[Question #12071] 4th Gen and RNA Test accuracy
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10 months ago
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I had two separate acts of unprotected insertive oral sex with the same sex worker twice in the span of three days. The first incident involved insertive oral followed by me getting rimmed back to unprotected blowjob untill completion, while the second one was just an unprotected blowjob to completion. I got a 4th generation test at 37 days post exposure that came back negative and then an RNA test 41 days post exposure that also came back negative. Is this conclusive? Are RNA tests accurate at 41 days post exposure? Should I re-test and when? I'm concerned because my partner and I had unprotected sex three weeks after my last exposure and now three weeks later they've developed a rash that started at their chest and rapidly spread to their thighs, upper arms, stomach+back and is seemingly slowly progressing down their legs+arms.
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Edward W. Hook M.D.
10 months ago
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Welcome to our Forum. Thanks for your questions. I'll be glad to provide some information.
Most experts consider HIV RNA PCR tests conclusive any time more than 11-12 days following an exposure although some suggest confirming those results with a 4th generation, combination HIV antigen/antibody test at some time more than 4 weeks after an exposure. You have done both. Your results are conclusively negative, proving that you do not have HIV. There is no need for concern and no need for further tests.
Also, for your information, the encounters you describe were virtually no risk for HIV. There are no proven cases of HIV which have been acquired from receipt of oral sex, including rimming.
Your sex with your partner did not put her at risk. You will need to look for another cause for the rash you have noticed- you have proven you do not have HIV. EWH
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10 months ago
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Got it, so just to confirm my RNA test at 41 days was accurate? I've had conflicting things told to me by different people. One said they become less accurate after the 10-33 day window period. Then also when does a 4th generation test become conclusive? I'm thinking about doing one final test to put my mind at ease.
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10 months ago
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One other thing. Is it true that Antibodies sometimes take up to 3 months to produce? Would this have impacted my RNA test? Could I be infectious while negative on an RNA test?
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Edward W. Hook M.D.
10 months ago
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Among untreated persons the accuracy of HIV RNA PCR does not decline with time. There is much misinformation on the internet on this topic. your two negative tests prove that you were not infected.
Similarly, anyone who states that antibodies may take more than 8 weeks to develop is mistaken. Sound like more internet misinformation.
4th generation test for HIV become completely reliable at 6 weeks (42-45 days).
I am confident you have not been infected with HIV in the exposures you describe. EWH
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10 months ago
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Ok, thanks for the information. I'm very anxious, so I'm just gonna ask a few more questions but not to the point of irritation. I want to do one more test for peace of mind and want to know; would my results be more accurate at 45 days exactly or should I wait a few days later? Also do RNA tests measure ones viral load? If so testing non reactive on that would confirm i'm not infectious right? Can you test negative and still be infectious?
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Edward W. Hook M.D.
10 months ago
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As you know, we provide up to three responses to each clients questions. These will be my final responses. Following that, the thread will be closed and there should be no need for you to return.
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It makes no difference when you test beyond 45 days. A negative test cannot become more negative and tests do not become positive beyond that time frame.
Diagnostic HIV PCR tests are qualitative and tell you whether or not the virus is present. Persons with negative PCR tests have no virus present and cannot transmit HIV to others. You cannot test negative on a HIV PCR test and infect others.
I urge you to be confident that you did not acquire HIV encounter you describe. This completes this thread. EWH