Aa
please advise me sir
I recently had a high risk exposure, November 18th, 2013. Last time I had unprotected sex with my partner who was diagnosed with HIV, he had unknowingly received it from his ex bf approximately 3 months prior. I have had unprotected sex with my partner prior to November 18th but that was the last exposure I received. Following the incident I have gotten tested multiple times. I am the insertive male partner (never been the receptive partner). I have a sore throat, and have had one for a long duration of time. I noticed a small, red, raised patch of skin, with no pain or itching, on the tip of my penis just below/around the urethra or hole (I am circumcised). My GP advised me that my chances of catching HIV from 3-4 unprotected incidents is highly unlikely and that the raised skin/redness on my penis can be a number of things. Still unsettled I continued to test weekly. I am aware that the only test considered conclusive is an antibody test at 12 weeks (can be up to 6 months) per the CDC and Health Organizations. My question is: Are the tests listed below a good indicator, (*not conclusive until the 12th week by antibody testing I am aware of this*), of my HIV status?
-Negative Antibody Blood work- November 13th (Full STD/STI Blood work and Urine Sample- ALL CLEAR)
-Negative HIV-1 DNA RT PCR proviral and HIV 1/O/2 Abs- November 25th, 2013 (1 week since last exposure)
-Negative HIV-1 RNA Qualitative- December 5th, 2013 (2.5 week since last exposure)
-Negative Antibody (blood work, may be oral)- December 13th, 2013 (3.5 weeks since last exposure)
-Negative HIV-1 DNA PCR and HIV 1/2 EIA AB SCREEN- December 16th, 2013 (4 weeks since last exposure)
-Negative Oraquick Antibody Oral Test- Aprox December 21, 2013 (4.5 weeks since last exposure)
-Negative Oraquick Antibody Oral Test- January 4th, 2014 (6.5 weeks since last exposure)
-Negative Oraquick Antibody Blood Test- January 6th, 2014 (7 weeks since last exposure)
Please advise me.
-Negative Antibody Blood work- November 13th (Full STD/STI Blood work and Urine Sample- ALL CLEAR)
-Negative HIV-1 DNA RT PCR proviral and HIV 1/O/2 Abs- November 25th, 2013 (1 week since last exposure)
-Negative HIV-1 RNA Qualitative- December 5th, 2013 (2.5 week since last exposure)
-Negative Antibody (blood work, may be oral)- December 13th, 2013 (3.5 weeks since last exposure)
-Negative HIV-1 DNA PCR and HIV 1/2 EIA AB SCREEN- December 16th, 2013 (4 weeks since last exposure)
-Negative Oraquick Antibody Oral Test- Aprox December 21, 2013 (4.5 weeks since last exposure)
-Negative Oraquick Antibody Oral Test- January 4th, 2014 (6.5 weeks since last exposure)
-Negative Oraquick Antibody Blood Test- January 6th, 2014 (7 weeks since last exposure)
Please advise me.
MEDICAL PROFESSIONAL
Welcome to the forum. I'm happy to help.
The most important details in your question are your test results, which prove you were not infected. You apparently don't realize or misunderstand a couple of important facts about the window period (time to defintive test results). First, even with the antibody tests, for which the official window period is 3 months, negative results are virtually 100% reliable by 6-8 weeks. Second and even more important, you had a lot more than antibody testing, and the combination of your various test results is 100% conclusive at this time. In fact, you could have stopped testing, with 100% confidence in result at the 4 week mark, with negative antibody, p24 antigen, and PCR.
That said, given the advice of most public health agencies and other experts, I can understand your desire and perhaps your GP's recommendation to have a final antibody test at 3 months, which will make it official. But it really isn't necessary; there is no chance any further test results will be positive, assuming no new exposures. The two threads linked below go into more detail about testing windows, including an explanation why the official advice remains 3 months despite scientific certainty at earlier times:
http://www.medhelp.org/posts/show/1704700
http://www.medhelp.org/posts/show/1891685
As you have noted, I'm not relying at all (and really paying little attention to) your exposure history or symptoms. The HIV tests are among the most accurate diagnostic tests ever developed, for any condition. As long as sufficient time has passed since the last exposure, as discussed above, the results overrule all other considerations. Your exposure was pretty high risk (unprotected anal sex with a partner with a recent infection and perhaps a high viral load), but the test results show for sure you weren't infected. Your symptoms were not suggestive, as your GP said, but it wouldn't matter if they were.
So all is well. Even if you decide to have a final antibody test 3 months after the last exposure, you can stay relaxed in the meantime. There is no chance it will be positive.
I hope this has helped. Best wishes and stay safe-- HHH, MD
The most important details in your question are your test results, which prove you were not infected. You apparently don't realize or misunderstand a couple of important facts about the window period (time to defintive test results). First, even with the antibody tests, for which the official window period is 3 months, negative results are virtually 100% reliable by 6-8 weeks. Second and even more important, you had a lot more than antibody testing, and the combination of your various test results is 100% conclusive at this time. In fact, you could have stopped testing, with 100% confidence in result at the 4 week mark, with negative antibody, p24 antigen, and PCR.
That said, given the advice of most public health agencies and other experts, I can understand your desire and perhaps your GP's recommendation to have a final antibody test at 3 months, which will make it official. But it really isn't necessary; there is no chance any further test results will be positive, assuming no new exposures. The two threads linked below go into more detail about testing windows, including an explanation why the official advice remains 3 months despite scientific certainty at earlier times:
http://www.medhelp.org/posts/show/1704700
http://www.medhelp.org/posts/show/1891685
As you have noted, I'm not relying at all (and really paying little attention to) your exposure history or symptoms. The HIV tests are among the most accurate diagnostic tests ever developed, for any condition. As long as sufficient time has passed since the last exposure, as discussed above, the results overrule all other considerations. Your exposure was pretty high risk (unprotected anal sex with a partner with a recent infection and perhaps a high viral load), but the test results show for sure you weren't infected. Your symptoms were not suggestive, as your GP said, but it wouldn't matter if they were.
So all is well. Even if you decide to have a final antibody test 3 months after the last exposure, you can stay relaxed in the meantime. There is no chance it will be positive.
I hope this has helped. Best wishes and stay safe-- HHH, MD
Understandable, just thought Id ask.
She just worried me a bit. But better to be overly conservative than the opposite I suppose.
Thank You.
She just worried me a bit. But better to be overly conservative than the opposite I suppose.
Thank You.
MEDICAL PROFESSIONAL
How can I judge your doctor's "intent"? Ask her! There certainly is no regulatory reason, and I suppose she's just being very conservative.
Thank you for your response but I have only one other question for you sir.
My HIV specialist here in NY, following the tests which I provided her stated above, has ordered HIV testing (RNA and Antibody) each month for 6 months. I provided her with all the information which I have provided you and she had told me that if I was infected the pcr tests are highly sensitive and would have caught the infection (like you said), but followed it with saying, as of now, your not infected and your risk of transmission to others is 0, however I must be tested for the next 6 months to ensure I am okay. I am by no means questioning your judgement, but was just curious as to what her intent with 6 months of testing is. To cover all bases? Conform to Health regulations?
Thank You.
My HIV specialist here in NY, following the tests which I provided her stated above, has ordered HIV testing (RNA and Antibody) each month for 6 months. I provided her with all the information which I have provided you and she had told me that if I was infected the pcr tests are highly sensitive and would have caught the infection (like you said), but followed it with saying, as of now, your not infected and your risk of transmission to others is 0, however I must be tested for the next 6 months to ensure I am okay. I am by no means questioning your judgement, but was just curious as to what her intent with 6 months of testing is. To cover all bases? Conform to Health regulations?
Thank You.
MEDICAL PROFESSIONAL
You're right -- looking back, somehow I thought you had the PCR plus a DUO test for both antibody and p24 antigen. However, it doesn't change anything: PCR and p24 do the same thing, detection of the virus itself, and PCR is the superior of the two. A negative PCR at 10+ days plus negative antibody at 4 weeks is a 100% reliable result.
In other words, yes: "the dna pcr and antibody tests are still sufficient to provide me with the same answer".
Thanks for the thanks about our services. Best wishes.
In other words, yes: "the dna pcr and antibody tests are still sufficient to provide me with the same answer".
Thanks for the thanks about our services. Best wishes.
Thank you for your prompt and well explained response. I cant thank you enough as I have been struggling to sleep, lack of appetite, and intense fatigue. I am extremely grateful for how quickly you answered. Not to question your judgement at all Doctor but you said: "In fact, you could have stopped testing, with 100% confidence in result at the 4 week mark, with negative antibody, p24 antigen, and PCR. "
I only received the antibody and dna pcr because the p24 antigen is a different test? Not to question your knowledge as I am young and not entirely educated on the subject but given the fact that I never had p24 antigen testing, the dna pcr and antibody tests are still sufficient to provide me with the same answer you have provided above?
Thank you so much for your help Doctor!
My sincerest regards for the information you provide to all of us on this forum and in reference to HIV :)
I only received the antibody and dna pcr because the p24 antigen is a different test? Not to question your knowledge as I am young and not entirely educated on the subject but given the fact that I never had p24 antigen testing, the dna pcr and antibody tests are still sufficient to provide me with the same answer you have provided above?
Thank you so much for your help Doctor!
My sincerest regards for the information you provide to all of us on this forum and in reference to HIV :)
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