[Question #8431] Finger Prick Rapid Testing

44 months ago

Dear Doctors,

I hope you bear with me with this one last follow-up. I have struggled with access to HIV experts in my area given the insane waiting time for a medical referral. I'm getting married in 6 weeks and I wanted to get some additional insight, as consequences of a missed infection could be catastrophic. I promise this will be my FINAL question altogether.

I would like to know if the Rapid Finger Prick AgAb HIV test (combo), administered by Planned Parenthood, is good enough compared to the blood draw test. I have received a non-reactive on this test at 79 days post-PEP (15.5 weeks after exposure), I was moving forward with the understanding that I'm 100% HIV negative. However, despite the timing of the test being beyond the window recommended by the CDC (the CDC recommends final testing at 3 months after exposure. So, does NY.gov, Alberta, British Columbia, Quebec / UK guidelines recommend testing at 10.5 weeks post-exposure), I do read in these guidelines that laboratory testing are recommended in such instance. So, my question is:

1- do you recommend a repeat 4th generation blood draw testing to completely rule out infection in my case?

2- also, my last testing was 5 days short of the 84 days post-PEP testing. Could this have an impact on the results/receiving a false negative?

and finally, a question regarding HCV. I have tested for Ab HCV at 4 weeks post-exposure, which came back negative. I'm not sure if this transmits through heterosexual sex but I'm aware of extended HIV testing in cases of co-infection with HCV.

3- Does the testing I have done with respect to HCV conclusive, leading to 100% conclusive HIV testing?

I do appreciate your patience and knowledge. Again, I apologize for posting yet again but given the delay in referral to HIV experts and my upcoming wedding date, this website is the only credible resource I have in this current time. I very much appreciate your help and trust that this shall be my final post. Happy holidays!

44 months ago

To add some additional context,

I really regret my decision to take PEP. It feels like this has placed me in an infinite anxiety loop given that I don't seem to find any consensus on the 100% conclusive testing after my exposure. I have spoke with multiple medical experts, each giving me a different answer and that has been really disturbing to me. I think this is something to be aware of for other readers who are about to take PEP.

The Infectious Disease doctor who was following me dismissed following the test at 8.5 weeks post-exposure with AgAb lab-based blood draw and claims that the rapid test only goes to confirm his claim on me being conclusively negative. I'm not sure if I'm able to trust him given that he deemed me conclusively negative even before the standard guidelines and there aren't many doctors around besides him that I can see about my situation.

It is also worth noting that the planned parenthood practitioner also claims that my rapid test is conclusive evidence on my negative test and is 100% reliable. I get the same information from the National clinian PEP line, the San Francisco PEP line, and the NY state PEP line, which is that my testing is conclusive.

I just want the 100% clear light and inquire if you'd recommend any further tests.

Edward W. Hook M.D.

44 months ago

I’m sorry to see that you cannot overcome your unwarranted and inappropriate anxiety over the virtually no risk exposure which you have contacted us about on two previous occasions. The answers to the questions to ask regarding HIV and the accuracy of your test results has already been provided that’s my responses will be brief.

1. The results of your finger prick, combination HIV antigen/antibody test are conclusive. I urge you (Once again) to believe them. As I’ve already explained, failures following PEP are so rare that recommendations regarding optimal follow up our variable. Nonetheless you can be entirely sure that your test results prove that you were not HIV infected. It is time for you to move on. No further testing is needed.

2. No

3. Hepatitis C is not transmitted by heterosexual sexual contact. Your 4 week test results serve to prove you were not infected.

It is past time for you to stop asking these unwarranted, anxiety driven questions. Following closure of this thread, additional unwarranted, repetitive and/or anxiety driven questions may be deleted without a response or return of your posting fee. EWH

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44 months ago

Dr. Hook,

Please, accept my apologies. I really do not mean to inconvenience you and I only continue to ask questions because I want the decisive and 100% confirmatory facts. The past four months have been very tense for me and even though I have been going to therapy consistently, I still have troubles moving on.

the reason I worry about the finger prick vs. the lab-based is because I remember seeing a post from Dr. Handsfield recommending lab-based testing for PEP follow-up. In question #6325, Dr. Handsfield says the following: "But the final conclusion that you didn't catch HIV is still a few weeks away: that will come with another AgAb test (preferably lab based, not a rapid test) 6 weeks after completing PEP." Do you mind elaborating on this preference? because it is in-line with what I saw in the CDC guidelines about preferred laboratory-based tests.

Also, the clinician I spoke with said the rapid AgAb is highly reliable with odds 99.9% of picking up infections. Does this mean there is a chance of 0.1% that I am HIV positive?

I do acknowledge the repetitive aspect of my questions and I truly and deeply apologize to you, Dr. Hook. Anxiety has gotten the best of me and I feel completely helpless in the face of this ordeal. I'm trying to convince myself against doing another test given that it will be unnecessary and I do appreciate all your help and assistance so far.

Edward W. Hook M.D.

44 months ago

Sigh. Your anxiety is unwarranted and could be a pathological manifestation of guilt over your misstep. My most important message for you is to seek professional counseling and to stop your anxiety driven overthinking of your risk. Brief responses:

By rapid test Dr. Handsfield was referring to rapid antibody only tests, not fingerstick combination tests. Believe your results.

No, there is not a 0.1% you are infected. EWH

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44 months ago

Dear Dr. Hook,

My sincerest apologies on the anxiety-driven questions earlier in the thread. Anxiety is a difficult condition and sometimes it gets really hard to cope. I would like to provide one final update on my situation.

I went ahead and performed one last test lab-based 4th generation AgAb at 17 weeks and 3 days (122 days post-exposure and 93 days post-last dose of PEP). The results once again came back negative, as you, my doctor, and all experts predict. So once again, accept my apologies and trust that I have full confidence in your and Dr. Handsfield advice. With two negative tests on fourth generation tests beyond the window period of any test, I'm pretty confident in my non-infection and my anxiety has substantially eased.

Some follow-up questions that I had out of curiosity more than a worry:

I do see some websites that say the fourth gen lab-tests are 99.97% accurate beyond 12 weeks. the missing 0.03% is very substantially low but I was curious. Is this a theoretical calculation? Has any infection been missed with a fourth generation test under any special condition/circumstances? I did see some reports of occupational exposures where people tested positive beyond the six month period (mind you these are publications for 1997 and 1999 that I choose not to link to save your time and eyes from looking at outdated publications).

And to bring it to my case, there isn't any chance that my two negative results (the finger prick and the lab ones) at 3+ months after last dose of PEP could be false negatives? (I know even if you assume 99.97% sensitivity for the lab test, the odds of that happening + infection risk would be 9 in 250 trillion if I base off my calculation of the 1 in 25 billion odds Dr. HHH gave me in the earlier thread).

Finally, what's the deal with recommendations advising testing 6 months after end of PEP? I see Dr. HHH saying that some experts even recommend testing 6 months after PEP, so is there any need for me to perform testing at 6 months post-PEP/exposure? Only asking because I will be married soon and I plan to have sex in the purpose of having kids soon so I don't want to take any chances.

Your answers will mean a lot to me and I will keep this thread as my baseline reassurance in case any anxiety resurfaces. Thank you very much Dr. I wish you a happy holiday season to you and your family.

Edward W. Hook M.D.

44 months ago

While currently available tests for HIV are amongst the most sensitive of all tests in modern medicine, no tests are perfect. In research studies of HIV tests investigators must depend on their study participants to inform them about the timing of previous exposures and their risk for HIV. Unfortunately, perhaps from embarrassment, some participants tend to under report their risks or misrepresent when they were last exposed. In your specific case your likelihood of having a positive test in the future related to your exposure of concern is far lower than your risk of being struck by lightning in the next 24 hours. Please accept your results, but your anxiety aside and move forward.

The six-month recommendation for testing following completion of PEP relates to the factors I mentioned above as well as underlying conservatism on the part of experts who do not want to take a chance of being wrong. I am unaware of persons who have developed proven HIV infection following a -6 week follow up test. Again, please don’t worry. EWH

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44 months ago

Thank you for the help Dr. Hook. Your advice is truly life saving.

I plan to move forward from this with no worry and I will not be pursuing further testing (fingers crossed pending any further anxiety :) ). Would it be okay to pursue relations with my future wife unprotected, with no fear of infecting her?

Edward W. Hook M.D.

44 months ago

This will be the final response is part of this thread. Given your test results, there is no reason for concern that you might transmit HIV to your wife in the context of normal, unprotected sexual relations. EWH---