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Window Period (WINDOW PERIOD)
Oct 13, 2006

Dr. Frascino: Many apologies if I am repetitive. To make things easier, if you want to refer me to an appropriate archived entry that is just fine. Through my searches however, I can't find anything to answer my question. Also, before I continue, I wanted to say I just made a contribution to your site. I don't include this information for any reason except to encourage others to contribute as well. Will you post your link in my reply, hopefully it will encourage others to give what they can.

A little background. I had unprotected oral sex from someone with unknown HIV status. I had tests (all negative, thankfully) at six weeks and four months. Are these tests conclusive? I think your answer will be yes.

Second question: why is there so much confusion about the window period. My doctor thought six weeks was generally fine. I don't hear six months anymore, except from the clinic where I got tested. They told me that my 4 month test was only 85-90% accurate.

Basically, one, if merited will you send me good karma and good wishes. Second, were my tests conclusive, and 3rd, though I have learned my lesson, for myself, and people in general, when is it safe to be assured of your test results? Many thanks.

Response from Dr. Frascino

Hi,

Certainly no apologies needed. The HIV "window period" is a confusing topic and recommendations can change as we learn more about HIV pathogenesis and the body's immune response to HIV infection and as we improve our testing techniques.

To answer your specific questions:

1. Is your four-month negative test conclusive? Yes! (You were correct in assuming I'd say "yes!")

2. Why is there confusion about the window period? Well, mainly because it's a confusing topic with all sorts of variables involved different and continually changing testing techniques, differences in host immunological responses (production of anti-HIV antibodies) that the tests measure, different guidelines put out by various agencies, different guidelines for different types of exposures, extenuating circumstances that may change testing parameters, etc. I'll post some information from the archives that hopefully you'll find helpful. Check out the very last post. It's a news release from today announcing yet another new HIV-screening test that may wind up changing the testing guidelines once again!

Next, good karma has been sent with my very, very best wishes!

Finally, thank you for your donation. Helping others in desperate need is an excellent way to keep our own problems in perspective and also a great way to rack up some excellent cosmic karma! I'll repost the link to my foundation per your suggestion www.concertedeffort.org.

Be well. Stay well.

Dr. Bob

Window Period Sep 6, 2006

Dear Dr. Frascino: I just recently made a contribution to your foundation. The only reason I mention it, is to encourage others to do so. Your work on this site and elsewhere is greatly appreciated and should be recognized.

My question is regarding window periods. I had an incident in April that put me at risk for HIV (relatively low). I was tested at three weeks, six weeks, and again after 16 weeks. Why is it that some people reccommend a definitive test after three months and others suggest that you need to wait for six months. Is my test at 4 months conclusive or should I go again at six months.

Also, what is the difference between the blood tests I got the first two times from my doctor, and the oral test I received at a clinic after 16 weeks (I couldn't wait for the blood test to come back, the 20 minute window helped my peace of mind).

Thank you!

Response from Dr. Frascino

Hello,

Thanks for your donation! (www.concertedeffort.org)

The three-month versus six-month question is definitely a QTND (question that never dies). I have tried to explain this conundrum many times in the past; however, I do realize it continues to be a source of confusion and worry for folks. I'll reprint just one of my attempts at explaining the rationale for the three-month window period below. If you're an avid forum reader, you might have noticed the current controversy has now been focusing on six weeks versus three months! You can catch up on that discussion in the archives, if you're interested.

Regarding the differences between tests, again this has been addressed many times in the archives. Have a look. The FDA-approved rapid tests are both accurate and reliable. We use them at the Frascino Medical Group (650-917-1357) on a daily basis.

Congratulations on your negative 16-week test. It is definitive, conclusive and WOO-HOO-able.

Stay well.

Dr. Bob

Robert James, this is your Mother talking Jul 26, 2004 okay so I am not your mother, but I do need some advice. You have said over and over if you think you were exposed test at 3 months, but you also say if you know you were exposed test to 6 months??? What gives? Don't quote the CDC. I want you to be straight with me, (there is a joke in there) Why are you not consistent? 3 months if I think and 6 months if I know! What is your opinion? I have had the works when it comes to symptoms and was diagnosed for 1 STD, all are gone except for the PN. This after a 1 time insertive exposure with a female who I fear has HIV. I had a neg elisa at 5 months. Do I need another test or not? And why the 3 or 6 months answers? P.S. and don't be straight the world loves you the way you are!

Response from Dr. Frascino

Hello Not My Mother, I do realize this issue is more than a bit confusing, so let me try once again to explain the rationale behind our advice. The question seems simple enough: three months or six months for a definitive result. The answer, however, is far from "straight" forward. The confusion results from variability in the immune response (time to produce anti-HIV antibodies) which is different from person to person, limitations in the test's sensitivity and specificity (ability of the test to pick up all true positives or eliminate all true negatives), and clinical judgment. In addition, there are special circumstances where our general recommendations for testing might not be applicable. For instance, when folks are simultaneous exposed to hepatitis C and HIV or when folks have previously received experimental HIV vaccines, consultation with an HIV specialist is often required to provide guidance on when to test and how to interpret the test results. Added to his are many very anxious folks who are absolutely certain they have contracted HIV, but in reality, have no identifiable risk. You know the type: "Grandma farted while trying to get out of her Barco-lounger chair. It smelled worse than usual. Now I'm convinced I've got AIDS." Of course, these folks require basic HIV prevention counseling and education, not HIV testing. But that doesn't stop them from getting tested "just to be sure," etc. So what would the answer be to these folks' "three months versus six months" question? In reality, neither, since they didn't need testing in the first place. And what about folks with some degree of potential ongoing exposure? How do we monitor their HIV status? So you can see this is not as straight forward as you might originally think. OK, back to your questions. The best I can do is take all the information provided to me from an individual questioner, apply the information concerning the limitations of HIV testing, the results of large-scale epidemiological studies, and the scientific facts pertaining to how HIV is transmitted, and then give the questioner my expert opinion and advice. Whether that person chooses to accept my advice or follow my recommendations is, of course, totally up to him or her. The reason I quote the CDC's published guidelines is that they are perhaps the most conservative set of published and well-referenced recommendations I have seen. So what can I, in good conscience and backed by science, advise? I can say that following a single possible or known exposure, the vast majority of infected persons will develop detectable HIV antibodies within three months of exposure. If the initial negative HIV test was performed within the first three months after exposure, repeat testing should be done at three or more months to rule out the possibility of a false-negative result within the window period. If the ELISA test is negative at three months or more after an exposure, the individual is extremely likely to be HIV negative. This is all based on statistical risk analysis and large-scale epidemiological studies. Now comes the confusing part. If a person was significantly exposed to a known HIV-infected person, the estimated statistical risks change and a second repeat test "might" be considered at six months or more from the exposure depending on the circumstances. And yes, there are very rare reports of seroconversion 6-12 months after a known exposure. The exact details of these very rare historical cases are a bit sketchy, but the reports do indeed exist in the medical literature. Today, however, extended follow-up testing beyond six months after exposure to rule out the extremely rare possibility of delayed seroconversion is not recommended, except under exceedingly rare circumstances that should be based on the clinical judgment of an HIV specialist. I realize some folks may find this response unsatisfying and perhaps unsettling. However, I'm here to provide you with the best confirmed scientific knowledge that we have, and that's the extent of our knowledge at this time. I'm also here to provide you with an expert opinion about that science. So let's proceed "straight ahead" (or should that be "gaily forward?") to your question. I would consider a negative ELISA test at five months following a "1 time insertive exposure with a female" of unknown HIV status to be definitive. I would not recommend additional testing. However, as always, the choice to follow my advice or not is totally up to you, whether you are my mother or not.

Good luck.

Dr. Bob

On the testing window, with a BUTT! Oct 3, 2006

Hey Mr. Sexy man,

I am one of the 10000000 aussies who worship you - the one who gave head to the sheila and was freaking out about it.

This is a question on the testing window - a specific one.

The question is coming up more and more often - I want to see if I am the one who manages to get a "different" answer.

Would you consider conclusive a negative 4th generation DUO P24/antibodies test done after seven weeks, after a low-risk exposure? (Giving a woman head).

You wrote before that "not everybody have access to those 4th generation tests, but everybody has access to my forums". I respect the fact that you might not want to publish a "yes" even if you thought that "yes" was indeed the answer. So, here's the deal: I will interpret a non-answer as a "well, yes, but I am not gonna say that in a WWW forum everybody can access".

It just means that I will do a (possibly unnecessary) 12 week test just to get your Woooo hoooo!!! But that's OK :-D

Hey,

My previopus message started with:

"Hey Mr. Sexy man,

I am one of the 10000000"

I was stupid enough to SIGN IT!!! Please delete my signature at the bottom of the message if you decide to publish it!!!

(Unsigned this time)

Response from Dr. Frascino

G'day Mate,

10,000,000 Aussies worship me??? Yikes, that's a whole lot of Oz-love coming my way. Guess I better stock up on the economy size condom multi-packs!

The general rule is that HIV-antibody testing prior to three months is not considered definitive or conclusive. I still agree with that. However, that said, I also still agree with my previously published opinion on the SYDSEX recommendation. I'll repost that below. So, as you can see, no, you did not get a "different" answer. In fact, you got exactly the same answer.

And don't worry, John Howard, we would never publish your name or signature. Ooops.

Dr. Bob

bobby can i get back on the Jobby?

Sep 26, 2006

hello bobby!!. I am yet another aussie, (actually i am a pom who came here for a holiday and decided to never go back to england), yes i am also one who likes to wear their cossies in an alluring fashion on Manly beach. However i am not another worry wort well not until recently anyway, i think reading that post from that other aussie who questioned the reliability of sydney sexual health clinics Six week TESTS put me in a spot of bother. You said that one should be quite confident in the reliability of those tests, anyhooo i am not a worrier rather an arguer i argued my way into another test at SydSexHealth at post 7.5 weeks they also threw in a DNA PCR test for good measure. it WAS negative whoopty f****g do i thought until i was reminded once agian of your universal recommendation for no test being reliable before 3 months. in a state of disdain i once again called up the nurses at SydSexHealth they raher politely told me to never come back again especially after my negative pcr. My question to you bob is this?? Am i kool, i mean offcourse i am kool in the paddington street sense..i dress allright have a trendy hair do etc etc do 150 push ups a day. BUT am i kool in the hiv sense? DO I NEED FURTHER TESTING?!!!!?? I really just want to believe these sydney std docs and go on minding my own businesss spending lazy summer afternoons listening to Maddonna while i work on my suntan on the beach because it has been rather hot here..also i wouldnt mind having sex again not worrying that i might give someone hiv so bobby can i get back on the jobby, Im sure you now what i mean? ;-)

love ya lots xoxoxo....johnno

Response from Dr. Frascino

Hey Johnno,

Paddington address, trendy hair, 150 pushups a day, cossie up the crack, Madonna on Manly Beach . . . yeah OK, you would qualify as Aussie-Boy Kewl, if it weren't for that wowser worrywart look on your mug. That is so un-kewl it makes you look like a cross between John Howard and Dick Cheney. I much prefer your whoopty f***ing do look.

The advice I gave Banana Bender hasn't changed. (See below.)

Do I think you need to spoil your kewl look with worrywart wrinkles? Nope. Can Johnno get back to Jobbo? Absoluto!

Stay well, Mate.

Dr. Bobbo

c'mon mate please help

Aug 30, 2006

oh cmon doc,,,i really need ur help...this is my 3rd time askin...im unemployed so im unable to make a donation...im just a student!!!...well i live in sydney australia...and i had a six week test done at sydney sexual health centre it was negative ,,,the DOCTORS at SYDSEX said ur result is conclusive and definitive..i argued with them quoting ur website ,,,they replied back that the internet is full of trash,,,,and that the modern tests in sydney are conclusive after six weeks.......so than i went to a reputable doctor near oxford street,,,,he said yep after six weeks ur fine,,and that he wouldnt get anoher test.....please answer me ,,,i really need ur help ....ive been traumatised ...all this conflicting information!!!!.......the HIV hotline in sydney also says six weeks is fine with modern aussie tests....and mind u this is SYDNEY,,,a first class city where hiv has been around since day one.....but i stlll dont believe this six week crap...but they wont even retest me...... what the hell should i do bob!!!!...i really need ur opinion mate ,,please answer me this time...whats the matter u'VE lost love for us aussie boys??....trust me ,,us aussies have lost no love for u...

cheers - RAT

Response from Dr. Frascino

G'day RAT,

Moi? Lose the love for spunky Aussie jackaroos??? No way, mate! I'm well aware of SYDSEX's recommendations. I'm also aware other countries' guidelines state six months in their guidelines. And there are some physicians who put the window period out to one year and beyond! The three-month guideline is the most universally accepted and I still believe, based on all the epidemiological studies, it's the most reasonable universally. Yes, it may be somewhat conservative in light of the improvements made in HIV screening (3rd and 4th generation assays, etc.); however, not everyone worldwide has access to these newer tests, but everyone does have access to what I post here. Also, no matter how good the test assays may be, there is still host variability. That means not everyone's immune system behaves in exactly the same manner. Some may take longer to produce detectable levels of anti-HIV antibodies for a wide variety of reasons. Consequently, my recommendation, at least for now, remains that tests taken prior to three months are not considered to be definitive and conclusive.

That said, I'm quite confident the six-week test in Sydney is indeed accurate, and I would not argue with their recommendations for folks getting tested there; although, there are extenuating circumstances in which I personally would extend the testing period (hep C coinfection, significant occupational exposures, etc.). Finally, the option to retest is always open to you, although you may need to pay for the test yourself, if your health plan refuses to cover it.

OK, banana bender, are we mates again? As always my affection for you guys stands out like a shag on a rock.

By the way, some Oz organizations would even like to shorten the six weeks window! See below.

Ciao bella,

Dr. Bob

Window period. Aussie policy.

Jun 13, 2006

Hi Dr Bob.

Just thought I'd share this with your readers. This is the current policy from ANCARD (Australian National Council of AIDs and Related Diseases). The passage below was taken from the 'Clinical Screening and Case Detection' section. Where there is reasonable concern about the risk of HIV infection, a patient with a negative test result should be retested one to three months after exposure or a specific event, and retested if there are clinical signs or symptoms. The seroconversion window period ranges from two to six weeks after infection (Schreiber et al., 1996). To identify very early infection, p24 antigen or nucleic acid amplification testing may be carried out. I found another officaial Aussie site that also suggested that when using current testing methods, one month is adeqaute to allow for detectable antibody production. I see that your 'New York Health Department' site also concedes that one month is ample time in almost all cases of seroconversion. Hope this helps ease the minds of some WW's out there.

Response from Dr. Frascino

G'day Mate,

Thanks for the information!

Dr. Bob

FDA Approves Qualitative Nucleic Acid Test Intended for HIV Detection October 10, 2006 FDA on Thursday approved San Diego-based Gen-Probe's qualitative nucleic acid test intended to detect HIV, Reuters UK reports (Reuters UK, 10/5). The test, called Aptima HIV 1 RNA Qualitative Assay, is a diagnostic test that detects the nucleic acid or genetic material of HIV 1 before the antibodies associated with the virus appear, according to an FDA release. "This product offers medical diagnostic laboratories the ability to perform a gene-based test for HIV 1 that, until now, was only available as part of a larger kit used to screen blood and plasma donors," Jay Epstein, director of FDA's Office of Blood Research and Review, said, adding, "This test also can detect infection with HIV 1 earlier than HIV antibody tests when used to detect primary HIV 1 infection" (FDA release, 10/5). The approval of Aptima comes one day after FDA approved Gen-Probe's Procleix Ultrio test -- which screens donated organs, tissue, blood and plasma for HIV 1 and hepatitis C and B -- the AP/Houston Chronicle reports. Gen-Probe announced that it will launch Aptima in November in conjunction with the Procleix Ultrio test (AP/Houston Chronicle, 10/5).



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