[Question #2117] Follow-Up To Question #1507

45 months ago
Dr. Handsfield and Dr. Hook - I had asked my question on confirmation/trust in my tests results back in December for 2 encounters I had in August 2016 as documented in Question #1507.  After seeing Dr. Handsfield's recent reply around moving away from a 4 week 4th gen HIV test being conclusive, I wanted to see if that impacted the assessment I was given back in December 2016.

In another reply (Question #2092), the person asking the question is in a similar boat as I am.  I took a 4th gen HIV test, along with tests for chlamydia, gonorrhea, herpes, and syphilis, and an RNA test (called HIV Early Detection test by Stdcheck.com) - all of which were negative, except for chlamydia which I was treated for via antibiotics.  Since those two encounters in August 2016, I have no no other risky encounters and have been entirely faithful to my wife.

In Dr. Handsfield's reply, he mentions that the combination of the 4th gen test and the RNA test is absolutely conclusive at 30 days - in my case it was 29 days.  So, do I need to do another 4th gen test or can I breathe easy knowing that the combination of the 4th gen and RNA tests I took back in late August are conclusive?
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Welcome back to the Forum.  I'll be happy to comment.  As you note and can imagine, the new data that a very few persons who acquire HIV may still have negative combination HIV antigen/antibody tests beyond 4 weeks has been disconcerting for many of our clients.  These data however to not change the fact that you would have had a positive HIV RNA test well before day 29 and thus you can still have absolute confidence in your test results and do not need further testing.

As an FYI for you and other readers, these recent data are still evolving but neither Dr. Handsfield nor I am aware of any patients, either of our own or form other colleagues, who have had positive combination tests which did not become positive by day 28 and from this, as well as the lack of additional reports would suggest that this event is very, very rare and for nearly everyone, a 4 week combination HIV antigen/antibody test should be considered proof that they were not infected. 

I hope this comment is helpful.  Certainly no need for you to test further- have confidence in your earlier test results. EWH
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45 months ago
Thanks so much for the reassurance Dr. Hook! If you don't mind - would you be open to looking the discussion between myself and Dr. Handsfield in #1507 and giving me your feedback? This isn't that I don't trust what Dr. Handsfield said (in fact, it's what gives me confidence that I'm disease free!), it's more to get further corroboration that I'm golden from a testing perspective.
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Actually, I reviewed your earlier interaction before I responded.  I agree entirely with the information he provided then, other than the issue of newer information relating to the combination test performance which I discussed above.  That was part of the reason for my confidence in my reply.  EWH
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45 months ago
Dr. Hook - Thanks for the reading my prior discussion with Dr. Handsfield and for your further reassurance in my test results - my apologies for assuming you had not.  I'll readily admit that I've had bouts of doubt over the last few months since my initial question in December 2016, but have regained confidence in them, especially since you make it clear that the RNA test I took is without a doubt conclusive given when I took it, and had I been infected, this test would've indeed been positive at that time.

So glad I can breathe easy knowing that the combination of my 4th gen test and RNA test proves that I wasn't infected!

Thanks again Dr. Hook!
45 months ago
One more question Dr. Hook - since you say that the HIV RNA test I took would've been positive well before day 29 had I been infected, how accurate is the HIV RNA test, percentage wise, at 29 days?
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
The HIV RNA test is completely accurate in infected persons at 29 days.  The reason it is not more widely used on a routine basis are the facts that this test has more false positives (not a problem in your situation), and cost.  Be confident of your results.  You did not get HIV from the encounter you mentioned.

This is my third response to this series of questions.  Thus, as per Forum guidelines this thread will be closed later today.  Take care.  EWH
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