[Question #7110] Follow up after research

7 months ago
Hello again, and I am sorry for the follow up, but i think i found the studies of importance:


The first one has a readable and clear table of HIV testing window periods and clearly shows the Alere Determine 4th gen ag/ab rapid test at 43 days for 99%.

What i am questioning is the second paper which says:

However, it is important to note that the 45-day window period is only for laboratory-based HIV tests performed on serum or plasma. For point-of-care tests (single-use devices used on unprocessed blood or oral fluid specimens), there are not yet sufficient data to recommend reducing the window period to less than 90 days. We are currently assessing the sensitivity of point-of-care tests through the CDC-funded Project DETECT, which evaluates the performance of rapid tests when performed on unprocessed specimens in real time through serial follow-up of participants identified during the process of seroconversion.14 One goal of this study is to provide the data needed to update the window periods for these tests in the near future.

My question is has there been new updates since these 2017 studies that close the rapid test window to 43/45 days as well -- the CDC website does reflect the 45 days for Lab based 4th gen tests but does not close that window from 90 days for point of care rapid 4th gen tests.

I hope this is not annoying and hope you can understand the confusion and clarify thank you
7 months ago
Interestingly, the first study claims OraQuick ADVANCE Rapid HIV-1/2 test achieves 99% by day 58.

As a person trying to make heads and tails of all of this, I hope you can appreciate the challenges and confusions relative to CDC website information!
Edward W. Hook M.D.
Edward W. Hook M.D.
7 months ago
Your follow-up question is repetitive and non-productive. The CDC and the website sponsored by it take a conservative stance which reflects the information provided in package inserts for tests. It does not reflect More recent data or experience. You came to us for our interpretation of the literature but you persist in trying to sort out medical literature more than 2 1/2 years old from publication (and even longer since it was submitted) to challenge the information we provide.  As I have explained to you earlier, fingerstick, point of care essays for HIV are held to the same performance standards as laboratory-based tests.  Your finger stick results should be believed. If you cannot or will not perhaps you should get a laboratory test. I will bet that you large amounts of money that the results will once again prove that you were not infected with HIV during the encounter that you described in your original post.

Let me remind you you do not know that you were even exposed. Do you have tested on multiple occasions with at least two different tests both of which have been negative at times long after all experts agree that the results are conclusive. Despite this you continue to worry and be concerned. I cannot help your anxiety. I can tell you with absolute confidence that your results indicate that you were not infected with HIV. I will have nothing more to say about this. If you choose to continue to troll the Internet that is certainly your prerogative but please do not ask me to resolve the misinformation which is there.  As I have explained earlier, much of which is found on the Internet is out of date yet remains there. Other so-called information there is taken out of context or a misinterpretation of available information. I wish you all possible luck in moving forward with your inappropriate anxiety. EWH
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7 months ago
Well, you sort of won the bet.  I went to a planned parenthood, had the alere combo hiv rapid ag/ab test done, 9.5 months after the event, and as you suspected, another negative result.

I cannot find a single reference to a test at 9 months plus after an encounter with no other risks after being NOT conclusive on the internet, especially a 4th generation one, rapid or otherwise, and additionally i read the product insert for the alere test and its specicficity and sensitiviy matches the lab based vein draw almost identically.  So this is helping me, some.

You would think this would put my mind at ease.  I bet 99.9% of people would smile and breathe a sigh of relief and not think about it again.

My anxiety has eased but has not completely subsided, and can be tough at times.  Guilt over an indiscretion i regret has manifested in fears that science has proved inappropriate (that somehow i contracted HIV).

I am seeking therapy help as i believe this is an OCD issue at this point.  I wanted to write this for anyone else out there that might have this same issue.

Have you doctor seen this before -- someone who does not accept negative results -- and do you think OCD therapy is the proper course at this point -- i.e. no further HIV tests?

Thank you.
Edward W. Hook M.D.
Edward W. Hook M.D.
7 months ago
Thanks for sharing your results.  As you anticipate, I’m not surprised at the outcome.  I ALSO congratulate you in your decision regarding seeking professional assistance in moving forward.  That makes far more sense to me than further testing.  I’ll not guess as to the best way to address your continued concerns but wonder if the problem is not OCD as you suggest but perhaps guilt.  I suspect that determining which will help determine the path forward.  A trained counselor is the way to go.  EWH---
6 months ago
Thank you for the encouragement -- for the record, the constant thinking about this, questioning lab tests vs rapid 4th gen tests, etc, is the possible OCD i want to address, even if it is only a few weeks old.  in the past, a test has been sufficient to quiet the fears, and in this case i am frustrated by my mind working non stop to question the tests.  So while i do agree the underlying guilt is the force acting here, perhaps addressing the illogical OCD thoughts may help?

In summary, I found this post of yours in earlier threads, and I find it rather applicable to me.  Can you confirm that this in turn would apply to my situation as well (perfectly, in fact?)

Sigh.  You really don't get it.  These tests have been approved for use by official bodies such as the WHO, U.S. FDA and other regulatory bodies.  All of these tests must meet the SAME performance standards.  Trying to measure differences in classes of tests in your situation is like trying to count stars in the sky- we may come to difference conclusions but if we use the same standards the differences between your count and mine are entirely inconsequential and poor therapy for a guilty conscience.  You got my assessment (this is more than opinion)- you do not have HIV, the odds were against it to start with and your testing proves that.  Your chances of having HIV are much less than your chances of being struck by a meteorite falling from the sky.  This will end this thread. EWH


Would you have anything further to add?

Many thanks

Edward W. Hook M.D.
Edward W. Hook M.D.
6 months ago
Yes, my past statement Is applicable to your situation as well.  I’m glad you looked at our past interactions with others.  Our intent is for them to serve as references for others without them needing to pay for a response.

I encourage you to seek professional counseling and hope that the information I’ve provided has been helpful.  As this is my third response, this thread will be closed shortly without further responses. Take care. EWH 
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