[Question #3771] Exposure and HIV 1 PCR RNA Test Report Clarification.

34 months ago

Good Morning Doctors, 4.5 weeks ago I went to see Malaysian CSW in Perth, Australia. No oral or penetrative sex was involved. I received unprotected Handjob and while giving the hand job the sex worker used her saliva for lubrication.  Later that day I freaked out thinking that I might have exposed myself to HIV as my penis came into contact with her saliva during hand job. After the exposure I had the following tests done through a private testing company. Test were done at a reputed Lab in Perth. 

1. 15 days post exposure 4th generation HIV AB/AG test - Not Detected

2. 15 days post Exposure HEP C RNA and HEP B DNA RNA- Not Detected

3. 15 days Post Exposure HIV 1 RNA Viral Load- The test report does not mention "Detected" or "Not Detected”. It simply mention

CLINIPATH PATHOLOGY NATA NO: 2619-2612

3C A CLASS Sheet 1

HIV-1 VIRAL LOAD

Date:   10/05/18                           

Time: 00:00

Lab No:9007000              Units Sample:Blood

HIV-1 RNA                                       < 40   Copies/mL

Log 10 HIV-1 RNA                       < 1.60 Log 10 Copies/mL

The Roche Taq man 48 assay used for this test detects A. B. C. D. E. F. G and 0 HIV-1 subtypes.

I tried to clarify this from the testing company and I was told that if viral load <40 then it is “Not Detected".  They are not medical professionals so I thought of taking an expert opinion for you guys. If the lab can mention "Not Detected" on Hep c and Hep b PCR Tests then why they didn`t mention the same on HIV 1 RNA Test. I was told by the private testing company that HIV 1 PCR RNA is not provided in the Australia for Diagnostic purpose and it was only after the company requested, the lab agreed. As per your opinion is it normal to have the HIV PCR RNA report the way i received and consider it as "Not Detected". Or it’s “inconclusive”. I also had HIV 4th generation test on 29th day post exposure and it was “Not Detected”.

I am getting married next month and worried about the exposure. As per your opinion after my HIV 1 PCR RNA test and 4th generation HIV Test, do I need to retest again or I should forget it and have unprotected sex with my wife after marriage. Thanks

Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Welcome to the Forum.  I'll be pleased to comment.  You have no reason for concern.  In fact there was no need for testing at all.  CSWs in Australia working in Australian bothels are, by law, regularly tested for STIs, thus is most unlikely that the woman you interacted with was infected.  Even if she was however, neither HIV nor hepatitis are transmitted through saliva and receipt of masturbation, even if the partner is infected and even if partners get each others' genital secretions on one another is a no risk event for STI acquisition. 

Your 4th generation HIV test was taken a bit early to be completely reliable, had you actually been exposure to HIV.  At two weeks such tests detect about 90% of recent infections.  That said the sort of exposure you had (no risk) and your HIV PCR test result both indicate that there really is no reason for concern related to the event you described. 

Regarding your concerns about the HIV test result, all such tests have a limit of detection and have some number of organisms/DNA copies below which the will not reliably detect them.  For HIV tests, early PCR tests reliably detected only more than 300 copies.  More than 10 years ago however, tests became more sensitive and now the limit of detection is 40 DNA copies.  This is, functionally a negative test however since infected persons with HIV typically have thousands of DNA copies of HIV circulating.  .

At his point my advice is to not worry further, that no further testing is needed, and to move on and look forward to your forthcoming wedding without concerns that you acquired HIV, hepatitis, or other STI from the exposure you have described.  EWH


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34 months ago
Thanks for the reply. it's was very reassuring

Just to inform that I went to see the Malaysian CSW in her private apartment in Perth city, it was not in brothel and I also mentioned at the end of my previous post that I tested for HIV DUO test at 29 days post exposure as well, the result was NOT DETECTED. You missed to comment on my HIV DUO test at 29 days post exposure. It would be nice if you can take into consideration that it was not brothel and I also tested for HIV Duo at 29 days post exposure and give your expert opinion.No other exposure since.  Bit anxious  because I am getting married and want to move forward with full confidence and certainty. Thanks. 







Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
 Thanks for the additional information. The fact that your partner who is not a licensed CSW does mean that she is less likely to have been checked for STI & AIDS. Irrespective however your risk for infection is virtually nonexistent both because of the nature of your exposure and your HIV PCR result.

I did miss your 28 day 4th generation result.  At 28 days your test would have detected over 99% of recent infections.  4th generation tests are not entirely conclusive until 6 weeks (42 days) after exposure although at that time they are very reliable.  The 6 week figure is from the U.S. CDCwhich tends to be quite conservative.  Neither of us on this site have ever seen or heard of a case from our colleagues who converted after 4weeks.

My advice to you is the same as previously.  Put your concerns behind you and move forward without fear or concern.  EWH
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34 months ago
Thanks doctor.  A last query

As you mentioned about DNA copies <40 , The test I had was HIV 1 PCR RNA , it was not DNA. From your explanation and nature of exposure should I consider that: 
1. If the report shows HIV 1 RNA <40 then it is a negative test, even if it does not mention on the report as NOT DETECTED. 
2. Rest I am able to calm myself after your expert opinion, just need to have your opinion on the above matter before I completely wrap the whole issue and concentrate on my wedding and future plans.

 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
I think you are overthinking this.  For both RNA and DNA PCR tests the lower limit of test detection is 40 copies.  Your tet is negative (and was confirmed by your other tests following a NO RISK exposure).  Thus
1.  Correct.
2.  It is time for you to stop worrying about this exposure and move on without concern.

As you probably know, we provide up to three responses to questions.  This is my third and therefore final reply.  This thread will be closed without further replies in a few hours.  EWH
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