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Confusion about New York State Testing website

Mar 6, 2008

Dear Dr. Bob, With all of the disinformation circulating on the web, you are a godsend. I live in New York and I had a very low risk exposure (protected oral with a high risk person) and I was considering getting tested (even though a Doctor I consulted feels it is unecessary based on my exposure). I went to the New York State website to find information about anonymous testing and read this doozy of a paragraph:

How soon after exposure can HIV infection be detected? With the HIV antibody tests used in New York State, virtually all people who are infected will test positive within one month of being infected. Most people will test positive even sooner.

The period between the time of infection and the time that a HIV antibody test can detect the infection is called the window period. During the window period, an infected person does have HIV and can pass HIV to other people, even if his or her HIV antibody test is negative.

So, if you HIV antibody test is negative, you can be sure that you do not have HIV only if you have not engaged in any HIV risk behaviors (such as having unprotected sex or sharing needles) during the past three months.

A PCR (Polymerase Chain Reaction) test looks for HIV directly instead of detecting antibodies. This test can find HIV infection as soon as the person is infected. It is usually used to find HIV infection in newborns. A different type of PCR test, called a viral load test, is used to measure the amount of HIV in the blood of someone who is already known to be infected. Doctors may suggest and HIV PCR test if they think a person has been infected with HIV in the past few days or weeks.


(the grammar and spelling mistakes are as they appear on the website, our government dollars at work)

Needless to say this paragraph left me even more confused. I'm hoping you can help me understand what they're talking about.

1. The first paragraph states that virtually everyone who is infected will test positive, with the tests currently used within New York State, within one month of infection, then a paragraph later states that if you test negative you cannot be sure that you are really negative unless the test was taken three months from the risky activity, what gives, if I'm testing in New York do I have to wait one month or three?

2. The Paragraph then mention PCR and states that PCR would be able to detect the hiv infection as soon as a person is infected, say what, I believe the CDC states that the eclipse period for a PCR is 10-15 days, some places state that it could take as long as a month, what gives?

Is New York spreading disinformation, can you help me understand what they're talking about?

Thank you so much for your valuable time.

-Confused in New York

Response from Dr. Frascino

Hello Confused in New York,

As it turns out, I don't think you are "confused in New York;" I think it's New York that is a bit befuddled at the moment. Well, at least the feckless individual who penned that policy statement. The spelling and grammar mistakes perhaps should have been a tip off that the author may have been a few beans short of a chalupa. So let's set the record straight (well gaily accurate anyway).

1. While it is true that improvements to HIV-antibody testing have allowed for earlier, more accurate diagnosis of HIV-positive folks, the published guidelines still use three months as the seroconversion window period. (That's consistent with chalupa's 3rd paragraph.)

2. There are two types of HIV PCR tests that measure somewhat different components of HIV and are used for different purposes. The HIV DNA PCR test is a qualitative assay used to detect cell-associated proviral DNA, including HIV reservoirs in peripheral CD4 cells. It is not considered sufficiently accurate for routine HIV screening (diagnosis) without confirmation. It is also not FDA approved for this purpose. It is however useful in resolving some cases of disputed or indeterminate serologic tests. The HIV RNA PCR is a quantitative assay that measures the HIV plasma viral load. The sensitivity of this test depends on the viral load, the threshold of the assay and the status of antiretroviral therapy. False-positive tests occur in 2% to 9%, usually at low viral titers (less than 10,000 copies per milliliter).

The paragraph referring to HIV PCR testing in the policy statement you quoted from the New York State HIV testing Web site did not differentiate between these two very different tests that both use PCR technology, thereby making that paragraph extremely confusing.

Turning now to your question, "protected oral" sex would carry an essentially nonexistent HIV-acquisition risk, assuming the latex condom was used properly and didn't break. Testing would not be necessary if this were your only risk (or more accurately, non-risk). However, if you wanted to get tested to calm any residual, even if unwarranted fears, you should wait until the three-month mark for a definitive and conclusive HIV antibody test.

Dr. Bob

thank u very much Doc. Bob!!
The unlucky guy???

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