[Question #417] Question regarding test results

34 months ago
I have a question regarding a combination of test results.

The exposure was condom protected insertive oral sex. I'm 99.9% certain the condom remained intact, and yes, everything except that nagging voice in the back of my head is screaming zero risk.

The first test was completed at day 44 and was a 4th gen rapid. The nurse indicated that the test was non-reactive and then showed it to me, which got the anxiety up and running. The top window had a clear pink control band right in the middle. The second window (p24) was completely clear with the exception of blood that leached up the sides. At first glance the bottom window (Ab) was also clear with the exception of blood that had leached into the very bottom portion of the window and then up the sides. Looking at the test very closely (mistake) I saw a faint, thin, slanted line that coincided exactly with where the blood stopped. It was not close to the middle of the window, much thinner than the control band and was not straight across but slanted/arched. When I questioned her about it she said that was not where the reactive band would show up, it was too narrow of a line, and not straight across. She then indicated that she had seen reactive tests and that this was not one.

That voice kept nagging so I went to a second clinic at day 47 due to the first being closed. They only had the ClearView antibody test using a finger stick. That test was reported non-reactive - no, I didn't look at it.

1) Not going to ask about the risk because I think we can all say it was zero.
2) Is there any reason to doubt the first test?
3) Is the combo of the negative p24 window on the 4th gen + the non-reactive on the separate antibody conclusive at nearly 7 weeks? I would think that if there were enough antibodies to completely clear p24 from the blood stream then an antibody only test would be reactive.

Thank you for your help!! It is greatly appreciated.
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago

Welcome to our Forum.  I'll try to help.  The bottom line however is that this was a no risk exposure.  There are no known cases of HIV being acquired through receipt of UNPROTECTED oral sex from an infected person.  In your case, you used a condom which did not fail as condoms do not leak just a little, when they fail they break wide open.  Thus your exposure was zero risk. 

1) Not going to ask about the risk because I think we can all say it was zero.
Agree 110%

2) Is there any reason to doubt the first test?
No.  What you describe is a completely negative test. 

3) Is the combo of the negative p24 window on the 4th gen + the non-reactive on the separate antibody conclusive at nearly 7 weeks? I would think that if there were enough antibodies to completely clear p24 from the blood stream then an antibody only test would be reactive.
Your reasoning is correct.  Fourth generation tests provide completely reliable results at any time more than 4 weeks after exposure. AT 7 weeks the antibody only test would have detected over 95% or recent infections

Bottom line, as you appear to have already concluded, is that you are in the clear.  Nothing more to worry about, no need for further testing and no need for concern related to the exposure you described.  I hope this confirmation of your own research and reasoning (good job !!) is helpful to you. EWH 
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34 months ago
Dr Hook,

Thank you for the kind reply and confirmation of what I was thinking. I guess this is kind of a follow up question. Do you think it is generally a bad idea to show a patient the test as it can cause over analysis as it did in my case? I really don't know if there is an accepted practice or not. I guess that if I do get tested at some point in the future (eg an annual test, which may or may not be recommended given my low risk activities) it would probably be a good idea to go with the verbal information as opposed to looking at the test kit.

- Cheers
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
You raise an important point.  In general how test results are transmitted must be individualized.  In some settings results are even given over the phone.  Clearly however the approach take him with you was not the best and did not suit you well. EWH---