[Question #2092] Hiv 4th gen accuracy

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83 months ago
I have a few question in regards of 4th gen hiv test and transmission of hiv from reciving oral.
My exposure: im a male and I recived oral sex from a femal escort, unknown status.
 I Did not think much about it because I always thought hiv was not a risk from receiving oral.
Unill I started researching online and read that the transmission risk for receiving oral sex is 1 in 20,000. 
Therefor I took a 4th gen hiv test and a RNA hiv test from quest diagnostics at 30 days just for reassurance. Im currently awaiting results.

However I just read one of the question that DR. Handsfield answered in this forum, where he states:
"Actually, I have seen data recently that makes me rethink giving 100% reassurance on the basis of a 4 week result on the 4th generation tests. However, all the experts I'm in touch with are confident the "long tail" doesn't go beyond 6 weeks"

1. How come when you guys state that there has not been a proven hiv case transmission from reciving oral, there still is a 1 in 20,000 chance for transmission to happen?

2. Since I took a 4th gen hiv and a RNA hiv test at 30 days, will I need to take another 4th gen at 6 weeks to be 100% conclusive.
Or am I on the clear from this exposure once I recive results?

3. Just for reassurance, If my exposure would of been a highr risk like unprotected anal sex, would my 4th gen and RNA hiv test that I took been final?

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H. Hunter Handsfield, MD
83 months ago
Welcome to the forum. Thanks for your question.

We have been expecting some questions in response to the recent comments I made about window period for the HIV Ag/Ab (4th generation) blood tests. Yours is the second, although your main concern appears to be the risk of HIV from oral sex. My first comment is that the 6 week window doesn't apply here. You had both a 4th gen test and an RNA test. That combination for sure is conclusive at 30 days (and probably around 20 days). The window period discussion about Ag/Ab testing is valid only when that is the only test done.

To your specific questions:

1) There is no conflict. The CDC estimate of 1 in 20,000 for oral to penile HIV transmission was based on claims of infected people, not proved infection sources. The problem is that most infected people don't really know when and where they were infected. Few HIV infected people have only one or a few possible exposure or source; most have been risky with multiple partners over long periods and really don't know. Others intentionally lie, covering up real risks they don't want to acknolwedge; or they are unaware of real risks, such as a spouse who is secretly gay or an injection drug user. In other words, even claims of catching HIV by receiving oral sex were rare (only 1 in 20,000); and as we have said, there are no known cases that were scientifically proved.

2,3) You will be in the clear when you get your negative 30 day results and would be equally conclusive if you had had a higher risk exposures, such as unprotected anal sex.

I hope these comments are helpful. Let me know if anything isn't clear. Also feel free to post your test results when you have them.

Best wishes---  HHH, MD
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82 months ago
Im reporting back with results.

-Hiv 4th gen combo- none reactive at 30 days

-Hiv RNA- none detect at 30 days.

1. Can I be 100% im not infectd and start a new relationship with out concern from this exposure in regards of hiv?

2. I will be getting tested for syphilis at 6 weeks. Do you recommend another hiv test along with it, at that time from the receiving oral sex exposure?

Thanks again

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H. Hunter Handsfield, MD
82 months ago
1) Your test results are conclusive. The business about the time to conclusive tests, and the possibility that the 4th generation (Ag/Ab, combo) test may not be conclusive at 28 days, applies only when that is the only test done. The  combination of negative RNA testing and 4th gen test at 30 days is absolutely conclusive. You can be 100% certain you were not infected.

2) I see no reason for another HIV test. But you are free to do it if yet another negative result will further reassure you.

I'll also remind you again that in the 30+ years of the known worldwide HIV/AIDS epidemic, there has never been a proved case transmitted mouth to penis. You're not going to be the first.

Does that help settle it for you?