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Anemia & HIV Part 2
Jun 7, 2009

I cant thank you enough for your precious answer to my previous question, you are the best. I just wish you can answer my below questions please, I beg you and I promise a donation for your well respected foundation. First let me mention that my last sex relation with my husband was 13 weeks before my test (no sex since, I am scared & worried), also to mention that he never came inside me (a bit of touch in the beginning maybe some precum) we always used latex protection at the end of the act (this has been a kind of rule in our relation). Coming to the questions but before that I promise you I will get tested at the 6 months mark as per you advice and I will donate. Questions: 1/ In case of infection shouldnt I have developed some antibody at 13 weeks that can be detectable knowing that ELISA 4th gen. is very sensitive for both antibody and p24? 2/ The Qualitative DNA PCR test that came negative (I know through reading your valuable site that this is not recommended as a confirmatory test for HIV by the CDC and should not be used so because of cost and because of false positive is more likely to happen etc.) but what about a false negative, can it happen also and at what stage of the infection or how? 3/ Please help me understand; wouldnt the Qualitative DNA PCR test have shown even a very small quantity of the virus in case of infection knowing that the last sex relation was 13 weeks before and that by then the virus should have been detectable? 4/ why the CDC recommend another test at the 6 months mark for person with significant exposure to an HIV+ confirmed person? My own understanding is that an exposure to an HIV+ confirmed or a person of an unknown status should be treated equal since we never know the status of the unknown person isnt it logic? 5/ what are the chances of a test coming back positive at the 6th month after the negative tests I had at the 3rd month? Have you heard of cases like that before? Please tell me your honest truth as usual. Sorry for being long, please Dr. Help me, maybe your answer will highlight some aspects to many of your worried readers. I am extremely anxious and will be so for the next three months and this is affecting my relation with my husband and two kids. Thanks you and May God bless you.

Response from Dr. Frascino

Hello,

Welcome back to the forum. Regarding your specific questions:

1. The vast majority of HIV-infected individuals will have detectable levels of anti-HIV antibodies and p24 antigen in their blood within four to six weeks following primary infection. Generally by the three-month mark routine HIV test sensitivity and specificity approach 100%. The CDC recommends for folks who have had a significant HIV exposure to someone known to be HIV infected that a six-month tests also be obtained to confirm HIV-negative status. Your negative fourth generation ELISA at 13 weeks is extremely encouraging. The odds are astronomically in your favor that you are HIV negative.

2. False-negative results are generally not a problem with HIV DNA PCR tests. Certainly there could always be a technical or clerical error, but in generally you can rely on a negative qualitative DNA PCR.

3. If you were indeed HIV infected 13 weeks or more ago, I would certainly anticipate the qualitative DNA PCR would be positive.

4. You'll have to ask the CDC that question. I didn't make that recommendation or contribute to that set of guidelines. I can tell you it has to do with statistical probabilities. In other words many folks get HIV tests for risks that are nonexistent at best ("grandma farted in her Barcalounger; do I now have AIDS?). Certainly these folks don't even need baseline HIV tests let alone follow-up tests out to six months. Other folks have negligible to questionable exposures ("a stripper kissed my Mr. Happy; do I have AIDS?"). Some of these folks need an HIV test for peace of mind to calm their anxiety and guilt. Certainly a 3 month test is more than adequate. Then there are lots of people who have a slightly higher risk exposure ("the condom broke; I withdrew immediately; I don't know the status of my partner"). Statistically speaking the vast vast majority of these folks will be HIV negative. Testing beyond the usual three-month window is therefore not recommended. Finally we have high-risk exposure like yours and mine. The risk of HIV transmission is obviously much more significant. There are rare reported cases of HIV seroconversion taking longer than three months in the literature. The guidelines most likely are erring greatly on the side of caution to make sure these documented high-risk exposures that are known to have higher probability of HIV transmission are very thoroughly evaluated. Holding all potential exposures to that standard of screening would not make sense statistically or scientifically or in terms of cost effectiveness.

5. The chances are nearly nonexistent in my experience.

Thank you for your donation to the Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's warmly appreciated. In return I'm sending you my good-luck karma that your final confirmatory HIV test remains negative. I'm very confident it will.

Good luck.

Dr. Bob


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