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$800 for a viral load test while I'm on pep?
Jul 19, 2008

I took your advice and finally found an HIV specialist. Just like I asked you about my last exposure, he told me not to worry but insisted on me getting a vl test for early detection to see if I'm infected from my 4 month old exposure just because I had a big concern. That people who are poz and undetectable are still detectable and that this is a different kind of test to see if I am infected. He said that being on pep for a few days shouldn't interfere with the test.

Would you happen to know what he was talking about?

Have I been ripped off?

He said that If my symptoms were due to HIV, then this test will show it 100% at 4.5 months even though my antibody tests have been negative out to 18 weeks. CAN I BELIEVE HIM? I think it would be strange if I was already infected and on pep, so I took up on it.

negative antibody plus negative vl at 4 months? please! And this is just for my past exposure. Not my recent encounter. I'll handle that just fine.

I told him that you advised me to get someone to monitor me and I've already made 3 appointments and got the full 28 day treatment for free! Thank goodness for the w. village and your great advice Dr. Bob!

I'm going to start making donations once I get my job back. AND I'm not saying this so that you can answer yet another one of my 10 questions. Just please answer this one in particular so that I can discontinue my past fears. I just need to know what's going on or what to expect if my vl test comes back negative.

Also, if my vl test comes back reactive, should I get off the pep?

Response from Dr. Frascino

Hi,

Sorry, but it's always difficult for me to try to interpret what was or wasn't said by another physician if I wasn't there to actually hear what he told you! If he is a certified HIV specialist, why not ask him what he's talking about?!?!? He should be able to explain what's going on in very understandable terms. If not, find another HIV specialist who can.

Regarding the other type of test he had you take, again I'm not exactly sure what it was. It could have been a quantitative test, such as an HIV plasma viral load (HIV PCR RNA) or a qualitative test, such as an HIV PCR DNA. Generally speaking, PCR tests are not recommended for routine HIV screening, but they can be helpful in certain situations. I would not trust an HIV PCR RNA quantitative RNA test performed for diagnostic purposes if the person was on antiretroviral therapy, because the antiretroviral drugs, if effective, could drive the viral load down, possibly to undetectable levels, thereby giving a false-negative result.

If your viral load comes back "reactive," the HIV specialist will perform appropriate confirmatory tests and, most likely, a genotype resistance test as well as a CD4 count. He would advise you to discontinue PEP if HIV seropositive. He would advise a HAART (highly active antiretroviral therapy) regimen if and when your CD4 count dipped into the mid-300 range, based on current treatment guidelines. Some of us are actually offering therapy at even higher CD4 counts.

My advice remains to work closely with a competent and compassionate HIV specialist with whom you can communicate freely. She will be your best resource to answer ongoing questions regarding PEP, HIV symptoms or HIV treatments.

Good luck!

Dr. Bob



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