I would appreciate your comments. 

Our relationship involved multiple instances of unprotected penis-vaginal intercourse and oral sex. 

My partner assured me that she was clear of STI’s, however for irrelevant reasons to this forum, I have major trust issues.

21 days after the last time we had sex, I had an HIV Qualitative RNA PCR test. The blood was taken at my home and sent to the lab, and I got my result within 24hrs.

My result returned ‘not detected’ for both HIV 1 and 2. 

My report states: “Sample provided does not contain the specified organism/s /target OR number of Nucleic acid copies are below the detection limit of the assay”

The clinic said that there is nothing to worry about and the result is 100% accurate, however the latter part of this paragraph has concerned me.

Please can you confirm whether:

1. I am definitely at no risk of HIV

2. I do not need any further HIV testing (the RNA PCR is the only one I have done)

3. I can move on with my life without any worry

Thank you for your time.

Heterosexually transmitted HIV is rare in the UK. I don't know what to make of "trust issues" about your partner. That you had unprotected vaginal sex doesn't necessarily put you at risk for HIV; and oral sex never transmits the virus, or so rarely the possibility can be ignored. Perhaps most important for reassurance, your negative RNA PCR test result proves you do not have HIV (unless exposed within 10-11 days before the test). "Below the detection limit" means no virus is present, period. For those reasons, I agree exactly with the advice you had from the clinic.

Those comments cover your three questions, but to be explicit, all three statements are exactly correct. I'm glad to see you understand!

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

Thank you for your analysis.

The ‘trust issues’ relate to my partner seeing another man during the relationship, which is why I ended it. I wanted to be sure I was clear of HIV as this is tested as part of my employment.

I had zero sexual encounters from the final date we had intercourse, to the day I had my blood taken for the RNA PCR (21 days: almost 22 days).

I (naively) read a post online that the RNA Qualitative PCR’s lack effectiveness if they are done 21-28 days after a final encounter (not sure if this is out of date or just untrue), hence I wanted to seek reassurance from yourself and Dr Hook as I now know you guys are the best in the field and have never been wrong with an assessment.

My follow up questions are:

1. When I am tested for my employment visa later this year, my HIV result will be negative? (i.e no chance this ‘not detected’ result will turn positive).

2. My only sexual encounter since these unprotected exposures 5 months ago has been deep / tongue kissing with a girl I was dating (I did not ask about her HIV status). No risk event? 

3. I can begin unprotected sex with my current gf?

4. Does it matter that blood was taken at my home and not at the lab directly? (i.e nothing can affect the specimen which could lead to my result being a ‘false negative’).

Thank you for your help.

1. Assuming no new exposures, any future HIV tests you have will be negative.

2. Yes, this was a risk free event.

3. From an HIV standpoint, there is no reason not to have unprotected sex with your new partner.

4. The HIV tests are very robust and not affected by the manner, time, or place of blood collection; or by specimen transport to the laboratory for testing.

I work in MENA and I am therefore tested every 2 years for HIV as part of my visa renewal.

Overall: “move on, everything is fine and stop thinking about HIV. There’s no chance you have it” ?

Thank you for offering this service and the time you have taken to help.

Your summary statement is perfect. Thanks for your kind words; I'm glad to have helped.