[Question #9535] HIV RNA PCR

31 months ago

Doctor, good day. I am gay. Sex happened 14 days ago. But the condom broke. It's possible he has HIV. It took like this for 2 minutes. Today is day 14. I had the HIV RNA PCR test. ( 1 IU/mL of HIV is equivalent to approximately 0.70 copies/mL of HIV. ) The test result will be out soon. If negative, can I close the issue?

1) If the HIV PCR RNA is negative on the 14th day, what is the probability that the 4th generation test will be positive on the 28th or 42nd day?

2) How reliable is HIV RNA PCR on day 14?

3) If the virus is less, will it be positive later? 0.70 copies rna pcr

3) Does the use of antibiotics have consequences?

H. Hunter Handsfield, MD

31 months ago

Welcome back to the fourm. I'm happy to help.

You don't describe the nature of the contact. Anal sex? Were you the insertive (top) or receptive partner (bottom)? Did you ask your partner his HIV status? Was either of you taking pre-exposure prophylaxis to prevent HIV (PrEP)? (Among MSM, nobody should ever have anal sex, even condom protected, without first discussing mutual HIV status. If your partner doesn't have it or if on effective anti-HIV drugs, of course there is no risk.) Not knowing these details, I will assume it was anal sex either top or bottom, and also that sex stopped quickly after the condom broke.

1,2) The RNA test would detect around 95% of infections at day 14, so a negative result will be highly reassuring but not conclusive. In that event, your plan for a follow-up AgAb (4th generation) blood test is exactly right. You can do it at 4 weeks: although 6 weeks is required for certainty when this is the only test, the combination of negative RNA at 2 weeks and negative AgAb at 4 weeks is conclusive.

3) Ignore numerical values below the positive/negative cut-off. If that cut-off is 0.9 (which is usual), any value below that (0.1, 0.5. 0.7) is equally negative and means no virus was detected.

4) Antibiotics have no effect against any virus, including HIV, and cannot affect your HIV test results.

Have you been tested for other STDs? What antibiotic(s) are you taking?

I hope these commetns are helpful. Let me know if anything isn't clear.

HHH, MD

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31 months ago

yes anal sex and I at the bottom. My partner said it could be HIV. I did not use prep. The condom broke and we found out later. Unfortunately there was exposure. antibiotic: Augmentin drug.

Hiv rna pcr test result will be out tomorrow. It says 0.70 copies. If it is negative, I will test again on day 28 (4th generation), but what are the chances of being positive on day 28? If pcr rna is negative on day 14.

H. Hunter Handsfield, MD

31 months ago

Most of your follow-up comments may not be visible, but I was able to dig below the surface and see them. (If you are using a word processing program, please stop and directly type your responses. Thanks.)

So I understand no PrEP, you were the receptive partner, and you didn't realize the condom had broken until after your partner finished. I'm not sure how to interpret "My partner said it could be HIV". Does that mean he knows or suspects he is infected? If so, you should have requested post-exposure prophylaxis (PEP). However, even without PEP, if your partner has HIV, your risk was about 1 chance in a few hundred of being infected. Treatment with amoxicillin/clavulate (Augmenting) makes no difference in HIV risk, but would have reduced the chance of gonorrhea and syphilis if exposed, and maybe chlamydia. Still, the safe thing would be to have rectal swab testing for gonorrhea and chlamydia, if not yet done, and a syphilis blood test in a few weeks.

I do not understand how you know that your RNA PCR test shows 0.70 copies, since the result will not be out until tomorrow. If it indeed shows 0.70 copies, it is a negative result and means that no HIV RNA was detected. As I already said, such a result would be about 95% reliable, and therefore 95% certain your AgAb (4th generation) blood test will be negative on day 28.

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31 months ago

No, I didn't say it was 0.70.

I had a test like this before. and the explanation read: The linearity limits of the test are 1x10^2-1x10^8 IU/mL.

1 IU/mL of HIV is equivalent to approximately 0.70 copies/mL of HIV. I wanted to point this out.

some doctors say hiv pcr is definite after 11 days. You say 95% for the 14th day. I trust you. It is very difficult to wait 28 days. I will have the 4th generation test on the 21th and 28th days

I'm scared :( . thank you very much doctor.

H. Hunter Handsfield, MD

31 months ago

So why not speak with your partner and confirm whether he knows he has HIV or has been tested recently and negative; or if positive, whether he is on effective anti-HIV treatment? If he is, probably he will share that information, and likely is not able to transmit the virus. If he is not known to be infected and hasn't been tested recently, perhaps he would do it now. This approach probably has the best chance of assuring you were not possibly exposed or infected, a lot sooner than waiting for test results.

If that not practical, if your RNA test is negative, you still can pretty much stop worrying. 95% is very high reassurance on the basis of your 14 day RNA test. If your partner does have untreated HIV, it makes the chance you were infected under 1 in a thousand. If your AgAb test is negative at 21 days, it will be nearly 100% proof.

Whatever happens now, this should be a teachable moment for you: no male should ever have sex with another male without first discussing HIV status and either not having sex at all or at least paying special attention to safe practices (for example, no anal sex) with partners who are positive and not on treatment, those who don't know, and those who seem hesitant about replying.

Threads normally are closed after two follow-up exchanges, and we're there. But I'll leave this open for one more cycle so you can let me know your RNA test result, if you wish to do so.

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31 months ago

The results are out today. result: Not detected. Reference Value: Negative

14th day HIV Rna pcr negative thank god. I was very afraid.


Also on days 21, 28, and 42 (I will have a 4th generation test)

Is the 21st day enough? Or can I close the issue completely on the 28th day? Thank you very much for the answers. I trust you. You are a very good doctor so I trust you. thank you

H. Hunter Handsfield, MD

31 months ago

Once again you have used some sort of input (from another word processing program) that does not display. Using editing format, I see your RNA result is negative at 14 days and you are planning on AgAb (4th generation) blood tests at 21, 28 and 42 days. As I said above, it is now almost certain you do not have HIV. The negative result at 21 days will confirm that, and a 28 negative result at 28 days will prove it 100%. That result plus negative RNA at 14 days is conclusive.

That concludes this thread. I hope the discussion has been helpful. You can stop worrying: you do not have HIV.

Best wishes and stay safe.

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