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Terrifed and Heart Broken
Feb 8, 2008

I posted this questions yesterday and of course I haven't had a response yet, with all that you do I know you are very busy. I have read through a number of your forums looking for an answer to my question and haven't found it. I hope you will help. I am a middle aged female who has been in a monogomous relationship for 25 years. About 4 weeks ago I did an incredibly stupid thing that I will regret until the day I die. I started to have unprotected sex with a male of unknown HIV status. After a few seconds I came to my senses and stopped. He did not ejaculate, and to be honest I'm not sure there was even penetration (I was intoxicated though). The guilt of this incident is eating me alive, I have told my husband and we are trying to work through it together. I called the aids hotline and they said to get tested in 6 weeks, I already have the appointment for a rapid test. It appears that you recommend that to be sure that you test again at 3 months, should I retest? The aids hotline told me that if there were no antibodies at 6 weeks I was all set. I have been reading symptoms and postings on your site and realize that my sore throat and tiredness probably have nothing to do with my potential exposure but of course mentally I'm convinced I have HIV. This is a nightmare and I need your help to understand my risk and what I should do to protect myself and my wonderful family. Thank you for all that you do to help others.

Response from Dr. Frascino

Hello Terrified and Heart Broken,

Your HIV-acquisition risk would be minimal, but not completely nonexistent. The odds are astronomically in your favor that you did not contract the virus from this extremely brief lapse in judgment. The current testing guidelines recommend an HIV-antibody test at the three-month mark. I am aware that some testing centers are recommending shortening the "window period" to six weeks (see below), due to improvements in the testing assays. However, at this point, for a number of reasons, I continue to recommend the three-month window period. As for what you need to do to protect your family, really not much! HIV, even if you did have it, is not transmitted by casual conduct. I would recommend you use latex condoms with your husband until your definitive test results are back. I also would encourage you not to be overly anxious. Read through the archives of this forum. You should find the information and testimonials there both enlightening and reassuring. By the way, I am glad you leveled with your husband.

Good luck.

Dr. Bob

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).

I think ur going to win the toaster Nov 20, 2007

Whaz up Dr. Bob,

Im in a bit of a dihlema. Had unprotected vaginal sex with a csw, and I have been freakin out for the past 7 weeks. Have had some red spots on the palms of my hands that seem to come and go( no pun intended)I got tested via hiv pcr dna at 18 days as well as 28 days along with antibody test negative. Then tested negative for rapid hiv at 5 1/2 weeks as well as 7 weeks. I am a complete worry wart being that I have major ocd. Had all other test run (chlam.Gon.,Hep a,b,c.,Shyphilis)all negative.)My doc. is from Boston area, and told me 6 weks in conclusive and to move on, but I am torn because of the debate overthe window periods. Can you please give me ur profesional opinion. Do i need to continue testing or does it look like im in the clear. By the way im the the gayest str8 man on earth( real picky as well) but if I made the switch, U would be the one. Im sure u hear that all the time, but its the truth. Holler back at ur boy if u get the chance.

Response from Dr. Frascino

Hi Metrosexual OCD-er,

The vast majority of those infected with HIV will have detectable levels of anti-HIV antibody in their blood by six weeks. However, a small percentage of folks may take a bit longer to develop this level of immune response.

Because the consequences of missing even a small percentage of true positives would be catastrophic, the current guidelines continue to recommend that HIV-antibody screening tests be performed at the three-month mark. HIV-antibody tests taken prior to this are not considered to be definitive. Your negative tests at 5.5 and 7 weeks are extremely encouraging, but not yet definitive. Regarding the PCR DNA, PCRs are not recommended for routine HIV screening.

Thanks for putting me over the top for the toaster oven.

Stay well. Good luck.

Dr. Bob



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