Aa
window period
Hello,i would like to ask about the window period..it is so confusing.6 weeks,3 months,6 months?what about the new generation tests..when can we be absolutely confident with our results?
Correct!!
That little paragraph meant a lot to me at the 2 month mark when I received my negative DNA PCR!!
That little paragraph meant a lot to me at the 2 month mark when I received my negative DNA PCR!!
Thanks for the link. I assume you are talking about this.
" Qualitative testing for viral genome serves as a marker of infection. It supplements or substitutes antibody testing for the diagnosis of HIV infection in special situations (such as suspected fresh primary infection: absence of antibodies during the diagnostic window; newborn of infected mother: presence of maternal antibodies - also see below)."
" Qualitative testing for viral genome serves as a marker of infection. It supplements or substitutes antibody testing for the diagnosis of HIV infection in special situations (such as suspected fresh primary infection: absence of antibodies during the diagnostic window; newborn of infected mother: presence of maternal antibodies - also see below)."
I understand you have carried out the HIV-1 Proviral DNA PCR. I assume it is a standard practice that subtypes A through G are looked for in that test. If I recall correctly my result sheet clearly stated subtypes A-G as I remember it looking for 7 subtypes. I am pretty sure there is a world wide standardization for Proviral-1 DNA PCR basic primers.
And moreover, Dude, U really need to start forgetting about PCR's and ELISA's and P24's. You really negative Bro!!!!!
And moreover, Dude, U really need to start forgetting about PCR's and ELISA's and P24's. You really negative Bro!!!!!
You got it!
Keep in mind though, after two months the DNA PCR test is GOLDEN. If you want to determine the validity of your test, I suggest you call them and ask which primers they use. If they state "A through G sir," and your test was at or after two months, then you are as close to 100% as you can get.
Remember, the antibody tests turn positive in over 90% of cases within the first month. There is absolutely no need for this test in the general population. Scientific research has proven the course of early infection, with viremia levels skyrocketing in the first few weeks, then declining with development of antibodies. This is fact. The only reason there is still speculation about the window period is because of the VERY FEW individuals who took longer than three months when outdated and obselete testing was used. How many times have you read that antibody testing has improved, the window period does not exceed 3-5 weeks, 6 weeks is conclusive, 13 weeks is more than sufficient, and so forth. The problem is mental. It is completely irrational and unreasonable to doubt these statements during this day and age and is most often linked to some underlying disorder such as guilt, anxiety, shame, etc.
The Dr. of this site does his best to reassure the worried well with his numbers and unfortunately the individuals he is trying to assure, focus on the ONE in a, instead of the last number 2000000. Try to be rational here, you know the facts, listen to them and get your antibody test at 6 and 13 weeks and rejoice when you have learned the real lesson involved.
Try reading the post by DR. Gallant from Hopkins about the difficultly rationalizing with the worried well. It definately puts things in perspective.
I or nobody else can ever tell you that you are not infected. Nobody can truly tell you that. That is a decision you will have to make one day! Hopefully my friend, rationality will take over and you make that decision sooner than later!
PEACE!!!
Keep in mind though, after two months the DNA PCR test is GOLDEN. If you want to determine the validity of your test, I suggest you call them and ask which primers they use. If they state "A through G sir," and your test was at or after two months, then you are as close to 100% as you can get.
Remember, the antibody tests turn positive in over 90% of cases within the first month. There is absolutely no need for this test in the general population. Scientific research has proven the course of early infection, with viremia levels skyrocketing in the first few weeks, then declining with development of antibodies. This is fact. The only reason there is still speculation about the window period is because of the VERY FEW individuals who took longer than three months when outdated and obselete testing was used. How many times have you read that antibody testing has improved, the window period does not exceed 3-5 weeks, 6 weeks is conclusive, 13 weeks is more than sufficient, and so forth. The problem is mental. It is completely irrational and unreasonable to doubt these statements during this day and age and is most often linked to some underlying disorder such as guilt, anxiety, shame, etc.
The Dr. of this site does his best to reassure the worried well with his numbers and unfortunately the individuals he is trying to assure, focus on the ONE in a, instead of the last number 2000000. Try to be rational here, you know the facts, listen to them and get your antibody test at 6 and 13 weeks and rejoice when you have learned the real lesson involved.
Try reading the post by DR. Gallant from Hopkins about the difficultly rationalizing with the worried well. It definately puts things in perspective.
I or nobody else can ever tell you that you are not infected. Nobody can truly tell you that. That is a decision you will have to make one day! Hopefully my friend, rationality will take over and you make that decision sooner than later!
PEACE!!!
Sorry, wrong link within the website:
This is it:
http://hivmedicine.com/textbook/testing.htm
3/4's of the way down it will talk about qualitative genome tests as a marker of infection. This is another way of saying DNA PCR.
By the way, it talks about the window period too. This is the updated 2006 version.
This is it:
http://hivmedicine.com/textbook/testing.htm
3/4's of the way down it will talk about qualitative genome tests as a marker of infection. This is another way of saying DNA PCR.
By the way, it talks about the window period too. This is the updated 2006 version.
Thanks for the information mpo131. This info has been really helpful. If I remember correctly, the test did cover A-G. Take care....
My PCR result reports don't say anything about the primers used.... I called Quest Diagnostics and the representative did not know.... Such is life....
So, if what I have understood about DNA PCR from what you have mentioned above is, it seems DNA PCR is pretty useless test to take for early detection as its reliability is not even known in 1st month. Also, keeping that in mind, it would be a good judgement to make that P24[& obviously RNA PCR] test is better equipped for early detection of HIV-1 than DNA PCR.
Reference from medhelp sexually transmitted disease forum:
User name: testing
Date posted: 11/27/2005
Thread Subject: HIV Testing
User name: testing
Date posted: 11/27/2005
Thread Subject: HIV Testing
I saw the article. It did not see anything regarding DNA PCR being called the marker for HIV. they talk about HIV-1 RNA and all but did not find any information on DNA PCR. Also, as you say, it may be marker for infection but what will be termed as a time to take it so the results are somewhat reliably. I have even in one of Doc H's old replies few months ago seen him mentioning that DNA PCR, if at all needs to be used should be used between day 7 and and day 20 as after that antibodies start appearing and ELISA starts becoming equally sensitive. Please correct me if I stand wrong in my assumptions.
Take a look at this link:
http://hivmedicine.com/textbook/acuteinf.htm
I believe this is a prestigious source, and it says that the DNA PCR is a marker for infection. I believe in that statement.
http://hivmedicine.com/textbook/acuteinf.htm
I believe this is a prestigious source, and it says that the DNA PCR is a marker for infection. I believe in that statement.
This is indeed a good place to share knowledge and thanks mpo131 for such a detailed view on PCR testing. I got 2 Proviral DNA PCR's done at 3 weeks and 2 months. Do you guys think they hold much value.
I appreciate mpo's posts as well. They are very informative. I think I undersood the tests relatively well, but mpo made some of the points that I was uninformed about much more clear to me. Thanks!
If this topic were not so worrisome, it would be really interesting... ;)
If this topic were not so worrisome, it would be really interesting... ;)
I am very impressed with your knowledge, and, in general, with this NEW forum. I believe, it gives many of us another avenue to vent. I, myself, am going to have to gradually "wean" away from this HIV stuff; as it has been on my mind pretty much 24/7 for the last 6 months. I am free and healthy, and I AM going to take it!! Thanks for your expertise and guidance, and confirmation that the PCR test, if taken correctly for the RIGHT reasons and timing, IS a diagnostic marker of infection. No one of authority outside of a few sites I have explored will go there. Take care.
The DNA PCR is used right away during rape investigations because viral replication does not peak until 2 weeks after infection. (1000000 copies per ML). The DNA PCR does not rely on free virus in plasma but in resting cells and like you stated can detect HIV at even lower levels than the HIV RNA PCR.
Therefore, if you tested a rape victim and recieved a reading of <50 or even 349 copies, what does that tell you? Nothing really. So in this scenario, testing during the first week after exposure, the DNA PCR would provide more information. However, if you tested that individual at two-three weeks during suspected ARS, the RNA PCR would be more valuable. Contrary to what you have heard or read, I can assure that the RNA PCR is the better test during ARS.
The published report by the CDC concerning the porn industry just echoes what I've been saying. If this test was missing infections during the first month, than what good is it? You can find hundreds of research conducted on this DNA test with conflicting results DURING the first month. Anything from 30% to 93%.
So, testing just after infection with the DNA PCR is provides more knowledge because the viremia level has not peaked. Compare the two possible results at this time from the different tests and the DNA would be better. Yet still inconclusive. However test during the 2nd or 3rd week after infection and the result of the RNA PCR would provide better information if HIV infection is present.
Therefore, if you tested a rape victim and recieved a reading of <50 or even 349 copies, what does that tell you? Nothing really. So in this scenario, testing during the first week after exposure, the DNA PCR would provide more information. However, if you tested that individual at two-three weeks during suspected ARS, the RNA PCR would be more valuable. Contrary to what you have heard or read, I can assure that the RNA PCR is the better test during ARS.
The published report by the CDC concerning the porn industry just echoes what I've been saying. If this test was missing infections during the first month, than what good is it? You can find hundreds of research conducted on this DNA test with conflicting results DURING the first month. Anything from 30% to 93%.
So, testing just after infection with the DNA PCR is provides more knowledge because the viremia level has not peaked. Compare the two possible results at this time from the different tests and the DNA would be better. Yet still inconclusive. However test during the 2nd or 3rd week after infection and the result of the RNA PCR would provide better information if HIV infection is present.
I am very glad to hear you say that. The sooner you cease in visiting these forums and typing HIV in the google box, the sooner you will feel better. In fact, you might just get to the point where the only thing you remember from this 6 months of complete HELL is that condoms must always be used.
Good luck in whatever you do, and ENJOY every waking minute of your new lease on life.
Good luck in whatever you do, and ENJOY every waking minute of your new lease on life.
Another issue with viral load test.
http://www.thebody.com/cgi-bin/bbs/showthreaded.php?Cat=&Board=testpos&Number=172601&page=&view=&sb=5&o=
However, I am not sure if viral load tests are same as DNA/RNA PCR. I assume it is Quantitative RNA PCR.
This pretty much tells that ELISA is truly the gold standard.
http://www.thebody.com/cgi-bin/bbs/showthreaded.php?Cat=&Board=testpos&Number=172601&page=&view=&sb=5&o=
However, I am not sure if viral load tests are same as DNA/RNA PCR. I assume it is Quantitative RNA PCR.
This pretty much tells that ELISA is truly the gold standard.
I certainly understand your concern after such an experience. The DNA PCR test after two months is as close to perfection in the medical community as any test out there. Evaluating your case, there is just no concievable way you are infected. NONE.
Given the multiple antibody tests out to 6 months, and the multiple DNA tests, and your one SINGLE POSSIBLE exposure to the virus equals 0 chance. They only thing keeping you hanging on is the symptoms to which you already have an answer. MONO.
As far as Dr. Daar, he is only one doctor that would consider further testing out to six months or a year. In fact, I believe that suggestion takes into account PEP and does not consider viral assays. Take Dr. Holidny for example. He has stated numerous times that the DNA PCR after one month is equivalent to an antibody test at 3 or 6 months. This is especially before 2003 when he decided that commenting on these tests were actually doing more harm than good--individuals wasting time and resources in turn increasing costs after recieving blow jobs. Even "doctor bob" who refuses to against the CDC states that false negatives are not a problem with this test and also stated he agrees wholeheartedly with Mass. testing policy. Also, Dr. HHH and Massachussetts state SIX weeks for heaven's sake.
It's frustrating to you because you are making it that way. HIV tests are very solid. Instead of focusing on the invalidated claims from individuals, focus on what the informed doctors and health organizations state.
Take care Ronnie and whatever is ailing you, rejoice in the fact it is not HIV. PEACE!!!!
Given the multiple antibody tests out to 6 months, and the multiple DNA tests, and your one SINGLE POSSIBLE exposure to the virus equals 0 chance. They only thing keeping you hanging on is the symptoms to which you already have an answer. MONO.
As far as Dr. Daar, he is only one doctor that would consider further testing out to six months or a year. In fact, I believe that suggestion takes into account PEP and does not consider viral assays. Take Dr. Holidny for example. He has stated numerous times that the DNA PCR after one month is equivalent to an antibody test at 3 or 6 months. This is especially before 2003 when he decided that commenting on these tests were actually doing more harm than good--individuals wasting time and resources in turn increasing costs after recieving blow jobs. Even "doctor bob" who refuses to against the CDC states that false negatives are not a problem with this test and also stated he agrees wholeheartedly with Mass. testing policy. Also, Dr. HHH and Massachussetts state SIX weeks for heaven's sake.
It's frustrating to you because you are making it that way. HIV tests are very solid. Instead of focusing on the invalidated claims from individuals, focus on what the informed doctors and health organizations state.
Take care Ronnie and whatever is ailing you, rejoice in the fact it is not HIV. PEACE!!!!
mpo: Thanks for your comments by the way. Regarding these discussions in general, I just find it so frustrating that there is not/are not more definitive tests for this virus in general. There seems to be so much uncertainty with this virus. It is very frustrating and, to be honest, scary for someone who is worried about possible infection.... While I appear to be not infected, every so often I read comments from learned HIV physicians on the web mentioning in passing testing out to long lengths of time (like a year) and it just makes me so worried..... Dr. Daar on thebody for example is an HIV expert who has studied the window period and early infection and he is extremely cautious in his advice about testing guidelines, and he works with this virus every day. Such is life...
Maybe I did not read the earlier posts in this thread so maybe we are talking about two different points. From what I have read, it seems that before one month neither test is particularly proven. All testing sites where a PCR DNA test is offered state that it is not entirely accurate before 4 weeks. That being said it is used to test rape victims around 24 hours after possible exposure or less. If the only point you were making was which test was better before a month's time, then you are that makes some sense from what I have read. After one month, it seems that the PCR DNA test is always the better diagnostic test.
I would wonder though, if your arguments are entirely set in stone why the more expensive DNA test is used in the situations I noted (rape investigations, newborns and adult entertainment industry). Apparently the very learned people and doctors in those relams of expertise made a decision on which test to use, and the decision was not an RNA test for diagnosis but instead the DNA test. I can see with newborn because the month issue is not a factor, but the other two would seem to warrant an RNA test by your arguments, but that is not what is used in practice.
I would wonder though, if your arguments are entirely set in stone why the more expensive DNA test is used in the situations I noted (rape investigations, newborns and adult entertainment industry). Apparently the very learned people and doctors in those relams of expertise made a decision on which test to use, and the decision was not an RNA test for diagnosis but instead the DNA test. I can see with newborn because the month issue is not a factor, but the other two would seem to warrant an RNA test by your arguments, but that is not what is used in practice.
Ronnie,
First I want to ask how you are doing? I have followed your posts for awhile and certainly sympathized with you and that harrowing experience. I am glad to have learned that you finally tested negative. Congratulations!
Now, I must say that I am bit surprised at your claims after the many extensive hours I am sure you have spent researching this topic. I can only assume that you have misunderstood something, or did not read all the posts. Therefore, I will clarify again.
The DNA PCR sensitivity is unknown before one month, and does not exceed 96% at one month in MOST cases. After or at two months the sensitivity is 100%. I refer you to an easy to understand published account conducted by the state of New York from 2001-2003. The state used the DNA PCR in diagnosing newborns. Over 1000 newborns-strong enough to make a case. As you will see, there were a considerable amount of false negatives up until six weeks, most occuring in the first 14 days of life. After I believe 72 days none were noted.
The RNA PCR is has more diagnostic value in the first few weeks of infection, not after. After ~25 days, the antibody test or a DNA PCR would be more valuable. I am sure that you are aware that viremia IN THE BLOOD in MOST cases, somewhere around 95%, skyrockets during primary infection, first three weeks. Now, thinking as a doctor, knowing these facts-1. a DNA PCR's sensitivity is unknown before one month, can give false positives, and only yeilds a yes or no answer. and 2. an RNA PCR's sensitivity during primary infection reaches in the 90% range and yeilds a quantitative result, i.e. 750,000 copies per milliliter, which gives 100% specificity. Which one would you conduct in the first few weeks. Especially considering the outbreak in the porn industry, where the individual tested negative after being infected. Neither of these tests rule out infection, they must all be confirmed with an antibody test. But when using an quantitative assay during primary infection and recieving a result reaching in the hundreds of thousands, certainly one can assume a patient is infected or reasonably rule in HIV infection. Why use a DNA PCR when the sensitivity before one month is not known and you only recieve a yes or no answer? Why not use an RNA PCR, which when reaching a result of let's say 1,000,000 copies per mL, you can reasonably rule in HIV infection. If a DNA PCR test comes back positive, how confident are you with that result compared with the RNA PCR result mentioned above. I implore you to read the studies conducted on a DNA PCR where they conclude that a positive DNA PCR should be approached with caution.
Granted the false positive rate is high, but they are USUALLY in the very low range.
I am fully aware that the DNA PCR is overall more diagnostic for newborns, or individuals with indeterminate test results. However, when initially positive, a second test must always be carried out. Also, if negative, the test must be confirmed at a later date. For newborns, one at birth, one at one month, one at four months, before a newborn can be REASONABLY considered HIV negative. DEFINITIVELY requires a negative antibody test at 18 months. For an adult with repeat indeterminate results, two negative DNA tests must be used to
diagnose.
First I want to ask how you are doing? I have followed your posts for awhile and certainly sympathized with you and that harrowing experience. I am glad to have learned that you finally tested negative. Congratulations!
Now, I must say that I am bit surprised at your claims after the many extensive hours I am sure you have spent researching this topic. I can only assume that you have misunderstood something, or did not read all the posts. Therefore, I will clarify again.
The DNA PCR sensitivity is unknown before one month, and does not exceed 96% at one month in MOST cases. After or at two months the sensitivity is 100%. I refer you to an easy to understand published account conducted by the state of New York from 2001-2003. The state used the DNA PCR in diagnosing newborns. Over 1000 newborns-strong enough to make a case. As you will see, there were a considerable amount of false negatives up until six weeks, most occuring in the first 14 days of life. After I believe 72 days none were noted.
The RNA PCR is has more diagnostic value in the first few weeks of infection, not after. After ~25 days, the antibody test or a DNA PCR would be more valuable. I am sure that you are aware that viremia IN THE BLOOD in MOST cases, somewhere around 95%, skyrockets during primary infection, first three weeks. Now, thinking as a doctor, knowing these facts-1. a DNA PCR's sensitivity is unknown before one month, can give false positives, and only yeilds a yes or no answer. and 2. an RNA PCR's sensitivity during primary infection reaches in the 90% range and yeilds a quantitative result, i.e. 750,000 copies per milliliter, which gives 100% specificity. Which one would you conduct in the first few weeks. Especially considering the outbreak in the porn industry, where the individual tested negative after being infected. Neither of these tests rule out infection, they must all be confirmed with an antibody test. But when using an quantitative assay during primary infection and recieving a result reaching in the hundreds of thousands, certainly one can assume a patient is infected or reasonably rule in HIV infection. Why use a DNA PCR when the sensitivity before one month is not known and you only recieve a yes or no answer? Why not use an RNA PCR, which when reaching a result of let's say 1,000,000 copies per mL, you can reasonably rule in HIV infection. If a DNA PCR test comes back positive, how confident are you with that result compared with the RNA PCR result mentioned above. I implore you to read the studies conducted on a DNA PCR where they conclude that a positive DNA PCR should be approached with caution.
Granted the false positive rate is high, but they are USUALLY in the very low range.
I am fully aware that the DNA PCR is overall more diagnostic for newborns, or individuals with indeterminate test results. However, when initially positive, a second test must always be carried out. Also, if negative, the test must be confirmed at a later date. For newborns, one at birth, one at one month, one at four months, before a newborn can be REASONABLY considered HIV negative. DEFINITIVELY requires a negative antibody test at 18 months. For an adult with repeat indeterminate results, two negative DNA tests must be used to
diagnose.
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