[Question #3138] Is it conclusive or not?

40 months ago
Dear Doctor, hopefully you can clear up a couple of things.  Approximately 32 days ago I had an encounter with a female masseuse.  She rubbed me for quite awhile and then masturbated me without a condom but did give me a prostate massage with her finger in my rectum that lasted a minute or two.  She did not use any barrier between her finger and my rectum.  What concerns me is that she may have transferred some sort of infectious fluid to me in my rectum via a sore on her finger/cut/bleed.  I was very concerned and had a two week duo test which was negative.  I was told this wasn't conclusive and therefore went back at 30 days and had another HIV duo test as well as a HIV-1 RNA quantitative viral load through labcorp. This was a Roche Taqman quantitative down to 20 copies.  Both tests were negative, with no reaction on the duo and no HIV-1 RNA detected.  I seem to have varying symptoms and I am told by my dr that these tests are conclusive.  He is only my primary care doctor though and not an expert.
1)Can I regard my 30 day HIV-1 RNA as well as duo conclusive?
2)If there was infection, would have at least ONE of the tests been positive?
3)I see where you say 6 weeks now is conclusive for the duo, but with combined with an RNA, do I need to repeat to be sure and TOTALLY SURE still?
4)Is there any limitations to the RNA test at 30 days where it wouldn't be absolute?
5) Is there any more I can do to be sure, 90 day test, DNA, etc?
Thank you
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Welcome to the forum. Thanks for your question, and thanks for reviewing other questions similar to yours. It sounds like you have correctly interpreted them.

HIV is not transmitted by hand-genital contact or fingering, anal or otherwise. The odds are strongly against your massage partner having HIV, but even if she did, you were not at risk from the events described. You didn't need testing at all. Also, your doctor is correct:  your test results are conclusive. You don't describe your "varying symptoms" but it doesn't matter:  testing always overrules symptoms, so even if you had typical symptoms of a new HIV infection, the test results tell the true story.

Those comments directly or indirectly answer your questions, but to be sure there is no confusion about it:  

1, 2) These are the same question in different words. The duo test alone is 95-98% reliable. The combination of that with the RNA test is absolutely conclusive at 30 days. One or both of your tests definitely would have been positive if you had acquired HIV.

3, 5) There are no tests that can make 100% conclusive results any more conclusive! You do not need any further testing.

4) The only factor known to delay a positive RNA test is treatment with anti-HIV drugs. In people taking pre- or post-exposure prophylaxis, it is theoretically possible that if the preventive treatment doesn't work, the time to positive tests (both RNA and others) might be delayed. In that circumstance, most experts recommend testing at 3 or even 6 months. Otherwise, this isn't known to happen.

Let me stress again that you were not at risk at all. But even if somehow there were a chance of infection, your test results show it didn't happen. All is well!

I hope this information is helpful. Let me know if anything isn't clear.

Happy new year--   HHH, MD

40 months ago
That definitely clears things up a bit.  There is a TON of information on the internet/CDC but not sure what to believe.  Luckily I had the ability to do both kinds of tests and reassure me somewhat.  I did have a small bump pop up the other day on my chest, went away in a few hours then two days later same place same bump, same duration.  Hasn't come back. It was a single round bump.  Im not sure If  should be worried at all about.  I wish I would have asked this in the original post but here are a couple other questions if you dont mind the followup.
1)If a HIV duo test coupled with a HIV RNA test at 30 days is CONCLUSIVE, why isn't this used more as a main way of detecting hiv infection?
   a) is it the cost/access?
   b) rate of false positives?--I have read anywhere from 2-9%

2)If a and b were not a factor, would this be the ideal testing method to decrease the spread of hiv?

3)Even if there were  any breaks in the skin(of either me of her) and the prostate massage in the manner described, you would say no risk?

3)To make sure it is clear to me (mind whirling)-you are absolute in your knowledge/thinking of the tests, that there is no doubt on my negative HIV status based on the exposure/duo/RNA--pretty much as conclusive as can get?

4)No matter what symptoms I get, I can disregard HIV totally?

5)Is there really no way that both tests(negative duo and RNA) at 32 days at the time of testing could be wrong?

Thank you for your insights
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
1) You're right about the reasons the RNA or DNA tests are not used to detect asymptomatic early infection. Their main purposes are to measure disease activity in people with known HIV, and occasionally to diagnose ARS in people with symptoms, before antibody develops; and indeed they occasionally give false positive results.

2) Testing per se is not the main strategy by which HIV transmission is prevented. I suppose if such tests were much less expensive and never gave false pos results, they would be used more in this manner.

3) The busiest STD/HIV clinics never see patients who did not have traditional risk factors. There are no patients whose only exposure was fingering. And if you think about it, there must have been millions if not billions of fingering events in which a cut or wound was present (just think how common such things as hang nail and small finger cuts are) -- but no known infection. COULD this happen? I suppose so. DOES it happen with any measurable frequency? Obviously not. I also cannot guarantee you won't be struck and killed by a meteorite, but I would not advise you to go through life taking precautions against it.

4) Yes.

5) From a statistical standpoint, the probability is so low as to be considered zero.

Consider a statistical analysis:  Let's say there's 1 chance in a thousand your masseuse had HIV.  And let's say 1 chance in a thousand it could be transmitted by the contact you had. The odds you caught HIV would be 1 in a million (1/1000 x 1/1000). Now let's say there's a 1 in a thousand chance the test combination you had could miss HIV at 30 days. The odds you have HIV now would be 1 in a billion (1/1000 x 1/1,000,000). I hope you'll agree that's low enough to be viewed as zero. (I'll also point out that if you live in the US, according to the National Safety Council, statistically there is 1 chance in 1,756 you'll be dead within 12 months of some sort of accident -- vehiclular, fall, drowning, fire, you name it. In other words, the chance you'll be dead in a year is 569,000 times higher than the possibility you have HIV (divide a billion by 1,756).

So my advice is a) forget about HIV and further testing and b) wear your seat belt.

Got it?
39 months ago
Hello. I am still nervous and had some additional testing last week because of strange things that i am experiencing.  I may have forgotten to mention, BUT the lady at the massage place where she gave me an unprotected prostate massage was from some part of ASIA(chinese, korean??).  With that being said, IF she was infected, she could have a different sort of HIV than we have mainly in the states and therefore tests are targeted differently?  So this past week (now eight weeks)I repeated my HIV duo test which was negative, RPR-neg, HIV-1 TMA APTIMA QUALITATIVE ASSAY PCR(only early detection test that is approved by FDA to help diagnose HIV-1), as well as HIV-2 PCR proviral DNA/RNA(not FDA approved but supposedly very sensitive)all done via Quest diagnostics.  All came out negative.  What scares me still is some uncertainty in testing. So, here are a few other questions
1)If we ONLY talk about the duo test, is it still conclusive at 6 or even eight weeks for HIV 1 AND 2?
2)If she had hiv-2, do i need to consider different testing algorithms or different tests to confirm or eliminate infectious state?
3)Are there limitations to my testing because of possible geographic situation, that any of these tests could fail to pick up a different strain/subtype/clade, non-b therefore giving false negative tests  on duos AND PCR's?
4)How long can possible symptoms of acute hiv last in the setting of normal tests?
5)IF HIV-2 was in play here, and i was having symptoms for this long, would have at least one of my tests (duo or PCR)shown positive? For HIV-2 or does it take longer with the combo tests because they mainly focus on type HIV-1?
6)What are your thoughts on the PCR for HIV-2 proviral DNA/RNA even thought not approved by FDA?
7)Is my testing for HIV-1 conclusive no matter what with my multiple duo, prior PCR, and now Aptima assay?
8)Do i need to consider any other specific testing say for HIV-2 like ELISA only test at 90, or even 6 months?
I really just want to  know, is my testing is rock solid??, or still a slippery slope and if so, what i can do to ABSOLUTELY extinguish HIV(OF ANY SORT) as a possibility and move on without fear of passing on?
I appreciate your valued knowledge, and yes, I will wear that seat belt.
Thank you
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Once again, these are asking the same questions in different words. The answers will always remain the same, no matter now many times and in how many ways you might ask. The HIV tests, collectively (and individually if done sufficiently long after exposure) always overrule both exposure history and symptoms. No matter how high the risk at the time of exposure, and no matter now typical the symptoms are for ARS, the test results tell the truth. In any case, as already discussed, you had an exposure with little or no risk.

1) Yes.

2,5) The tests you had cover HIV2 as well as HIV1. It is not true that the combo tests "mainly focus" on HIV1.

3) No, this is an unrealistic worry.

4) A few days tops. Within 4-5 days of ARS symptoms, the antibody and/or antigen and/or DNA/RNA tests will be positive.

6) I have no knowledge of or experience with the non-approved HIV2 RNA/DNA tests. But my guess is they are highly reliable.

7) Yes.

8) No.

There is nothing you can do to make it still more certain you don't have HIV. You cannot get more than 100% certain.

That completes the two follow-up comments and replies included with each question and so ends this thread. Do your best to move on without worry; I hope this discussion helps you do that. Best wishes and stay safe.