[Question #4624] RNA Test?

26 months ago

Hi Dr Hook and Dr Handsfield, your dedication to HIV and the people it affects is astounding.

The forum you provide is an amazing service and it most definitely helps so many people.

I had a drunken evening at strip club in South Africa, KwaZulu Natal (yes probably the highest HIV Infection rate in the world area). I am someone that does get over concerned about ‘’WHAT IF’S’’, so this evening got me quite anxious. I was very drunk can’t really remember too much of the evening, so I am not too sure if I had sex during a Private strip show, or not. TERRIBLE!!! If I did I could imagine it being very brief as it is something I wouldn’t risk doing is unprotected sex. But let’s just for this sake say I did have a brief  few seconds penetrated exposure, what are my chances of being infected with HIV or anything else? Today is day 18 after the possible exposure and I haven’t had any significant symptoms of ARS or STD’s.

At day 16 and a bit I got tested with a PCR RNA, came back not detected. I also did a 4th Gen at the same time also came back Negative (I know it’s a bit early for the 4th Gen Test but I just thought it would be good to add this test)

My reason for concern is that I am married and am freaking out that I can’t have unprotected sex with my wife and she may start questioning me as to why.

Now I have read through quite a few questions and answers here and I am confused about something.

AS per the RNA test Dr Hook states that any time after Day 12-14 the RNA test to be conclusive.

While Dr Handsfield states that it is only 90-95% conclusive?

Now I understand that I could have had a possible High Risk exposure and that may change the thoughts behind any early test being reliable. But in my situation I kind of was hoping that my 16 day RNA test will be conclusive and I wouldn’t have any fear of having unprotected sex with my wife.

Your advice will be greatly appreciated.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Welcome to the forum. Thanks for your question and your kind words.

First, I would not consider there to be much difference between "conclusive" and 90-95%. But more to the point, as a general rule, all HIV experts would reccommend that in addition to PCR/RNA, to be 100% certain someone is free of HIV, an antibody test needs to be negative 4-6 weeks after exposure. It's just a matter of safety and common sense. On the other hand, there are few if any documented cases of people having HIV with negative RNA results after ~2 weeks after exposure. For example, routine testing of all donated blood specimens for HIV RNA appears to be 100% effective in preventing transfusion related infection. Still, no test is perfect, and Dr. Hook also recommends that RNA testing be accompanied by a 3rd generation antibody test or an AgAb (4th gen) test at 4-6 weeks. I use the 90-95% figure in order to assure that questioners do so and not rely 100% on the RNA test.

If I were in your situation, I would be entirely comfortable continuing unprotected sex with my wife without worry that I could transmit HIV. 

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

HHH, MD
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26 months ago
Hi Doc, just a follow up, i went for a 4th gen test today, was 27 days past my possible exposure.

Came back negative/nonreactive.

Is 27 days negative post exposure plus 16 day RNA  enough to put this incident behind me?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Yes, that combination of tests is conclusive. You're home free and indeed can "put this incident behind" you.---