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NAAT RNA TEST QUESTION! One Pioneer to Another!
Jun 13, 2008

Dr. Bob a pioneer,

Being a former (and recently recovering) high anxiety worry well I have a question that I hope will assist in both my own, and others, healing. Information is key in the battle against anxiety knowledge is power!

With RNA testing, NAAT in particular, becoming more popular in urban settings and with health providers, I have noticed a huge lack of information regarding to them on the web. I know they are an excellent tool in seeking to discover early acute infectionsbut my question is whether they are also capable of picking up older infections as well. For instance, I was tested after 3 months with an antibody test and it was negative. Regardless of exposure, I have been told by experts (including yourself thanks!) this test was conclusive. Unfortunately, I had other health issues coinciding with this situation and all of my other doctors and general practitioners still mandated I test to 6 months and that it was very possible to become positive after a 12 week negative. I did as they said and tested at 4 and 5 months all negative and all unnecessary and all very scary. At nearly the 6 month mark (174 days), I took a NAAT and an antibody test to finally end all doubts and move on. Both were negative.

My question is simply this why do ANY doctors recommend a test after 3 months? Do we not now have the power to have a universal solution to testing beyond three months? Shouldnt a combination NAAT and Blood (or rapid) antibody test at the three month mark be ruled conclusive? Am I missing something? After the terrible anxiety I endured (and thousands from the look of things endure annually) and am now seeking therapy to recover from, I would imagine we would simplify things as much as possible. Yes, NAAT provides false positives (roughly 5.6% of the time I believe).and those can be even more anxiety provokingbut can they provide false negatives? I am SURE every person on this site would risk a false positive in order to have a true conclusive result. My only doubt with the test, and possibly this is a reason that prevents them from being widely used, is this: as they seek acute infections by discovering the virus itself RNA I believewould a test such as mine, 3456 months after a possible infection be capable of discovering the virus? If a viral load is much higher at initial infection, is this a requirement in order for the NAAT to be effective or can it also pick up tiny amounts of the virus?

From one pioneer to another.and one healing heart to the doctor he has to thank, I hope you can shed some light. One must be the change he hopes to see in the world!

EA

Response from Dr. Frascino

Hi EA,

Why do any doctors recommend HIV tests beyond three months? Well, that sounds like a simple question, but the answer is unfortunately anything but simple. Perhaps easiest to understand is that no one wants to miss a diagnosis, because the consequences can be catastrophic. Consequently, physicians may well err on the side of caution. Couple this with the fact that many older guidelines recommend the six-month window. Throw into the mix that HIV is a world pandemic and not everyone has access to the latest testing techniques such as third- or fourth-generation HIV-antibody tests or PCR testing for instance, and you can begin to see why some physicians may just prefer to stick with a six-month recommendation. There is no doubt that there have been significant improvements in HIV diagnostic testing technology. This has led to the ability to detect the virus somewhat earlier. Most (although not all) HIV specialists are now quite comfortable with the three-month window, baring any extenuating circumstances.

As for NAAT testing, you essentially answered your own question. Let's assume your figure of 5.6% false-positives is correct, although in reality I'm not sure that's the correct number. That would mean one out of every 20 tests would be a false-positive. This would create pure pandemonium. You claim: "I am SURE every person on this site would risk a false-positive in order to have a true conclusive result" a few months earlier. I strongly disagree. Think back to your first test and imagine being told you tested "positive!" Most folks don't understand the concept of "false positives," especially when they are very fearful and already think they are positive. If we were handing out false-positives at this rate, I'll bet we'd have folks lining up to jump off the Brooklyn Bridge. RNA testing has its place in the management of HIV disease, but that place is not routine HIV screening.

Finally, you ask if RNA testing would be capable of detecting virus "3456 months after possible infection?" Hmm . . . doubt that would be relevant, because 3,456 months equals 288 years and even McCain isn't (quite) that old!

Dr. Bob



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