I would appreciate your assessment please. 

21 days after the last time we had intercourse, I had blood taken for a PCR Qualitative test for HIV 1 & 2 RNA. My result was ‘not detected’ for both.

This was (and still is) the only HIV test I have done.

I have read the HealthTap forum and have been surprised to see so many Doctors disagreeing with one another regarding the conclusiveness of the HIV RNA PCR test and its timeframes (I am not sure if this is simply a case of out of date advice or some being ultra conservative). I have become worried about my own circumstances as I would hope there would be a correct answer! 

I have read posts on this forum and see you both maintain that once the HIV RNA PCR Qualitative tests are negative by day 12 after an event, that is the end of the matter and no more testing is needed.

Please can you advise whether I am 100% clear of HIV and at zero risk?

Thank you in advance for your help.

First, you describe a near zero risk exposure for HIV, assuming you're in the US or other industrialized country, and that your friend isn't a sex worker or injection drug user. I would bet that not one person in the US has acquired HIV in a situation like this in the past few years. Well, no more than a small handful anyway. First, HIV is rare in such women. And if present, is never transmitted by oral sex and only once in every 2500 exposure by unprotected vaginal sex.

Second and even more important, your negative HIV PCR RNA test is conclusive -- always conclusive after 11 days or more. It's not that Dr. Hook and I "maintain" that such results are conclusive; that's what the data prove. You are exactly right with "...this is simply a case of out of date advice...." Over the years both the RNA tests themselves and the data on their performance have improved. It was once common advice that it takes longer for conclusive results, but 11 days is now a broad and data-supported consensus. But these conclusions indeed have evolved rapidly, and there are still many online contrary (but wrong) resources that haven't been updated. And it also is true that some sources have conservative, take-no-chances philosophies -- sometimes with an ulterior motive to discourage modern sexual standards.

"Please can you advise whether I am 100% clear of HIV..." Yes you are "...and at zero risk?" Also correct.

I hope this response settles your fears. Let me know if anything isn't clear.

HHH, MD

My friend and I are both from England and she is not a sex worker; or injection drug user (that I am aware of). Unfortunately, she did not agree with testing after these events, hence I am coming to you for the medical guidance.

We had intercourse on 3 occasions total (I gather your ‘zero risk’ assessment remains unchanged?)

1. I can put these events out of my head and not give HIV infection a second thought? 

2. Any further testing is a waste of time as the negative result will not change whatsoever?

3. I can engage in unprotected intercourse with my new GF?

I understand that you and Dr Hook have never been wrong with an HIV question on this forum, therefore your reassurance is greatly appreciated.

Thank you again for your help.

Your numbered questions ask me to repeat myself in different words. The answer to all three is a loud yes!

And it is true that in 21 years, no forum user worried about HIV has turned out to be infected. If and when it finally happens, surely it will from a genuinely risky exposure (think unprotected anal between two men) and will not have atypically negative test results.

I have found out that my friend last had an STI checkup almost 8 months before our encounters. She said that this did not include HIV testing, and was only for Chlamydia, Gonorrhoea and Herpes.

She also said that she was seeing two guys on and off before our encounters (and AFTER this last checkup): each being ‘friends with benefits’ and she slept with each of them a few times.

I guess what I am wondering is if she had slept with either of them 1-2 days before we met, would she have been highly infectious if one of the guys was HIV positive?

Does this additional information change your analysis that I am at zero risk; or is this immaterial? 

Thank you for your assistance throughout. I will be sure to recommend this forum to others.

But all of this is completely irrelevant anyway! Your test results prove you do not have HIV; re-read my previous comments above Therefore, the risk of HIV at the time of possible exposure doesn't matter. You could have told me you had mainlined HIV infected blood and I would give you the same reassurance:  you don't have it.

That concludes this thread; thanks for your kind comments about our services.