Why is the RNA test offered and will we see a change in CDC guidelines?

[Julianbos]

Hello

This is a great website and I really appreciate all that you do to try to calm the feverish mind (mine in particular over the last 3 weeks)!

I had unprotected insertive anal sex (I was the top) on Mar 30 with a male SW.  It was a very foolish and stupid mistake.  It was my first experience with anal sex but that is no excuse.  The SW said he tested negative 3 weeks prior but that was still very silly, I accept and acknowledge that.

Post the encounter, I developed a sore throat and balanitis within a week which of course sent my mind into feverish (I did not have a fever) fear.  I researched a lot of medical reports and became aware of the statistics, testing window period, types of tests, symptoms, etc.  Rationally, I knew the statistical risk (I am NOT justifying my stupid behavior) and that symptoms are poor indications of whether I have contracted HIV. 

So I went for a full STD panel with a rapid Oraquick Advance test on the 15th day after the exposure.  The rapid test was negative.  I knew the statistics and I also knew the window period issue.  So I insisted on a RNA test out of pocket.  I was treated for gonorrhea and chlamydia as a precaution.  However, that induced diarrhea which added another ARS symptoms in my mind  I know I was being irrational but fear is hardly rational.  I probably spent 80 hours in two weeks "researching" and losing sleep.

Today I received the results, all the STD tests were negative and the RNA test was negative (<70 copies/ml).

I know the window period and CDC guidelines and I intend to test again in 3 weeks and 9 weeks to give myself final peace of mind.  The question I want to ask is something I know rationally no one can tell me on the forums and I will get the final answer in 9 weeks. 

Setting that aside, I have the following questions to ask:

1)  If the RNA test is not conclusive, why is it offered and recommended (I know I asked for it) by some medical professionals? 
     - I have seen documented cases of the RNA test showing a false negative at 6 days post exposure.  Is there any documented literature about RNA tests with false negative at 2 weeks post exposure?  If that is the case, why is the window period for a RNA test two weeks?
     - I am aware that people under HAART can have undetectable viral loads but everything I have read suggests that in the initial phase of infection (1-4 weeks), the virus is replicating into the hundred of thousands of copies/ml.  If that is the case, why isn't RNA testing conclusive?  Is it because it is still unclear of how the HIV virus replicates itself post exposure in the human body? 

2)  CDC guidelines is for 3 months but very respected HIV researchers are saying 6 weeks is conclusive.  Both MA and Australia have adopted this standard.  (I was tested in Boston).  I understand this has to do with the effectiveness test of the 3rd versus 1st generation of antibodies testing.  Will we see a further compression of the CDC guidelines?

I am sorry for the wall of text and I hope the questions made sense.

Lastly, after going through the self induced pain, I would say that safe sex is your only protection.  The statistics does not matter as all it takes is one exposure and it is not worth the agony of not knowing and fearing given the window period of HIV.

Thanks for your help
Julian

[Andy Velez]

Julian, let's just stick with your situation rather than getting into more abstract details. We're really not interested in the why of other sites or the CDC's possible changes in the future. The RNA PCR was never intended to be a diagnositc test.

Nor is the status report that anyone whom you are with, whether a sex worker or a civilian, worth anything in knowing your HIV status. Often even a well meaning person doesn't know their status accurately.

Yours is the only test confirmed status that matters. You can do an HIV test initially at 6 weeks. The average time to seroconversion is 22 days. All but the smallest number of those who are going to seroconvert will do so within 4-6 weeks after an exposure. It's necessary to do an HIV  test at 13 weeks/3 months for a conclusively negative result.

HIV is not easy to transmit. It is a fragile virus. Your being the the insertive partner puts your risk at a significanly lower level than if you had been receptive unprotected. And it was a single time. All of those factors weigh in your favor against infection having taken place.

But lower risk is not the same as no risk. So you need to learn from this experience. You can have anal sex as often as  you want to in either position and with as many partners as you want to. But you need to do it the safer way which means always without fail the insertive partner needs to be wearing a condom. No exceptions no matter what you think you know about the person's history or how great he looks. A condom everytime is the way to go.

Good luck with your test and hopefully you'll make it through safely this time.

[Julianbos]

I am aware of the 3-5% false positive of a RNA test and it would be absolute HELL if it came back today in that range.  I know and I will test in 3 and 9 weeks but I have to say it gave me some peace of mind today. 

Hopefully HIV tests gets improved and they can shorten the time frame for testing as it would be vast improvement to mental health all around.

The last three weeks is a experience I would not wish on anyone.  I have read up on the odds, no matter how in favor it is, its a roll of the dice I will never take again.  Lesson learned!

Thank you Andy.

[Andy Velez]

You're welcome.

You'd be better advised to test at 6 weeks initially. A negative at that point would be much more meaningful than at 3 weeks, but it's up to you of course.

[Matty the Damned]

Julian,

I'm not sure where you get the idea that 6 weeks is now the official window period in Australia. I'm in Australia and, as far as I can tell, the official window period here is still 12 weeks.

MtD

[Julianbos]

MtD, I recall seeing it in my search over the last two weeks but I don't have any official links to provide.  My mistake.

Andy, I will test in 3 more weeks which will be 6 weeks post exposure, sorry for the confusion.  9 more weeks will make it 12 weeks post exposure and CDC guidelines.

[Andy Velez]

OK. Good luck.