OraQuick Accuracy when on PrEP/ART

[stuartlittle]

Hey all. First off, thank you moderators for the incredibly helpful and consistent information. With all of the truly terrifying inconsistencies in data, symptoms, blah blah blah you can find on the internet, hearing people with real, first-hand information talk about things in a consistent, clear, and succinct manner is a refreshing reality check.

I understand that OraQuick oral swab testing is not intended for people on PrEP or other antiretroviral therapy. Wondering if there is any further information about why that is? Is it something to do with how the test works or how PrEP or ART functions? Also, if a person on PrEP took one anyway, how accurate/reliable can those test results be considered, realistically? I guess what I’m asking about is an off-label use of the test, which I recognize is obviously not ideal...

Here’s the situation: It’s possible that my partner was exposed shortly before beginning PrEP. He had been on it, but lapsed for about 2 weeks because of an insurance situation. During that lapse, it’s possible he was exposed. He then tested negative with a lab blood test, and was then prescribed Descovy, which he began. We are now at the 6-week point, and getting another lab blood test done this weekend, which I understand is - for the large majority of cases - fairly conclusive, since most will have seroconverted after 22 days, on average. (Been reading these boards carefully!) A couple days ago he took an OraQuick oral swab test and was negative. Is there any world where that’s helpful/hopeful?

Thanks for any help you can offer. Fingers crossed.

[Jim Allen]

Hiya,

In short, taking HIV meds may increase the window period for testing.

Hence as an example when someone is taking PEP we say to test with an approved blood-drawn HIV antibodies test 6 weeks after finishing PEP for a result, this result will rarely ever change. 3 months after finishing PEP remains definite although, it's not really needed to retest. If testing with a rapid test then test at 3 months post finishing PEP.

With PrEP delay can happen as well, although same as with PEP fairly rare and as part of the PrEP routine people should be testing more routinely as a standard for HIV & STI's, so every 3 months.

Any negative test results your partner has is a good thing, however regardless of his test results, just keep looking after yourself so use condoms and consider talking to your healthcare provider about taking PrEP as an additional layer of protection.

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 starting PrEP as an additional layer of HIV prevention going forward.

Keep in mind that some sexual practices which may be described as safe in terms of HIV might still pose a risk for transmission of other far easier to acquire 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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Few ref.

2015:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4641668/

2017:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5578893

2017:
https://www.poz.com/article/taking-prep-contracting-hiv-may-stall-positive-test-result

[stuartlittle]

Thanks for this info! Just to clarify/follow-up: aside from a possible delay in seroconversion (or assuming that seroconversion has in fact already occurred) is it even possible for the OraQuick oral swab test to detect antibodies in a person who is on PrEP? I’ve read a bit about one case where the use of PrEP after a recent infection seems to have caused a “blunted” infection, where antibody levels were low enough to slide under the radar. Not sure what to make of that.

When you say “fairly rare” what do you mean? A delay in seroconversion?

While I know that any negative result is a good thing, I guess what I’m wondering is, knowing what we do about the tests and the data, what we might expect from the blood test this weekend? Again, we’re at the 6 week mark, and his oral swab results were negative.

[Jim Allen]

Hiya,

where antibody levels were low enough to slide under the radar. Not sure what to make of that.

Yes, as said taking HIV meds may increase the window period for testing.  The tests can pick up on the antibodies, the problem is whilst being on PrEP it might take longer for antibodies to be produced at levels that would be detected.

I guess what I’m wondering is, knowing what we do about the tests and the data, what we might expect from the blood test this weekend?

Look I can't give your partner an assessment through you, for a number of reasons not to mention that it's 2nd hand information you are giving me.

All I know is you think your partner is on PrEP and they may have had at least one exposure that you know about before taking PrEP... As part of PrEP your partner should be testing more frequently at least every 3 months and this in part is because PrEP could delay test results so a false negative.

Continue to protect yourself.