[Question #10104] A few HIV testing questions

25 months ago

Hello doctors! Thanks for your time. I had a few testing questions for you. All my tests are performed thru Quest Diagnostics

1. Generation 4 Antigen/Antibody test- I read the test guide/algorithm and it states that if a result is positive they will do a confirmation/supplemental test to determine between HIV 1 or 2. Now if lets say someone has a positive antigen/antibody test, but a negative confirmation/supplemental test is it reported as negative for both? Or will it show positive generation 4 test but negative confirmation/supplemental test? Does the machine just spit out the results as they are? Or can it be changed by the lab.

2. PCR Pro-Viral DNA- it states "HIV-1 DNA, Qualitative, PCR - HIV-1 DNA PCR is a sensitive method for detection of pro-viral DNA. It has been used in the management of perinatal HIV infection". Does this mean the test is not accurate/reliable for adults?

Thanks!

Edward W. Hook M.D.

25 months ago

Welcome to the Forum. Thanks for you questions. I'll be glad to comment. I happened to be on the Forum when your questions arrived so you are getting a response somewhat more quickly than is the norm. Any follow-up questions may take longer to receive a reply.

It sounds like you have questions about the accuracy of test results. I hope not as these tests have been scrutinized like no other tests in modern medicine and, as a result, when performed as recommended provide highly reliable results. In response to your questions:

1. Persons with a positive 4th generation test at Quest are then evaluated first using a test to distinguish antibodies to the two viruses. If this test is indeterminant, then a PCR test for HIV-1 is performed. Results would be reported out as either HIV-1 or HIV-2, not as negative.

2. There are several HIV PCR tests, one is qualitative, one is quantitative. The qualitative test is accurate and used for HI diagnosis in both adults and newborns. The quantitative test could be used for diagnosis but is typically used to for persons on HIV therapy to measure response to therapy.

If you have specific questions about the accuracy of your tests, please ask. Otherwise, have confidence in the results of tests done at the appropriate time at Quest- the lab is highly reliable and respected. EWH

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25 months ago

Thanks for the reply! So I probably didn't explain it well enough. If someone has a positive gen4 test, but a negative supplement test. Is the result on paper a negative? Or on paper does it show positive gen 4, negative supplement/confirmation test? If someone had false positive gen 4 test, but negative supplement/confirmation test are they aware of that? I hope that question is a tad bit more clear (sorry). As far as the PCR, I was referring to the DNA PCR (pro-viral) on the site it says its for perinatal or children up to 18 months. Does this mean its not good/accurate for adults?

Edward W. Hook M.D.

25 months ago

If the 4th generation test is positive and then the supplemental algorithm testing is negative, the results of the 4th generation test are still reported. In such cases, which are extraordinarily rare, the person should then seek in person evaluation by a specialist.

Regarding the PCR tests, as I said in my original reply, "The qualitative test is accurate and used for HIV diagnosis in both adults and newborns. " Thus it IS good and accurate for adults.

You indicate you have been tested. I presume the test results have been negative. If so, I urge you to believe them. EWH

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25 months ago

Thank you! Yes I had a PCR DNA (pro viral), a PCR RNA (quantitative) and two generation 4 tests. They were 6 months (gen 4 and PCR DNA) and 1 year (gen 4 and RNA) all were negative/not detected/not reactive. But I had some weird symptoms around 7-8 weeks after my possible exposure. Unprotected vaginal sex with a woman of unknown status. I also drank a coffee and the lid (where you were to sip) looked like it might have had blood (or something) on it.

Thanks for your reply!

Edward W. Hook M.D.

25 months ago

Final answers.

Thanks for the additional information. You can complete confidence in your test results. You have now been tested three ways (for antibodies, for viral proteins (antigen) and for viral nucleic acids) without evidence of infection. There is simply no way that your symptoms could have been due to HIV or that you were infected through either of the exposures you describe.

You can move forward with confidence. No need for continuing concern. No need for additional testing. EWH

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25 months ago

Thanks so much! One last question (if you don't mind) was the sipping a coffee/coffee cup with potential blood even a risk? I see a lot of different answers online (probably not the best method)

Edward W. Hook M.D.

25 months ago

It was no risk.

Thread is over. EWH

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