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please clear this up for me

Jul 25, 2007

i have read so many different things about the window period for HIV testing. when do most people test positive after being infected. It seems like 3 months or 6 months is the common answer but are these just to be safe or do most people really take 3 or 6 months to test positive.

Response from Dr. Frascino


I wish I could clear it up for everyone. That way confused folks wouldn't be constantly writing in asking me to clarify this admittedly confusing conundrum!

The vast majority of HIV-infected folks will have detectable levels of anti-HIV antibodies in their blood within four to six weeks. No one argues that point. The controversy comes into play for those relatively few people who take longer than the usual four to six weeks to seroconvert to HIV positive. For most situations without extenuating circumstances, I believe the three-month mark is adequate for HIV screening. Some, usually older and more conservative HIV guidelines, suggest a six-month test for a definitive result. Other newer guidelines in locations with availability to the most recent generation of testing assays suggest six weeks may be plenty. And then there are those extremely rare reports of delayed seroconverters that tend to drive the worried well 'round the bend. So you can see there is no complete consensus on this issue. I'll reprint a post from the archives that addresses the three-month versus six-month issue. You can read additional information in the archives and/or by doing a quick search of the entire site.

Dr. Bob

3months or 6 months ... and las vegas Jan 13, 2006

Hey Dr. Bob,

I know you've discussed this before but can you review it for us dummies just one more time? Please???Just a simple answer. Is the window period 3 months or 6 months?

Also, I just heard your Foundation's year-end raffle --- the Las Vegas vacation and $$$$-- has been extended until Jan 31st. I just bought 3 raffle tickets and I am so planning on winning!!!

Finally, how do I make an appointment at your office. I frequently come to San Francisco and really want a full evaluation.

Thanks doc!

Monty Carlos

Response from Dr. Frascino

Hello Monty,

I know you, and tons of others, would love a simple answer to this question. Unfortunately the answer just isn't all that simple. I'll reprint just one of my previous responses for your remedial review, OK?

Next, Vegas! Gosh, with a name like "Monty Carlos," I can see why you might like gambling. Your name sounds a lot like "Monte Carlo," one of the world's most famous gambling destinations. I had a wonderful (and profitable) time playing roulette there a few months ago. Gambling in a tuxedo while speaking French is just so damn civilized! Yes, my foundation's year-end Las Vegas Getaway raffle has indeed been extended to the end of January. The raffle ticket order form can be downloaded on the Foundation's Web site at Details about the prize and cash can also be viewed on the site. Good luck!

Finally, to make an appointment at the Frascino Medical Group, all you need to do is call and schedule a time! At least this part of your question really does have a simple answer! The office number is 650-917-1357.

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

Cure for HIV and Aids (CURE)
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