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After Negative PCR RNA - further testing wtih PCR DNA?
Aug 21, 1998

Dr. Holodniy

Like many others who have written to you. I too am attempting to determine if I have been exposed to HIV prior to seroconversion. My primary motivation is to start early treatment if infection exists since early studies for treatment during acute infection are so promising.

Question:

Four days after possible exposure I was started on PEP treatment (combivir) for 28 days. 2.5 weeks after exposure I tested negative by PCR RNA, although, I realize this could be a result of the meds. 5.5 weeks after exposure (1.5 weeks off meds.) I tested negative by the Elisa and I am awaiting another PCR RNA result taken at that time.

If this PCR RNA test is negative should I consider a PCR DNA test or any other test that might help identify acute exposure? I am somewhat concerned because I did experience various symptoms that could be associated with ARS. The only symptoms that have persisted are swollen lymph nodes in my neck and armpits.

Thanks ..........

Response from Dr. Holodniy

We don't have enough information yet to definitively answer your question. If infection were present and suppressed by therapy, then 1.5 weeks after stopping therapy should be long enough to see a detectable viral load (RNA). That conclusion is extrapolated from people who are infected and stop therapy. In the case of PEP, it is theoretically possible that HIV infection is present but not completely established, in which case it might take longer to see the emergence of HIV replication and hence a detectable viral load. A DNA PCR might have the same problem (ie limited number of infected cells in the circulation), but would be more likely to be positive because active replication is not required for detection. MH



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