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Author Topic: Question  (Read 1019 times)

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Offline Sharjah

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Question
« on: June 17, 2021, 01:13:52 pm »
Hello

My risk is that I gave very brief unprotected oral to a guy of unknown status. Probably for 30 seconds. There is conflicting info online. Did I have a risk?

I tested 28 days post incident. All results negative the test was a duo test. Again. What is the window period? The nurse told me the result was conclusive but again there is conflicting info online.

Finally. The nurse told me my 1 month test covered everything from this incident. However I have read online conflicting info about syphillis window period. Some says 99.9% after 28 days some says wait 12 weeks. I know this is not the forum specialist subject but do you have any knowledge or do you know any forums similar to this where I can ask the question?

Thank you for your help. I am desperate to move on with my life.

Offline Jim Allen

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Re: Question
« Reply #1 on: June 17, 2021, 01:26:37 pm »
Hiya,

If you had had a risk, I would have said test to confirm your HIV status with a blood-drawn HIV antibodies test at six weeks post-incident, a negative result at that time will rarely ever change. Although not generally needed if you wish, you can re-test at three months post-incident for peace of mind.

However, you had no risk to test over. See giving a blowjob, the mouth generally lacks a route for HIV to infect, even if you had gaping holes in your mouth like meth mouth saliva also acts to neutralize HIV by damaging the receptors needed to infect human cells. It's such a minute risk that we don't even recommend specifically testing over it.

Just get tested whenever you are next, normally due for a regular STI & HIV screening.

Syphilis testing window I am not going to comment on other than it does not alter the HIV testing window and as mentioned you did not need to test for HIV over this incident and that although there are plenty of STI's you could get from oral sex I would not recommend running out and testing outside of routine for them either.

Here's what you need to know to avoid HIV infection:
Use condoms for anal or vaginal intercourse, correctly and consistently, every time, no exceptions. Consider talking to your health care provider about taking PrEP going forward as an additional layer of HIV protection.

Keep in mind that some sexual practices which may be described as ‘safe’ in terms of HIV transmission might still pose a risk for transmission of other STI's, so please do get fully tested regularly and at least yearly for all STI's including but not limited to HIV and test more frequently if unprotected intercourse occurs

Also, note that it is possible to have an STI and show no signs or symptoms and the only way of knowing is by testing.

Kind regards

Jim

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Offline Sharjah

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Re: Question
« Reply #2 on: June 18, 2021, 04:33:51 am »
Hi Jim,

Thank you for the response. It is reassuring that I can expect a negative test. one question would be is why is there differences of opinion in window period? The nurse said 28 days (if there was a risk), surely if as you say 6 weeks is conclusive then her advice is risky?

I am not doubting you , just wondering why as the last few weeks have been so stressful.

Thank you

Offline Jim Allen

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Re: Question
« Reply #3 on: June 18, 2021, 04:54:34 am »
Well ill be frank I don't care about what the nurse said, but like all assessment details and testing guidelines here they are based on peer reviewed and scientifically backed evidence, not opinions although we do stick to the side of caution.

To explain in short, the median time to develop detectable antibodies is about 22- 28 days +-. A true four-week duo test provides high confidence with estimates in the 90-95% range, although some people take slightly longer.

The antibodies part of the test will screen against HIV 1 & 2 antibodies. The duo test also checks for p24 antigen in response to HIV 1 that is often present at detectable levels sooner but can drop off rapidly, by six weeks, a blood-drawn antibodies test or duo test you are looking at about 98%+ confidence.

We are conservative with the testing guidelines issued. Hence the recommendation to test at six weeks blood-drawn lab version, a negative result at that stage would rarely ever change. You can retest for a definite result for the rare/odd outlier at three months if you need that peace of mind.

If you are testing with rapid tests, they can be somewhat less sensitive to recent infections, and the rule of thumb is to wait and test at three months, and the result is considered conclusive.

However - From what you posted there was no real-world risk that warranted testing outside routine, so move on with your life. Use condoms, consider PrEP moving forward and test out of routine at least yearly.

Jim

---

2015
Taylor, D., Durigon, M., Davis, H., Archibald, C., Konrad, B., Coombs, D., et al. (2015). Probability of a false-negative HIV antibody test result during the window period: a tool for pre- and post-test counselling. Int. J. STD AIDS 26, 215–224. doi: 10.1177/0956462414542987

Patients typically want accurate test results as soon as possible while clinicians prefer to wait until the probability of a false-negative is virtually nil. This review summarizes the median window periods for third-generation antibody and fourth-generation HIV tests and provides the probability of a false-negative result for various days post-exposure. Data were extracted from published seroconversion panels. The median (interquartile range) window period for third-generation tests was 22 days (19-25) and 18 days (16-24) for fourth-generation tests. The probability of a false-negative result is 0.01 at 80 days' post-exposure for third-generation tests and at 42 days for fourth-generation tests.

Generation 3 & 4

http://i-base.info/guides/testing/test-accuracy-results-and-further-testing

http://i-base.info/guides/testing/appendix-1-different-types-of-hiv-test

Generation 4

2012
Rosenberg NE, Kamanga G, Phiri S, et al. Detection of acute HIV infection: a field evaluation of the determine(R) HIV-1/2 Ag/Ab combo test. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3318673/

Results. Of the participants 838 were HIV negative, 163 had established HIV infection, and 8 had acute HIV infection. For detecting acute HIV infection, the antigen portion had a sensitivity of 0.000 and a specificity of 0.983. For detecting established HIV infection, the antibody portion had a sensitivity of 0.994 and a specificity of 0.992.

2011
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222669/
Conclusions. Combo RT displayed excellent performance for detecting established HIV infection and poor performance for detecting acute HIV infection. In this setting, Combo RT is no more useful than current algorithms.

In total, 953 people underwent HIV testing. HIV antibody (Ab) prevalence was 1.8% (17/953). Four false positive rapid tests were identified: two antibody and two p24 antigen (Ag) reactions. Of participants diagnosed as HIV Ab positive, 2/17 (12%) were recent seroconverters based on clinical history and HIV antibody avidity test results. However, none of these were detected by the p24 antigen component of the rapid test kit. There were no other true positive p24 Ag tests.

https://www.cdc.gov/hiv/testing/clinical/index.html
2018
CDC recently published research findings that estimate the window period for 20 U.S. Food and Drug Administration (FDA)-approved HIV tests. The study showed that laboratory testing using antigen/antibody tests detects HIV infection sooner than other available tests that detect only antibodies. If a person gets a laboratory-based antigen/antibody test on blood plasma less than 45 days after a possible HIV exposure and the result is negative, follow-up testing can begin 45 days after the possible HIV exposure. For all other tests, CDC recommends testing again at least 90 days after exposure to be sure that a negative test result is accurate.

Bentsen C Performance evaluation of the Bio-Rad Laboratories GS HIV Combo Ag/Ab EIA, a 4th generation HIV assay for the simultaneous detection of HIV p24 antigen and antibodies to HIV-1 (groups M and O) and HIV-2 in human serum or plasma. Journal of Clinical Virology, S57-S61, 2011

Nick S Sensitivities of CE-Marked HIV, HCV, and HBsAg Assays. Journal of Medical Virology, S59-S64, 2007

Eshelman S Detection of Individuals With Acute HIV-1 Infection Using the ARCHITECT HIV Ag/Ab Combo Assay. Journal of Acquired Immune Deficiency Syndromes, 121-4, 2009

Speers D et al. Combination assay detecting both Human Immunodeficiency Virus (HIV) p24 antigen and anti-HIV antibodies opens a second diagnostic window. J Clin Microbiol 43:5397-5399, 2005

Ly TD et al. Evaluation of the sensitivity and specificity of six HIV combined p24 antigen and antibody assays. J Virol Methods 122:185-94, 2004

2020 http://www.bhiva.org/ https://www.bhiva.org/file/5dfceab350819/HIV-Testing-Guidelines.pdf
Recommendations (Grade 1A)

• Clinic policies and patient information regarding the HIV test window period should be based on 99th percentile estimates; where a test is undertaken sooner than this time interval, window period data should be used to counsel patients as to the likelihood of a false-negative result.

• Fourth-generation laboratory tests reliably exclude HIV by 45 days post-exposure, and this should be the window period applied when utilising these tests.

• Third-generation laboratory tests reliably exclude HIV by 2 months post-exposure, and this should be the window period applied when utilising these tests.

• POCTs reliably exclude HIV by 90 days post-exposure, and this should be the window period applied when utilising these tests.

2015 WHO http://apps.who.int/iris/bitstream/handle/10665/179870/9789241508926_eng.pdf;jsessionid=1F192FECF734A0DE7E2520864984AE63?sequence=1
In many settings post-test counselling messages recommend that all people who have a
non-reactive (HIV-negative) test result should return for retesting to rule out acute
infection that is too early for the test to detect. However, retesting is needed only for HIV-negative individuals who report recent or ongoing risk of exposure. For most people who test HIV-negative, additional retesting to rule out being in the window period is not necessary and may waste resources.

Generation 1/2/3

Pilcher CD et al. Performance of Rapid Point-of-Care and Laboratory Tests for Acute and Established HIV Infection in San Francisco. PLOS ONE, 2013.

Branson BM State of the art for diagnosis of HIV infection. Clin Infect Dis 45:S221-225, 2007

Coombs RW Clinical laboratory diagnosis of HIV-1 and use of viral RNA to monitor infection. In Holmes KK (editor), Sexually Transmitted Diseases. New York: McGraw-Hill, 2008

Maldarelli F Diagnosis of Human Immunodeficiency Virus infection. In Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases (sixth edition). Philadelphia: Elsevier Churchill Livingstone, 2004

Parry JV et al. Towards error-free HIV diagnosis: guidelines on laboratory practice. Comm Dis Pub Health 6:334-350, 2003

3rd gen testing accuracy Perry KR et al. Improvement in the performance of HIV screening kits. Transfus Med 18:228-240, 2008

« Last Edit: June 18, 2021, 04:57:55 am by Jim Allen »
HIV 101 - Everything you need to know
HIV 101
Read more about Testing here:
HIV Testing
Read about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read about HIV prevention here:
HIV prevention
Read about PEP and PrEP here
PEP and PrEP

 


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