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gay sero-discordant relationship (MAGNETIC COUPLE PROBLEMS) (SHOULD I DUMP MY POSITIVE LOVER)
May 19, 2008

Hi,

My bf is HIV+, I am not. I thought I could handle the pressure but Im thinking again. I dont know. He is a great guy and would be "the 1" in an ideal world. I read the archives and understnd you are in a happy magnetic relationship, which is why I write to you- maybe you can help. I have several questions on several levels.

When we initially met he was not diagnosed as hiv+, as I started dating him in the window period. We always had safe sex. I got tested 4 weeks into the relatinship and was neg. The 3 month mark is coming up in June and will get tested again.

I have a difficult time forgiving him for having been irrisponsible with his body. We got tested together as the realtionship progressed. I am incessantly angry and regretful. So much so, its consuming me and why I dont think I can cotinue. I do love him but cant stop thinking about what could have been. I am also extremely fearful on contracting HIV. Indeed, I understand that there are low risk practices we can adopt. But low risk is still a risk and do not think I can continue like that.

I am scared of contracting HIV. I have always been the "top" and always used condoms without slippage/breakage. We make out passionately (tons) and I had a large open wound in my lip (he had none) and understand that this is minimal/non-existant risk. With respect to oral sex, he has never come in my mouth and recently I have only been the reciever.

My concern is that I have a very severe tonsilitis- white spots on tonsils, swollen tonsils, temperature, hearing muffled, bed ridden, etc. No other rashes or symtpoms that do not coincide with anything else but tonsilitis. I am naturally scared of sero-conversion and the acute phase. I know that we cannot diagnose sero conversion on symtoms which is why I want a test asap. My last contact with him was 11 days ago- are there any tests that are 100% reliable that allow for a shorter window period than the 3 month window? I understand there is the HIV Duo Test or HIV 28 Day Test - includes HIV p24 antigen. This claims to detect HIV 28 days after the event, and the p24 effective 11-16 days after. Is this true?

Understanding that the tonsilitis is viral, is it possible for some of these test to mis-interpret antibodies to the tonsilitis as antibodies to HIV and therefore give a false positive?

Looking forward to reading you shortly. Thanks.

Response from Dr. Frascino

Hello,

Let's deal with your tonsillitis and testing issues first and then turn to your relationship concerns, OK?

First, why assume the tonsillitis is viral? It could very well be bacterial. I would suggest you have your general medical doctor take a look and do a strep (and maybe gonorrhea) test. I agree you do not have the usual constellation of symptoms that would suggest HIV acute retroviral syndrome (ARS); however, symptoms associated with ARS are so variable you can't really rely on what's "usual!" I agree with your decision to get tested.

Regarding HIV-screening tests, yes, they are getting more sophisticated and this may well shorten the HIV window period. (See below.) Some testing sites have indeed changed their window period guidelines. (See below.) However, the majority of published guidelines, including those from the CDC, still recommend an FDA-approved anti-HIV antibody test (ELISA, EIA, rapid test, etc.) at the three-month mark as the best and most accurate test to take for routine HIV screening. Claims of accurate test results at 11-16 days have yet to be validated. As for tonsillitis (viral or bacterial) causing a potential "false-positive" HIV-antibody test, no, this is not a problem.

Turning now to your relationship issues. You mention your great guy would be "the one" in an "ideal world." Well, unfortunately the "ideal world" as you're defining it exists only in your imagination and in fairy tales. Our existence, I've come to realize, is a series of unscheduled events . . . sex, love, illness and actually even life itself can all be considered unscheduled events of our relatively brief sojourn on this marvelous planet.

Perhaps your boyfriend had a lapse in judgment that led to his seroconversion. Or perhaps it was a condom failure or some other type of accidental exposure. Was he really so "irresponsible?" The virus found me while I was working. I sustained a hollow-bore needle puncture and laceration while performing a medical procedure on a patient with advanced-stage AIDS. Was I "irresponsible" for being clumsy or perhaps hurrying too much that day and not taking extra, extra precautions??? I could have avoided the exposure if I referred the patient to someone else rather than caring for him myself. Was I being irresponsible by risking my future "ideal world?" No. I don't believe so. Life didn't work out the way I planned. I've learned life seldom works out the way anyone plans it! And that's a crucial point. Folks who can take life as it comes with all its twists and turns and "unscheduled events" are generally those who are happiest and, in the broad sense of the word, most successful in enjoying our all-too-brief existence. Those who can't adapt don't usually survive. And if they do, they tend to be remarkably unhappy. Just take a read through the archives and you'll meet gazillions of extremely unhappy folks who are having incredible difficulty adapting to various situations. A really amazing group are the ones who can't adapt to (or believe) their negative HIV status!!! They are convinced they must be HIV positive. This is usually based in guilt, irrational fear and unwarranted worries. But here they are clamoring for reassurance from me, an HIV-positive guy, because they are so miserable being HIV negative!!! My happiness is directly related to my adaptability. For instance, I never planned to be president of a not-for-profit foundation that raises money for needy HIV/AIDS causes worldwide. This opportunity merely evolved from my "unscheduled events". But I'm extremely pleased and proud to be doing this work. In many ways I'm reaching and helping more folks in desperate need doing this work than when I was seeing patients full-time in my medical office. Challenges can become opportunities. Perhaps what I am doing now is my actual "ideal" work world and not the one I imagined when I was in medical school!

Regarding your being "incessantly angry and regretful, so much so, it's consuming (you)," that is obviously an unworkable situation for you personally and will eventually poison your relationship. That you "can't stop thinking about what could have been" is preventing you from enjoying and appreciating what "is"! I would recommend couples counseling for you and your lover. You need to confront and explore these feelings and your lover needs to know exactly how you feel. Much of it, as you rightly intimated, could be rooted in your long-standing (and largely irrational) fear of HIV. This issue will require counseling as well. Interestingly enough you've learned to accept other low-risk activities in your life driving in a car, perhaps sometimes above the posted speed limit or through a yellow caution light; flying in an airplane; walking in the rain (lightening could strike!); etc. Some folks take even bigger risks hunting with Dick Cheney, voting for Dubya, etc. and yet still remain irrationally fearful of, say, itsy bitsy spiders or garden snakes or lap dances at the Badda Bing. Ultimately, when you really put HIV risk into its proper perspective, it becomes much less frightening. Yes, low HIV risk is still a risk, just as low risk for potential car crashes remains a low risk every time you hop behind the wheel to go to the local Piggly Wiggly for a carton of Ben and Jerry's. No one is denying that. How you choose to live with those risks is up to you.

As for your Mr. Right being "virally enhanced," well some (many) folks would trade places with you in a New York Minute, if indeed this guy is your ticket to Happily Ever After. So many folks never meet "the one." To use a card game analogy, in life we really can't control the hand we are dealt; however, how we choose to play those cards is totally up to us. So do you play or do you fold? The choice is yours. I will tell you that should you choose to fold because of HIV, there is an excellent chance someday in the future you'll be singing "The One that Got Away Blues" and perhaps your comment, "I do love him but can't stop thinking about what could have been," will take on a whole new and tragic significance.

Good luck to you both.

Dr. Bob

QUICK & EASY - WINDOW PERIOD OPINION Mar 29, 2008

Dear Dr. Bob,

Some other MD's like Dr. HHH al medhelp.org says that a negative antibody test taken at weeks 6-8 is nearly 100% accurate. Why does he say that?? Do you agree with him??

I've seen in several posts answered by him, how in low-to-non-risk situation people is sent home free with a 6-8 negative test.

i know what you are going to tell me .. and the three month mark .. and everything.. I just want your medical opinion regarding what doctor HHH say: ~100% accurate @ weeks 6-8. Do you agree with him??

Txs doc My best wishes for you.

Response from Dr. Frascino

Hello,

I cannot explain another physician's opinion. You'll have to ask him to justify his statements if you don't agree with them. I base my comments on sound scientific research and personal experience.

Regarding HIV-antibody tests, the vast majority of HIV-infected individuals will have detectable levels of anti-HIV antibodies in their blood within six to eight weeks. There is no disagreement on that point. The published guidelines recommend a window period of three months. Ultimately, as our testing techniques continue to improve and become more widely available to testing sites worldwide, the published guidelines may well shorten the window period. Some specific testing sites (Australia) have published guidelines with shorter window periods based on their testing methods. However, so far the national guidelines in the U.S. and most international guidelines as well continue to recommend three months. One could make the argument that even if HIV testing catches "the vast majority" or even "nearly 100%" of HIV-positives, that is not good enough when dealing with an illness as catastrophic as HIV/AIDS. So whether it's Dr. HHH, Dr. Phil, Dr. Seuss or Dr. Bob, you can choose to believe whomever you please, but I urge you to look at the rational behind the statements and not compare apples with oranges. Statements taken out of context can appear to be conflicting when in reality the opinions actually are quite consistent, which I think is the case here.

Dr. Bob

can i woo-hoo too? (TESTING GUIDELINES) Apr 4, 2008

hi Dr robert. i received oral sex from a person i dont know at all.i got tested for hiv on the 2nd and on the 3rd month,both negative.i know that i have to get retested on the 6th month just to be extra sure.but some doctors told me that an hiv test is 100% conclusive after 12 months!!! is this the reality? i cant stand this anymore.. why there is not unanimity?please only you can tell me the truth. thank you in advance.depressed from greece

Response from Dr. Frascino

Hello Depressed from Greece,

Unanimity would be great; unfortunately we're not there yet due to a variety of factors. For instance, not everyone's immune system works exactly the same. Some folks may take a bit longer to produce detectable levels of anti-HIV antibodies in the blood than others. These specific antibodies are what most HIV screening tests rely on. Other potentially complicating factors involve the various different HIV-screening tests used. The new generation tests are more sensitive in being able to detect anti-HIV antibodies somewhat sooner than older versions of the tests. In addition different countries and different testing sites/organizations within the same country may publish different guidelines, which can lead to additional confusion. The general trend, with the availability of the newer screening tests, is to shorten the window period. Australia, for instance, has published guidelines shortening the time to a definitive test to six weeks. (See below.) Other guidelines used six months. Most now agree three months is adequate. Your HIV-acquisition risk is oral sex, which carries only a very, very low risk. You have tested negative out to three months. I would consider these results to be definitive and conclusive. I do not feel additional testing is necessary. I suggest you stop worrying and start WOO-HOOing! If you want to reconfirm your negative status with a follow-up test at six months to put any residual fears permanently to rest, fine. Personally I don't think it's necessary. The result will undoubtedly again be negative. As for a 12-month test, that's overkill!

So stop being depressed and start celebrating!

Dr. Bob

Please please please answer me third time asking. Jan 5, 2008

Hey Doc Bob,

I had Vaginal/oral sex with an Australian CSW on Dec 14 2007, it was protected untill the condom broke (AAWWWRRR!! Stress, Panic and Anxiety for me!) I only found out when we changed positions and she quickly put a fresh one on.

the next day I had some painful aches in my groin which went away by day 3 post exposure, by day 12 I developed a couple of canker sores in my mouth which went away in 3-4 days.

from days 14 -19 my scalp was crazy itchy and my eyebrows and ears were sheding skin when I got some more on my cheek I went to the doc, he Diagnosed me with Seborrheic Dermatitis.(Never had it before and I'm a 22yr old male)

Its day 22 the SB is still there, mainly on my scalp but flares up when showering.

Ive also had a stiff neck with swollen glands and have had a low grade fever for approx three days running.

Ive also had a rash type thing (Really freaked me out!) over my chest & neck, it almost looks like two rashes combined into one.First ones looks Like slight background redness/purpleish then Ive got these dot like things that are raised look like pimples but not. they are all over my chest back and collar bone region.

Ive recently come from a malaria affected country and was on some drugs(Doxycyline and Primaquine) as a preventative method. (Finished them at day 19 post exposure)

Anywho my questions from this are:

1) In your professional opinion whats my risk for having aquired HIV?

2)Is Seborrheic Dermatitis associated with HIV ARS? (Alot of sources on the net say 'yes' and some other forums say'No' so theres confusion on my part)

3) I'm going crazy here thinking of the consequences and my anxiety is through the roof, Whats my options for testing? Would a HIV Antibody test 4 weeks (28 days) post exposure be at all reliable or indicative? what about the other testing methods PCR p24 etc?

4)I can't sleep, work or function properly with this over my head, I just got to know, your always scared of what you dont know. Your work is appreciated and respected by alot of us aussies. Cheers mate, many thanks!

Response from Dr. Frascino

Hey Anxious Aussie,

1. Your HIV-acquisition risk is a failed condom while rooting like a wombat with Sheila. The estimated per-act risk for acquiring HIV from unprotected (or broken-condom) insertive penile-vaginal sex with a partner confirmed to be HIV positive is 5 per 10,000 exposures. Your estimated risk would be even less, because we have no idea if your bouncing Badda Bing Betty was poz or not. Also, the estimated risk statistics are generalized and cannot be used as an actual risk for a specific wham-bam-thank-you-ma'am. (See below.)

2. Can seborrheic dermatitis be associated with HIV? Yes, it can. However, please note, the vast majority of cases of seborrhea have absolutely nothing to do with HIV.

3. I'd recommend a rapid HIV test at the three-month mark. HIV-antibody tests taken prior to the three-month mark are not considered to be definitive. PCR testing is not recommended for routine HIV testing, due to the rate of false-positives, other technical considerations and cost. I'll also post some information from the archives about new Australian guidelines advocating testing at six weeks. (I'm cool with that recommendation if the newer generation HIV tests are used, as they are in the land of vegemite and kookaburras).

G'day and g'luck.

I may well be in Sydney and Melbourne within the next few months, so now that I've given you some advice, any chance you can help me with a few surfing lessons? I'm rusty and as much as I enjoy being rescued by hunky Aussie lifesavers in skimpy Speedos, I really don't want to make a fool of myself in front of my Aussie mates on Bondi.

Ciao and good luck with your test. I'm here (or there) if you need me mate.

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



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