[Question #7100] HIV testing and dates of test

7 months ago

Hello Doctors:

I have a question about HIV testing and the tests i did take and whether or not i can consider them accurate at this time.

10 months ago or so, I visited a massage person in the US and I am pretty sure nothing happened that would trasnsmit HIV, but it was dark and I was not sober and i know she was naked and who knows and wanted to be sure nothing happened taht could have infected me. So 48 and 50 days after the incident, I went to planned parenthood and a local STD clinic in my city which each both gave me a 4th generation rapid finger stick blood test -- i think called alere (got the name of the test from their websites) -- which had results available in 20 minutes. Both tests showed negative to HIV.

I did not think about this until a few days ago and got nervous that maybe these tests are not good or not as good as getting a vein blood draw which i dont like doing. I cannot believe i would think that -- why would planned parenthood and this well known clinic offer these tests if they lacked complete accuracy?

So yesterday i took an Oraquick test i got at Walgreens which is now 10 months past the incident and it was done correctly and registered that the test worked and the result was negative as well.

Given the timing of these three tests and their negative results, can i take to the bank and rest completely assured I am hiv negative or is a blood draw required for that 100% result I am seeking?

Thank you.

Edward W. Hook M.D.

7 months ago

Welcome to the Forum. Thanks for your question. I happened to log on soon after your question arrived so you are getting a reply somewhat more quickly than is typical. If there are follow-up questions, responses may be somewhat longer in coming.

I agree with your sense that the event you describe was a virtually no risk event. Your test results conclusively confirm that you did not acquire HIV from the event you describe. The ALERE finger stick 4th generation test is evaluated in the same manner and using the same criteria used for other, HIV tests performed on venous blood are performed and provide conclusive results at any time more than 6 weeks following an exposure. Your subsequent Oraquick test at about ten months just confirms the earlier result.

You can have complete confidence in your results and rest assure that you did not acquire HIV from the event you describe. There is no reason for further testing or for continuing concern about that event. I hope my comments are helpful to you. EWH

---

7 months ago

Thank you.

Let me tell you why i am asking i read on some internet sites ranging from quora to CATIE and others that the 4th generation Alere needs 90 days to be conclusive -- so i took the Oraquick recently as mentioned. Now i read on your comments that Dr HHH has mentioned that Oraquick could miss 1-2% of infections no matter how long one waits to test -- even 10 months,

As you can see i am very confused and just not sure what to think.

Any sense of why some sites say the rapid 4th gen tests need 90 days or 3 months to be conclusive and also claim rapid 4th gen tests are not as good as lab based ones?

thank you.

7 months ago

Additionally i took a 2nd Oraquick today which again was negative.

Edward W. Hook M.D.

7 months ago

I can understand your confusion. One of the problems With the Internet is that much of what is said there is out of date. This is a particular problem for the Alere fingerstick test. They were problems with the performance of that test that we’re discovered and fixed soon after it was introduced. Those problems were resolved within 3 to 6 months of the test becoming available and tests performed at this time (and for the last few years) are just as reliable as laboratory test test. Your results are reliable and conclusive.

Similarly, statements that currently available HIV Tests do not provide conclusive results until 90 days are out of date.

Once again, I urge you to believe your tests and to move forward without concern. There is no need for further testing. EWH

---

7 months ago

Thank you, I am trying, although the mind can generate powerful anxiety where there needs to be none at all.

Perhaps i can use my final question in a four part way that might help with all of this.

(1) why does the Alere Determine 4th gen rapid -- the newer currently available hiv tests you reference -- have the ability to detect hiv faster than older antibody tests -- is it technologically more sensitive and therefore detects stuff faster?

(2) why would folks continue to claim that 'outliers' to this test exist and 'antibodies might not be generated by the body for 12 weeks and therefore in this outlier case cannot be detected by a test for 12 weeks (3 months)' ? if the body does not produce ag (anitgens) within six weeks and does not produce antibodies for 12 weeks, well, you see my question -- how does the test work by 6 weeks?

(3) and on these 4th gen tests, vein blood draw is conclusive at 28 days, whereas rapid fingerstick is 6 weeks -- is that due to the difference in amount of blood examined?

(4) does the FDA apporoved Oraquick when performed correctly have any meaning when taken >3 months, in my case, at 10 months? is that in itself a conclusive test?

thank you again

7 months ago

Oh, sorry, one more -- at 10 months past exposure, would the INSTI rapid test that takes 2 minutes and uses a finger poke of blood be any better than Oraquick in terms of accuracy?

Edward W. Hook M.D.

7 months ago

As you point out, these will be the final responses. Your questions are becoming a bit repetitive and betray your anxiety. They also suggest that you are looking for information on the internet where you will find statements that are out of date, taken out of context, or just plain wrong with no easy way to tell which are accurate and which are not. We urge our clients to not look to the internet for information on HIV or HIV tests.

1. The "rapid" fingerstick test uses a different technology for the test process. There is no meaning difference in sensitivity. Rapid tests have the advantage of providing results quickly but also take more operator time to perform. For this reason they are used in some settings but not others since they take more time to process.

2. I cannot explain the basis of the misinformation which you have apparently seen on the internet. I think you are being misled which is precisely the reason we URGE clients, and particularly those with anxiety issues to stay off the internet. All 4th generation, combination antigen/antibody tests perform similarly and ALL provide conclusive results within 6 week of an exposure.

3. You are incorrect, see my comment above. Both the finger stick and venous blood tests provide conclusive results at 6 weeks, not 4 week. At 4 weeks both will detect about 99% of recent infections but not all.

4. Repetitive. The Oraquick provides virtually conclusive results at 3 months. It is an antibody only test and like all current antibody tests, results are final by three months. Unfortunately, the Oraquick is a tiny bit less sensitive than other tests which use blood rather than oral fluid for detection.

5. Yes, an INSTI test on blood would be more accurate than an OraQuick. The slight decrement in sensitivity of Oraquick is that occasionally oral fluids do not have sufficient antibodies for the test to detect.

I hope this and my earlier responses are helpful. As I mentioned, this will be my final response and the thread will be closed shortly without further responses. I urge you to accept your test results, and work to move forward, perhaps with the help of help to address your anxiety. Take care. EWH

---

7 months ago

Doctor this will be my last question hopefully.

on the CDC website they differentiate conclusive window periods for 4th gen ag/ab lab tests and rapid ones - 45 and 90 days respectively:

An antigen/antibody test performed by a laboratory on blood from a vein can usually detect HIV infection 18 to 45 days after an exposure. There is also a rapid antigen/antibody test available that is done with a finger prick. Antigen/antibody tests done with blood from a finger prick can take longer to detect HIV (18 to 90 days after an exposure).

this may be out of date or not correct but it’s the bogey that is causing. my anxiety.

can you please clarify and comment on this, please?

thank you