[Question #13607] POST PEP RNA TESTING & oral
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6 days ago
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Edward W. Hook M.D.
5 days ago
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Welcome back to the Forum. Thanks for searching for information. I'm sorry what you found was not reassuring. If you have been searching other sites, I anticipate that you may have sound other, somewhat (but not very different answers to you questions/concerns). Different sources may not tell you the basis of their recommendations and there is variability from site to site on how different sources express their assessments. For instance, as a government source, the general approach of the CDC is that they cannot "afford" to EVER be wrong, particularly when data are limited and as a result, on occasion CDC recommendations tend to be among the most conservative. Our assessments and explanations are based on our study of the scientific literature including assessment of the quality of the studies making recommendations. We supplement this information with regular consultation with expert colleagues. With this background, I'll go to your questions:
1) Is the recommended post PEP completion testing for RNA now 11 days conclusive? I have read statements of 14 days, 11-12 days, 11 days from various posts. I was thinking I had to wait 6 weeks to test 4th generation Duo?I tested RNA at 10 & 17 days post PEP completion - not detected. And 17 days post PEP DUO- Not detected. Is this conclusive? Exposure was unprotected vaginal intercourse with an asian woman in massage parlor of unknown status.
Response. Dr. Handsfield has previously explained to you any risk of HIV, even without PEP was close to zero. I will not repeat that, Regarding PEP follow-up, data are limited as PEP is highly effective and thus determining when results are conclusive might be debated. That said, PCR tests have gotten progressively more sensitive and there is general agreement that when persons acquire HIV, PCR tests are positive within 11 days of exposure. Our results are based on these data. Similarly high quality studies are quite clear that DUO tests are always positive within 42-45 days of exposure. These data are solid and probably, if anything somewhat conservative. We have never seen nor heard of someone who acquired HIV who have positive tests beyond the time frames I mention.
2) I had a further exposure 9 days ago - unprotected cunnlingus at asian massage parlor. I mostly licked near her clit and did not go down further towards her vaginal opening. I have read that this is low risk but not NO RISK. I wasn't worried much about this exposure because of the low risk until I started feeling sick on Tuesday (5 days post event) - woke with a very sore throat, aching lymph nodes in groin, headache, and gastrointestinal pain / discomfort - very loud grumbling and upset and no appetite. The gastrointestinal pain has lasted from Tuesday to today (6 days) so far.Could this be HIV taking its course starting with my stomach from oral exposure?
Response. Dr. Handsfield has already explained to you both that cunnilingus is a close to no risk exposure in the unlikely circumstance that your causal partner has untreated HIV. I will not repeat that. He has also explained to you why persons with symptoms from recently acquired HIV ALWAYS have positive tests. I will not repeat that either.GI pain is an uncommon manifestation of recently acquired HIV and that persons with symptoms due to HIV always have positive tests.
Bottom line- you are worrying more than you need to. You do not need further testing. Please don't worry. EWH
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5 days ago
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Thank you for this Dr Hook.
To clarify, Dr Handsfield misread my initial message as me stating that I had condom protected vaginal sex, when it was unprotected vaginal sex with an asian massage parlor female, so the exposure was LOW RISK instead of CLOSE TO ZERO risk (although it didn't change his recommendation?). I found this strange since condom vs no condom vaginal sex would logically come with substantially differing risk?
Also, to clarify, I have not had a new test since the unprotected cunnlingus exposure 10 days ago.
1) Can you please confirm that my 17 days post PEP completion RNA test was sufficient from my initial exposure and no further testing is required from the unprotected vaginal sex exposure?
2) Can you please confirm if you recommend a test from the unprotected secondary cunnlingus exposure in asian massage parlor from 10 days ago? I understand that it is classified as very low risk exposure but with recent symptoms, is testing recommended to be certain? If so, would RNA text tomorrow (11 days post exposure) suffice? I have a Oraquick antibody test with me, would that be positive at this point if I have symptoms? Or since it is only antibody, would I need a RNA or 4th generation test this early? I know that you state that tests are always positive when symptoms present, even the Oraquick? I understand that symptoms are antibodies VS virus in the body but based on window periods, evidence seems to suggest its too early for antibodies to be detectable, particularly with Oraquick which can miss up to 5%ish of infections.
Thank you for your time on this.
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Edward W. Hook M.D.
5 days ago
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As I said, I read your earlier interaction with Dr. Handsfield- all of it, and agree with his assessment. Your risk for HIV was substantially less than a fraction of 1% even before you took PEP. Your 17 post PEP result is conclusive. I urge you once again to believe it.
Regarding your subsequent exposure and repetition of your question, my assessment is unchanged. Your risk from this activity is also virtually zero (I trust you won't quibble about how small a fraction of a fraction of 1% it is) and see no need for testing. That said, testing is ALWAYS a personal choice and given your anxiety, I anticipate you are likely to test. If you do, the results of an HIV RNA PCR OR a 4th generation test will almost certainly be negative, proving that your symptoms are NOT due to HIV. An Oraquick is a less reliable test.
EWH
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1 days ago
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Good morning Doctors,
I am in total panic mode. I just received a note in my Medical testing portal that my HIV RNA test conducted on Tuesday was undergoing "confirmatory testing."
My 2 previous RNA tests came back within less than days (test Monday, results Wednesday morning).
This test was done Tuesday morning and then this message today (Friday) saying undergoing "confirmatory testing."
I tried messaging / calling to find out status but they only have a service where you can text with someone and all that they will tell me is that I need to wait for the lab to complete the testing.
The testing was done at Labcorp and portal is STD.com.
I did both an RNA & 4th generation test this past Tuesday the 2nd. The 4th generation results came back really quickly on Wednesday as negative.
Reminder about the exposure - cunnlingus with Asian massage worker 11 days prior to testing.
I know that you stated that testing wasn't even necessary from this exposure but now I'm in total panic as it sounds like the test picked up something that they are doing confirmatory testing?
I was initially concerned by my symptoms, which is why I tested so the negative 4th generation is reassuring since you said that no 4th generation test can be negative when symptoms are present?
That said, 11 days is before window period for 4th generation test. Only RNA would pick it up, is that correct?
I am a total wreck and trying to review what you said statistically about chances of oral transmission - 1 in 10,000 if HIV is present?
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Edward W. Hook M.D.
1 days ago
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I'm sorry that your result is concerning. My assessment and the statistics I provided are unchanged and I cannot comment on why your test might be undergoing "confirmatory testing". Normally the thread would be closed now but I will keep it open so you can share the results of your confirmatory testing. As I said, since symptoms are due to the interaction of antibodies to HIV and the antigen, negative 4th generation tests, which test for both antigen(the virus) and antibodies to the virus are always positive in persons with symptoms. In asymptomatic persons tests may take up to 6 weeks to become positive. I wish I had a better answer but you will need to wait for the confirmatory testing which I anticipate will show that you do not have HIV. Please share your results when they become available. EWH---