[Question #9094] Question #9050 follow up- How conclusive is HIV 1 RNA PCR Qual at 53 days

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36 months ago
Hello Doctors,Following my risky exposure with the swinger couple I am still anxious that my results may not be conclusive enough.I mentioned before I had an HiV test At 2 weeks past exposure with an NHS sex clinic in UK. Researching about tests window period I booked a 28th day test with a private company claiming to be the World’s largest provider of sexual health services. They claim is a 4th generation test with 99.8% accuracy at 28 days. Report came back as HIV 1&2 abs/p24 ag Not detected - negative. Cheking guidelines and being anxious I booked the same test at 46 days and came back again as negative. I was a bit paranoid as I got a slightly enlarged lymph node in my neck around the 6th week and had some loose stools but not to the consistency of diarhea ( no more than 2 stools per day). I called the company to ask more info about the Manufacturer of the test and the laboratory that they used but they gave me generic answers and this made me think that something might be wrong with those tests and I am probably infected. After becoming even more anxious I did some research and found a respectable clinic owned and directed by a DR. With over 25 years of experience in Sexual Health and HIV in UK. I booked and appointment for the 53th day after exposure and the DR. Suggested  a HIV 1 RNA PCR Qual test performed in their own clinic with a 3 hours time result ( they are one of the very few clinics in UK that invested in their own GeneXpert machine that is located inside their clinic) and he told me that the test will be the most accurate and will tell me for sure if have or not the virus( probably not in his opinion) following this exposure and I will be able to carry on with my life. Result came back as Not Detected- Negative and he told me to carry on with my life and don’t seek for further testing. I am married and have a 1 month old baby. My wife is breastfeeding only, is it safe for me to have sex again with my wife without putting them at risk?
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H. Hunter Handsfield, MD
36 months ago
Welcome back, but sorry to see you still are in a state of major overreaction. I reviewed your recent discussion with Dr. Hook and agree with all he said.

From your description, I wonder if you've been in touch with London's Freedom Health Clinic. Indeed they are world class; you can rely 100% on their advice. And indeed, answering the question as you posed it in the title:  100% conclusive. You have now had several conclusive tests, despite a very low risk situation for HIV. Suck it up and move along with no further worry. You should never have stopped having sex with your wife and certainly should resume sex with her now. And for goodness sake, stop all the internet searching about any of this. You've been way, way overboard and it's time to return to shore.

Please no follow-up questions about it. There is no information you can provide me that would possibly change my opinion or advice.

Regards--  HHH, MD
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36 months ago
Hello Dr, I know you told me no more question but I want to ask only a last one and I promise I will get away of internet searching and all forums, the first 2 tests  4 th gen test were performed through Better2Know , not sure how much I can trust them because of the uncertainty they showed in the conversations I had in regards the Lab they tested me and their Manufacturer for the test.

Second clinic where I had the RNA pcr tests is indeed in London but Is not the one that you mentioned, however as I mentioned before the Dr. that runs it and recomended me the RNA PCR test at 53 days has a lof experience in this field.and I have no doubts about that test being performed in the highest establishment with the best equipment.
My last questions will be:
 1: If we Say that my first two 4th gen tests would not have been done right, will the HIV -1 RNA PCR Qual test performed in the GenExpert Machine be conclusive by itself At 53 days?

2: I’ve seen that you And many other experts on other forums don’t recommend this Rna Pcr tests as diagnostic tests And some people Even Say that after a certain period this tests won’t be able to discover the virus as the Viral Load can go down ( I an confused as I know this was not a Viral load test But a Qualitative test , But is there Any difference between them And will this test alway L’s be accurate?)

3. Why is considered low risk if I had unprotected sex with a couple that I found out that has a long history of swinging And probably unprotected sex (they Said they are STD free But not sure if to trust).
4. I know Maybe I am Over reacting But don’t want to put my wife And newborn baby At risk in anyway because of my stupid mistake as I still an enlarged neck lymph node.

I would appreciate if you can reply one more time And I will go Away And delete all my browsing history And never go back on internet.

Thank you
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H. Hunter Handsfield, MD
36 months ago
From your description, I agree you can rely on the expertise of the clinic you are seeing.

1) There is rarely if ever such a thing as the AgAb HIV tests "not being done right". The lab methods are highly standardized, using equipment designed and provided by the test producers. They are pretty much foolproof; I have never heard of a false negative test result on account of lab error.

2) As far as I know, all the available RNA tests have similar performance. They are never negative in infected persons, except those on effective anti-HIV treatment or those rare persons whose immune systems are more effective in suppressing HIV (called "elite controllers").

3) Heterosexually transmitted HIV remains quite rare in most industrialized countries; and many swingers are tested frequently, as your friends said they are as well.

4) You can rely on the test results, which overrule your lymph node or any other symptoms you have now or may develop.
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36 months ago
Hello Doctor,

Thank you for your reply.

Can you tell me what is the difference between the HIV-1 RNA PCR qualitative test that I took and a a HIV-1 RNA PCR viral load test if is any? Will the test that I got always detect infection even if the viral load will go down or 53 days could be too late for the test to dectect infection?

 Let’s say that in the worst case scenario my Ab/Ag tests were wrongly performed so we consider them not conclusive, Will my HIV-1 RNA PCR Qualitative test performed on GenXpert machine at 53 days be conclusive on its own (I have seen in many posts that you and other experts don’t recommend this test as the only detection method for HIV and no further testing needed?

Can I be 100% sure that I am not putting my wife and newborn baby at any HIV risk?

Sorry for going on and on again on this but really need that extra reassurance to get my life back.

Appreciate all your help.
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H. Hunter Handsfield, MD
36 months ago
Those two tests are equivalent. I'm not an expert in the details of the lab testing procedures and cannot comment further. However, newly infected persons probably never have undetectable viral load as soon as 53 days. If and when that happens, it takes at least a few months.

I don't play "what if" games about highly improbable scenarios. These are not realistic concerns. If you remain worried about it, I suggest discussing with the provider(s) you seeing at the clinic. And yes, you can be certain you are not putting your wife or child at risk.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Do your best to go forward with no further worry!
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