinion regard as suggestive of an acute HIV infection, we will encourage the patient to re-test at an appropriate interval which we will decide with the patient. However, it is almost always the case that a negative HIV DUO test at 28 days or more will be conclusive and will not need repeating."

getitright my symptoms started on 29 days..nearly all symptoms,fever,night sweats ,headache,weightless...I tested again on Day 50 .My question is that is it enough days for the production of antibodies or I have tested  early.

[RainLover71]

I think we all know that A DUO is highly reliable at 4 weeks and then a final test a 12 weeks just to make it all official.

[Teak]

Dr. Jose Gonzalez-Garcia, MD, MBBS, LMS, MRCP(UK), MRCGP, PhD
Dec 06, 2011 To: jjllmm
Hello,
Thank you very much for your post and welcome to our forum.  I am afraid that it is going to be me answering your question, and not my colleague, Dr Sean.
It is certainly quite unfortunate that you had contracted herpes type 2 in this unprotected sexual encounter.  The negative test that you had at 8 weeks is certainly highly reassuring and a very good indication as it is possible to detect the HIV antibodies already at that stage.  However current "UK guidelines still recommend to have a final test at 12 weeks for it to be considered final and fully conclusive."  Having said all that, and speaking out of my own clinical experience, I have never come across anyone testing negative at 8 weeks and then positive at 12 weeks.  Therefore I am very confident that you are HIV negative.
Best wishes,