Dazed and Confused (WINDOW PERIOD 2008)
Jul 6, 2008
Ok, ok. I know the whole 'window period' is a question that never dies but why do SOOO many people and doctors disagree on this topic? I've read some posts from the archives that state certain dr.'s want their patients to test for years to be certain HIV infection did not occur while others are telling their patients their 3 or 6 month test results are conclusive and to seek mental help if they can't accept their negative status. I just don't get it ??? I am of course a 'worried-well'(or at least I am hopefully 'well'). My other question is this, I have tested multiple times via blood draw ELISA/EIA and all have been negative out to 32 weeks. At the 32 week mark I also did a PCR HIV by DNA which was negative. Was the 32 week mark too late to get an accurate result from such a test (meaning could at 32 weeks the virus already be at undetectable levels)? I am going in again this week for another HIV 1 & HIV 2 antibody test along with another HIV PCR by DNA at the 38/39 week mark. The exposure was 20 seconds of unprotected vaginal sex with a male of unknown status.
Response from Dr. Frascino
The window period can indeed be a cause for confusion. Some recommendations and guidelines have changed as we've learned more about the natural history of HIV infection and seen improvements in our testing assays. Consequently, I can understand why there may be some discussion about three months versus six months or even six-eight weeks versus three months. However, any physician who is still advising patients to "test for years" is clearly uninformed and just plain wrong! (See below.)
Regarding your specific situation, barring any extenuating circumstances, all you needed was a negative ELISA test at the three-month mark for a definitive result. Your repeatedly negative ELISA tests out to 32 weeks are therefore definitive, conclusive and excessive! As for PCR testing, this is not recommended for routine HIV screening, due to the rate of false-positives, other technical considerations and cost. I would strongly advise you to stop testing. If you continue to have difficultly accepting the truly wonderful news of your definitive HIV-negative status, get psychological or psychiatric help. This problem is in your head, not in your blood! Stop chasing a disease you could not possibly have and begin dealing with an illness you definitely do have: irrational HIV fear and anxiety.
300 pound nightmare (WINDOW PERIOD 2008) Jul 3, 2008
I know you have answerd this question at least 10,000 times I know I have read through them over the last 4 or 5 weeks lol but for some reson just as many of the worried well that wrote them I also think I am the one, hell as fare as I'am consernd I know I'am the 1 in a million that got HIV from about 2min of unwraped insertive oral witch i didnt even get hard for(she was really 300 pounds and I'am not into big girls) she works at the local jerk joint here in Florida nothing like a night of drinking with a good friend and then making a awsome decision. Any how I'am married I did tell my wife with in about 48hours of this most unenjoyable event hardest thing I have ever done in my life still not sure whats wrong with her she just looked at me and said why would you tell me this and dont ever do it again want to go out for dinner thats the truth word for word didnt see it going down like that at all any how I also have 2 of the greatest kids you will ever see, 4 and a year and a half boy and girl love them so much and cant beleave I let them down like this. its been almost 6 months I was tested at the local health dep at 6 weeks neg witch the Dr there said I didnt need an HIV test for what I had done and then freaked out at about 8 and a half weeks and got and oral quick advanc test finger stick also neg in witch I was told for the 2nd time after a test that 6 to 8 weeks is good and that I have nothing to worry about told my wife about the resalts she once again looked at me like i was crazy and said can we have sex now (I had not had sex with her from the time of my jerk joint fun till then for fear of giveing her some thing)so life got back to normal jim and janet sex me on top her on bottom so much fun lol and then about 5 weeks ago I was told 3 months was the all clear mark not 6 or 8 and half weeks so what do I do lose my f*&king mind what have I done my wife is a teacher I own a local A/C company how could I be so stupid so here comes the itchy red skin rash witch mind you I have gotten every time I get stressed my hole life so I start reading gotta love the web haha I find you witch if you dont know are like a god to people like me and then I find Dr HHH on medhelp who does seem to no his shit too who does say 6 to 8week test is good along with lots of other web sites Dr K says no need for testing for my risk but still I think I'am the 1 that guy who gave his whole famly HIV from unwraped insertive oral so I start drinking and smoking again after 6 years of being smoke free I also run 3miles at least 5 times a week still do it lungs just dont feel as good lol so I sit up at night drinking and smoking ummm good and reading not so good just cant understand why 2 Dr told me I was good at 6 weeks and 8 and a half weeks when 3months is the mark I didnt know any better have been with my wife for 17 years and I am now 33 so most of my life and have been have unwraped sex with her for the last 4 months based on what they said well tonight was when I really lost it she now has these red itchy spots is this and ARS or as she says nothing I dont no Iam not a DR but after what they told me do they no or do they not remmber Iam and A/C guy need less to say plzzzzzzzzzzzzzz help plzzzzzzzzzzzz answer this question again plzzzzzzzz I almost know what you are going to say 3 months is the mark insertive oral is low risk i really want to no why 50% of the people if not more are saying 6to8weeks is good that the 3month thing is just CDC guide lines that are very conservative bottom line is I cant bring myself to get tested again I beleaved what I was told and just cant get past the fact that Iam sure I have given my wife and 2 kid HIV plzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz help another dumb drunk irish guy.
Response from Dr. Frascino
You are correct in your anticipation of what my advice is going to be:
1. Your HIV-acquisition risk is extremely low.
2. HIV-antibody tests taken prior to three months are not considered to be definitive or conclusive. Your negative test out to 8.5 weeks is extremely encouraging.
3. I have no control over what other experts or testing sites might say about the window period. The three-month guideline is based on a considerable amount of research and yes, it is on the conservative side. However, when dealing with an illness, like HIV, it's wise to be on the conservative side, so as not to miss any potential HIV infections from testing too early. You can read more about testing guidelines in the archives. I'll also print some information from the archives below.
4. Your fears about being HIV positive are irrational. If you can't get over them, you should seek the help of a psychiatrist or psychologist.
5. Stop smoking. If you don't, it will kill you in a very painful and undignified fashion.
6. Stop boozing. Isn't that how you got into this problem to begin with? It's time to clean up your act, grow a pair and do what you know needs to be done.
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
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.
Window Period (WINDOW PERIOD) Oct 13, 2006
Dr. Frascino: Many apologies if I am repetitive. To make things easier, if you want to refer me to an appropriate archived entry that is just fine. Through my searches however, I can't find anything to answer my question. Also, before I continue, I wanted to say I just made a contribution to your site. I don't include this information for any reason except to encourage others to contribute as well. Will you post your link in my reply, hopefully it will encourage others to give what they can.
A little background. I had unprotected oral sex from someone with unknown HIV status. I had tests (all negative, thankfully) at six weeks and four months. Are these tests conclusive? I think your answer will be yes.
Second question: why is there so much confusion about the window period. My doctor thought six weeks was generally fine. I don't hear six months anymore, except from the clinic where I got tested. They told me that my 4 month test was only 85-90% accurate.
Basically, one, if merited will you send me good karma and good wishes. Second, were my tests conclusive, and 3rd, though I have learned my lesson, for myself, and people in general, when is it safe to be assured of your test results? Many thanks.
Response from Dr. Frascino
Certainly no apologies needed. The HIV "window period" is a confusing topic and recommendations can change as we learn more about HIV pathogenesis and the body's immune response to HIV infection and as we improve our testing techniques.
To answer your specific questions:
1. Is your four-month negative test conclusive? Yes! (You were correct in assuming I'd say "yes!")
2. Why is there confusion about the window period? Well, mainly because it's a confusing topic with all sorts of variables involved different and continually changing testing techniques, differences in host immunological responses (production of anti-HIV antibodies) that the tests measure, different guidelines put out by various agencies, different guidelines for different types of exposures, extenuating circumstances that may change testing parameters, etc. I'll post some information from the archives that hopefully you'll find helpful. Check out the very last post. It's a news release from today announcing yet another new HIV-screening test that may wind up changing the testing guidelines once again!
Next, good karma has been sent with my very, very best wishes!
Finally, thank you for your donation. Helping others in desperate need is an excellent way to keep our own problems in perspective and also a great way to rack up some excellent cosmic karma! I'll repost the link to my foundation per your suggestion www.concertedeffort.org.
Be well. Stay well.
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).
Response from Dr. Frascino
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.
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.
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
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
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.
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
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.
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
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.
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
Thanks for the information!
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).
Window period Jun 9, 2008
Dr Bob, Please help me to answer my worries. On april 20, my frinds had a bachlor party for me and i ended up having anal sex with TS escort, I was too drunk to remember if the condom was broke or not. At 28 post exposure days I did PCR DNA and came negative, also same time did ELISA and the STD panel and came back negative. Also did anoher test at 41 days and came back negative. I know I scrowed up big time before my wedding and my fiancee does not know, my qustion is 6 weeks good enouph indicator to go foreward with my plans and wedding? Also is it possible or documented any where that after 6 weeks seroconvert took place? I was reading a lot and there is so much conflict in this matter, also Is the PCR DNA accurate and reliable at 28 days? I really need your help please. Than you in advance and I would like to make donation but dont know where!
Response from Dr. Frascino
Once again, all this information is in the archives (have a look!), so I'll be brief:
1. HIV-antibody testing (ELISA, etc.) done prior to the three-month mark is not considered to be definitive or conclusive.
2. PCR testing is not recommended for routine HIV screening due to the rate of false-positives, other technical concerns and cost.
3. My advice is simple: Level with your fiancée. Use latex condoms for protection until your three-month test confirms your definitive negative status.
4. Donation information for the Robert James Frascino AIDS Foundation can be found on the foundation's Web site at www.concertedeffort.org.
Good luck with your upcoming nuptials. I see no reason to delay your wedding. Your chance of being HIV infected is so remote it's nearly nonexistent.
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