[Question #2302] HIV test

46 months ago
Hi doctors 
As previously mentioned I had what I believed to be protected sex with a csw in London massage parlour. I am 36 white British with no stds before this event. The csw was white Romanian. We used a condom but in my anxious mind it must of broke. I'm sure it didn't. Anyway I tested rapid insti antibody at day 14, 18 and 27 all negative. I also tested at day 21, 26 and 27 the alere rapid antigen and antibody test which gives results in 20 minutes. My questions are do I need further testing? How accurate is the alere antigen/antibody test at 27 days? What are my odds now of being hiv positive? 
Many Many thanks 
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
Welcome back to the Forum.  In preparing to answer your question I reviewed your earlier interaction with Dr. Handsfield and agree with all that he said.  The exposure you describe we very, very low risk due to the low likelihood that your partner had HIV, the probability that your condom did not fail, and the fact that even if the condom failed and your partner had untreated HIV, your risk for infection would be less than 1 in 1000-2000.  Now with a negative combination HIV antigen antibody tests, the probability that you were infected in 1 in millions, and probably less than 1 in tens of millions.  Until recently we counseled clients that results of combination HIV antigen/antibody tests are 4 weeks (27 days is close enough) were completely reliable.  More recently official estimates however have been revised to indicate that results are not entirely reliable until 6 weeks.  Having said this, the proportion of positive tests which are not positive by 4 weeks is extraordinarily low.  Neither Dr. Handsfield nor I have ever seen or heard of a patient with recently acquired HIV whose test was not positive by 4 weeks. 

Thus, I see no medical reason for further testing.  There is just so realistic likelihood that you acquired HIV from the exposure you have described.  EWH 
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46 months ago
Thanks Dr Hook. 
im guessing this is anxiety but as mentioned I had 6 hiv tests three of them being the alere rapid antigen/Antibody at 21,26 and 27 days. Percentage wise. How accurate are these tests at this time? I am a bit worried as they were not lab tests. I am planing to do an insti rapid antibody test at 6 weeks just for peace of mind. How accurate would this be?

Thanks again 
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
It is difficult to provide a precise percentage for you.   I would point out however the your risk for HIV is not the percentage of new HIV infections which would be missed by the test if positive but that number multiplied by the chance that you were going to get HIV which, as you and Dr. Handsfield already discussed (likely less than on a hundreds of thousands, if not millions.  This at this time your likelihood of having HIV is certainly less than 1 in millions.  You are over-testing, wasting time and money.  I would suggest that you put some of that effort in addressing your large amount of unwarranted anxiety.  EWH
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46 months ago
Hi Dr Hook

I am an anxious person and the fact that I cheated on my wife is killing me with guilt and I am trying to address this However I just wanted your thoughts on the alere rapid ag/ab test. I know the lab tests are better but how much better? Here in the London the private clinics are saying that at 4 weeks these rapid ag/an are conclusive unless a hi risk exposure. I just wanted an experts opinion on this so that as you mention I don't waste anymore time/money testing. That was my last question. Many thanks again 
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
Sigh.  You really don't get it.  These tests have been approved for use by official bodies such as the WHO, U.S. FDA and other regulatory bodies.  All of these tests must meet the SAME performance standards.  Trying to measure differences in classes of tests in your situation is like trying to count stars in the sky- we may come to difference conclusions but if we use the same standards the differences between your count and mine are entirely inconsequential and poor therapy for a guilty conscience.  You got my assessment (this is more than opinion)- you do not have HIV, the odds were against it to start with and your testing proves that.  Your chances of having HIV are much less than your chances of being struck by a meteorite falling from the sky.  This will end this thread. EWH
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