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Pooled NASBA
Mar 23, 2004

Dear Dr.Wohl,

I really admire your answers in this forum. It makes the whole reading experience extremely reassuring for people like us who are going through difficult times.

I recently tested Negative with an ELISA/NASBA (Nuclisens HIV-1 RNA QL) combo test conducted by the State of North Carolina Department of Health. This was 28 days after a possible exposure (UNPROTECTED INSERTIVE ORAL). I have read some literature that says that NASBA is comparable with PCR. Do you think the same ? Also this NASBA (which is actually a Nucleic Acid Test-NAT) was done on a pool of 90-100 ELISA negative samples as is the norm in NC under the STAT program that they are currently conducting. Dr. Chris Pilcher who conducts this test, says that the minimum limit of detection in this pooled concept is 2000 copies/ml.

Link for the STAT Program:

My risk factors are:

1. I am uncircumcized. 2. I did not notice any blood in the mouth of the lady (35 year old) who performed oral sex on me nor do I have any cuts/sores on my penis. However, she later told me she has gingivitis since she was 16, got her tooth extracted about a month before she performed oral on me and gets her tongue pierced regularly for tongue-rings (she was not wearing a tongue ring when she performed on me). So, I am not too sure about the blood factor.

Do you think that if I was actually infected, I would have either produced antibodies or had more than 2000 copies of virus/ml of my blood 28 days following exposure ? In other words, do you think I need to get tested again ?

thanks doc

Response from Dr. Wohl

You are very well informed so there is little I can add to your analysis except to offer that I think you did not acquire HIV during this encounter. I say this as your exposure risk was very minimal and if you had become infected chances are that at 28 days you would indeed have a significant quantity of virus in your blood.

The STAT program is very effective but new. At this point I would not take the existence of the program to mean that you should deviate from usual procedures for ruling out HIV after a significant exposure (i.e. a negative result should not dissuade someone from repeat ELISA testing at 3 months). In your case my own opinion is that your exposure risk is miniscule but if it would help you sleep better at night, get a repeat ELISA at 3 months.

Thanks - DW

Time for treatment?
thanks Dr Wohl- a truly grateful writer

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