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A definitive HIV Testing response please.
Apr 16, 2001

Hi Ryan. You're a stud! Thanks for your invaluble work in this Forum; even when you answer the paranoid, OCD,... I am a healthcare worked and use the resource often.

Background: To date, I am sero-negative. I had an unsafe incident very recently. I have some reason to be concerned. (I was the bottom, being penetrated by a treated, sero-postive top; his condom broke and neither of us was aware of it until he came inside me.)

Testing: I understand that if I take a western blot/anitbody test, nothing may show, should I sero-convert, for up to 6 months. If I took a PCR/virus load test, today, three days after the incident, and I was infected on Friday, would actual virus show up? this soon?

I'd like to know because if so, clearly that's the test I would like to have done. As well, I would consider having some kind of PEP done immediately, before the onset of acute viremia...

Next Steps: If I wanted to get a PCR done, and possibly PEP, where in New York City could I do so? I do not want to go through my MD, insurance. I get rtesting regularly, for the last 8 years, every 6 months, in a publis clinic. What ASOs, if any, offer this service?

Thanks in advance for your help.

Response from Mr. Kull

Unfortunately, you are right about having some reason to be concerned. However, a one time exposure to an HIV positive person does not guarantee infection (see "Serodiscordant male couple anal sex" http://www.thebody.com/Forums/AIDS/SafeSex/Archive/TransmissionSexual/Q2984.qna).

You bring up a lot of important questions, so I'll try to answer them point-by-point:

1) Your PCR test three days after exposure will not be meaningful enough to determine whether or not you've been infected. PCR testing is not approved for diagnostic purposes. It is possible that virus would be detected, but a negative PCR will not be definitive enough. You also need to be aware of higher false positives on PCR tests, so confirmatory tests are absolutely essential. A p24 antigen test is more reliable and meaningful in the early weeks than a PCR test.

2) For post-exposure prophylaxis (PEP) to be effective, medication probably needs to be administered within 32 hours of exposure. Taking medication after that period will probably not prevent infection and can only be classified as an early intervention. There is some research that shows benefits to having primary infection intervention with antiviral medication.

3) You cannot get PCR testing in New York State without the state being alerted to it. You can only get anonymous antibody testing through certain state run clinics. Most sites are confidential at this point. Insurance companies do not have access to HIV results that are performed by your doctor or the state, but they can require HIV testing for enrollment. If you currently have health insurance, the results of your PCR or antibody test cannot and will not affect your entitlements. If you don't have health insurance, do your best to find a plan you can afford, PRONTO.

4) I do recommend that you speak with a doctor about your situation, or find a doctor in New York City that has experience with HIV. In case you have been infected by your partner, you are going to want to know all of your options based on the most up-to-date information.

For more information about your testing options through the Department of Health, call 1-800-TALK-HIV.

RMK



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