[Question #5460] HIV 4th Gen Testing

20 months ago
https://www.ncbi.nlm.nih.gov/pubmed/29140890

I was  reading this study and came to the conclusion unless someone miss counted the dates of when their “exposure” took place or unless they were taking Prep all 4th Gen HIV test should be conclusive within 4 weeks based on the serology of the HIV virus. 

Is this a valid conclusion?
20 months ago
I think someone tried to answer my question but I cannot read the reply. 
Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
You need to be more patient.  Answers may not be posted immediately.

For all practical purposes a 4th generation HIV test will provide reliable results to exposed individual by day 28 (4 weeks) after exposure.  Several years ago however, the CDC, which tends to be conservative in their advice stated that there were very rare instances in which persons did not become 4th generation HIV test positive until between 4 and 6 weeks. Thus while I have never seen such a case., out of respect for the CDC and because most of our clients request to be told a date when they can be 100% (not 99.999%) confident that they are not infected, we now use the 6 weeks cutoff to be absolutely confident in test results.  

Thus, while I would be completely confident in a 4 week result, our official recommendation is 6 weeks (42 days).

I hope this perspective is helpful. EWH  
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20 months ago
Thank You for your clarifications. 

I j results from a herpes test I did 30 days post exposure  back in January and was wondering how accurate they would be.  Or if I should retest now 6 months later.?

  • HERPES TYPES 1&2 IGG IGM on 01/18/2019 negative 
  • Details
  • HSV 1 IGG TYPE SPECIFIC - <0.91 Range: 0.00-0.90 - index
  • HSV TYPES 1/2 IGM COMBINATION - Less than 0.91 Range: 0.00-0.90 - Ratio
  • HSV-2 IGG TYPE SPECIFIC - Less than 0.91 Range: 0.00-0.90 - index
  • Edward W. Hook M.D.
    Edward W. Hook M.D.
    20 months ago
    Blood tests for herpes are far less reliable than blood tests for HIV.  The middle, IgM test that you mention is specifically recommended to NOT be used because it is highly unreliable, giving both falsely positive and falsely negative results.  The IgG HSV-1 test (first one listed) misses up to25% of persons of have HSV-1 infections and may have problems as well with false positive results.  Finally, the IgG test for HSV-2 detects about 90-95% of HSV infections by 63-6 months after exposure.    Thus while these test all suggest that you did not acquire HSV, there are better tests (the Western blot test performed at the University of Washington) and 30 days is probably too early to have a high degree of confidence in the result.  

    This is my final response as part of this thread.  Knowing your story, I really see no reason for you to continue to worry about STIs of any sort, including herpes and encourage you to move forward without continuing concern,  If you have further questions on HSV however, they should be directed at Ms. Warren's site.  EWH
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    20 months ago
    Thank You for all your information. 
    20 months ago
    I guess I still have one response left. 

    I’ve been reading online about condoms (I know misinformation) but I’ve also been reading Dr. HHH and your responses about condom failure. Apparently there is a misinformation about how often condoms do break and about micro-tears. 

    My question is if there is a tear or break is it something that is quite noticeable or is it something that does take really good inspection.

    On Monday I was using a green condom during vaginal intercourse and pulled out and saw that there was no skin showing and when I took it off it came off in one piece. 

    I’m assuming in that instance it was not a considered broken or damaged. 
    Edward W. Hook M.D.
    Edward W. Hook M.D.
    20 months ago
    I would assume that the condom you used was intact and did not fail.  When condoms break which occurs about 1% of the time they are used, they typically break wide open leaving no doubt that they failed.  "Microleakage" of condoms is an internet-fueled myth.  The risk for condom breakage goes up very slightly when sex is with a new partner, when rectal intercourse is involved, and if the condom is put on without leaving space at the tip.

    I suspect you have nothing to worry about and see no need for testing of any sort.  This completes this thread.  Take care.  EWH
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