[Question #786] Alere Determine rapid Test

52 months ago
Hello,

I had a low risk encounter. I snorted cocaine from a shared dollar bill roll immediately (a few seconds) after someone who later claimed had "full blown aids." About 44 or 45 days later i went to a local clinic where they administered an Alere determine antigen/antibody rapid test. The test result was nonreactive or negative. Can i relax now? Or is another test warranted? I'm very stressed please advise.
Edward W. Hook M.D.
Edward W. Hook M.D.
52 months ago

Welcome to the forum.  You are quite right, this was a very low risk encounter.  While there are a very few cases in which HIV MAY have been transmitted through blood exposure encountered in the course of snorting cocaine they are so uncommon as to not be able to quantify how often this occurs.  Even more importantly, the Alere 4th generation test that you were tested with provided reliable test results at any time more than 28 days after an exposure.  you are in the clear.  no further reason for concern related to this exposure and no reason for further testing

I hope this comment is helpful to you.  EWH

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52 months ago
Thanks for the response.  You guys do great work here. Some follow up:

1a does it matter if it was a rapid test? Would that make it less reliable? 
1b. What would it take for hiv to transmit with a cocaine snort? This man wasnt visibly bleeding and it was my first snortcin months so my nose was intact.  
2. Is there any way i could get a false negative in both the antigen and antibody test? I've seen info about a 2nd window 
3: are you really dr. Hook? I've seen you on medhelp  and here. No offense, youre very active. 

Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
52 months ago
You apparently have doubts about my replies:

1a does it matter if it was a rapid test? Would that make it less reliable? 
As I said "the Alere 4th generation test that you were tested with provided reliable test results at any time more than 28 days after an exposure".  Rapid tests are held to the same performance standards as lab tests for approval by the FDA.  there are logistical pros and cons to each type of test which make them more useful in some settings than others but the performance standards are the same. 

1b. What would it take for hiv to transmit with a cocaine snort? This man wasnt visibly bleeding and it was my first snortcin months so my nose was intact.  
There are just no sufficient data to answer this question.  As I said above "While there are a very few cases in which HIV MAY have been transmitted through blood exposure encountered in the course of snorting cocaine they are so uncommon as to not be able to quantify how often this occurs." 

2. Is there any way i could get a false negative in both the antigen and antibody test? I've seen info about a 2nd window 
The so called "2nd window" is the latest internet based hysterical response to mis-interpretation to a hypothesized possibility that has no practical application in current testing.  As I said before, you should believe your results.

3: are you really dr. Hook? I've seen you on medhelp  and here. No offense, youre very active.
No offense taken, I'll take it as a back handed complement.  Yes, I am really Dr. Hook.  Several years ago MedHelp was bought by another company who decided to discontinue their Forums.  Dr. Handsfield and I now work to help folks through this ASHA web-site.

Hope this helps.  EWH
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52 months ago
Your responses are helpful, I was under the impression the rapid tests were less reliable. and it wasn't meant as a backhanded compliment, Take it as a sincere compliment. 

Your replies don't give me doubts, it's the conflicting information I find online. Some places say snorting is a theoretical risk, others say no risk, others small risk. The CDC doesn't address this, and even The clinic I went to started by saying it was no risk, and later said it was actually a small risk, so can you see/understand  my confusion /frustration. I called a helpline the week of the incident and they said no risk.

I've read other threads where you say a result after 28 days is conclusive, and that's what you told me. Believe me, I want to go with this information. Why do I find on CDC and other sites that the only conclusive time is 3 months? I want to be sure I'm in the clear , I do not want to put my partner (hiv neg female) in harm's way, and i want to know if I can put this behind me. Any possibility of an incorrect result is worrying to me as I would like not to take a chance. If you tell me to trust the 43-44 day ag/ab rapid test I will do my best. Sorry for the repetiveness. 

I know this is my last question. Thank you for your time. Again, the work you and your colleagues do is admirable.
Edward W. Hook M.D.
Edward W. Hook M.D.
52 months ago

Thanks for your explanations.  the information which can be accessed on line is sometimes helpful but all too often is taken out of context or mis-interpreted.  This problem is not helped by well respected organizations such as the CDC which give overly conservative recommendations and advice.  At the same time however, we can understand the CDC's perspective, as an (unfortunately) politicized organization providing scientific guidance, their stance is that they cannot "afford" to make a mistake.....even once.  Thus their advice tends to overly conservative and they will often fail to provide definitive advice "just in case".  In my mind, this does not serve nervous persons well.  I think the same sort of stance is all too often provided from other sources.  From a practical perspective, there is no meaningful difference between "no risk" and "theoretical" risk.  I can tell you there is no risk that you are going to be struck by lightening while reading this reply but in fact, there is a "theoretical risk" it could happen.  An advantage of this site is that the information is individualized.

You are in the clear.  For the reasons mentioned above, the CDC provides advice which conform to the results reported in FDA approved package inserts.  The FDA package inserts are based on the stated goals of the study (i.e. to prove that tests perform equivalently to already approved comparison tests which in turn used as their benchmarks for conclusive results a three month time point.  The fact however is that the data from the study showed that results were completely reliable much earlier- 8 weeks for antibody only tests and 4 weeks for combined antigen/antibody tests.  Trust the 42-44 day results of your fourth generation test. 


Hope this clarifies things.  As per Forum guidelines, this thread will be closed later today.  EWH



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51 months ago
Hi Dr. Hook,

I went back for another rapid test today. 52-53 days later. Nom-reactive. I also asked for a lab test which will come back in a week.

What makes you so sure 28 days is enough? I see conflicting information about the sensitivity of the tests, also CDC hasn't added raid tests to the algorithm. That doesnmt make me feel confident.  

I know these aren't debate forums, but I know stats, and I would never say absolutely in the clear if there is a small probability/possibility of a mistake.  
Edward W. Hook M.D.
Edward W. Hook M.D.
51 months ago
Your are debating.  You are also ignoring my earlier statement, based on Forum guidelines that the thread would end after my third reply.  If you wish to continue this exchange you will need to start a new thread.  EWH---