[Question #5041] HIV test conclusive ?

26 months ago
Hello, I am a Gastroenterologist and that actually raises the level of anxiety. In December, I had an episode of protected (male condom) vaginal intercourse with an asian masseuse, and to my recollection the condom had no issues at the end. About 5 weeks later i noticed a white coating on the posterior aspect of my dorsal tongue, the coating came off easily with brushing teeth and tongue with no underlying inflammation nor bleeding and normal mucosa. I assumed that was just normal tongue debris (Do not know). A week after I had a mild sore throat with no other signs nor symptoms, so i panicked and I got tested.
I had a blood draw: HIV-1/2 Antigen/Antibody Screen by CMIA done at day 48 after exposure (Day1 being the exposure). 
It came back non reactive. I am assuming after extensive research that this is a 4th generation test, and thus if so, my question is: Is the result conclusive at 48 days and should i move on with my life. Thank you in advance.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Welcome to the forum and thanks for your question. It is gratifying when professionally knowledgeable persons have confidence in our services.

Yes, the AgAb tests are 4th generation (antigen-antibody testing for both HIV1 and HIV2 is the definition of "4th generation"). These tests indeed are conclusive by 6 weeks after the last possible exposure, so your test at 48 days proves you do not have HIV, assuming no more recent exposure. This result overrules all other considerations:  no matter how high the risk of HIV at the time (you describe a low risk exposure, because of the condom) or no matter how typical the symptoms (yours are not, starting much too late after the exposure event) the test result shows you were not infected. Indeed you should "move on with [your] life" without further worry.

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

HHH, MD
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26 months ago
Thank you for the surprisingly quick reply. Yes to clarify, that was my only exposure.
My only confusion would be that guidelines I have looked at are suggesting a 3 months exit test. An my test was done at 7 weeks. 
Are those guidelines outdated ? 
I looked at your training details and your research.  And your credentials are admirable, so you earned the trust/confidence.
Again thank you for the assistance and the prompt reply.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Indeed a more rapid reply than usual. I happened to log on soon after your question. Forum users should not expect nearly real-time responses.

With the AgAb HIV tests, guidelines for testing at 3 months indeed are outdated; the science is clear about the reliability of AgAb tests after 6 weeks. The main exception is for people on anti-HIV drugs for pre- or post-exposure prophylaxis (PrEP, PEP), which might prolong the time to conclusive tesitng. Some agencies simply have not gotten around to change their longstanding advice; others may not understand the science and reliability of the tests; and still others intentionally take hyper-consertive stances, often on the basis of their legal departments.

Thank you for your kind comments about the forum moderators' credentials. The forum sponsor, the American Sexual Health Association, is a highly professional agency with high standards.
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26 months ago
Thanks again for the response.
One last thing before we close this question.
I have been trying to locate a good updated study about the window period and I have been not succesful this far.
Do you of any i can lookup on ncbi/pubmed.
Have a great day, thank you. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
This is the review that led to our modifying our advice on this forum from 4 to 6 weeks for the AgAb tests. You'll see that 45 days is stated as the maximum window, but all experts (including the authors of the study) agree there is no meaningful difference in reliability at 42 days (6 wk) vs 45 days. https://www.ncbi.nlm.nih.gov/pubmed/29140890 

That concludes this discussion. Take care.
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