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pos. person on meds testing neg. possible? (HIV ANTIBODY TEST VERSUS HIV VIRAL LOAD TEST)
Jun 2, 2009

Hi Dr. Bob. First thank you for all your generous answers. My question is:If someone is on meds for hiv(any, not specific)and their v.l. is undetectable, how possible is it they can go down to the local health department and test negative? Thanks for your time....m.p.

Response from Dr. Frascino

Hello m. p.,

How possible is it that an HIVer on antiretroviral medications that have driven his HIV plasma viral load to undetectable levels will test "HIV negative" (HIV-antibody negative) at his local health department? The answer is it is not possible! HIVers with undetectable viral loads will continue to test HIV-antibody positive. These are two very different types of tests that measure two very different and distinct things. See below.

Dr. Bob

again about the window period (HIV ANTIBODY TEST VERSUS VIRAL LOAD TEST) Jul 11, 2008

doc i read all ur logs about window period which says that the HIV test is certain when its done after 6 months of the exposure, but i was just going through this log I met and fell for a MD (family doctor) and he with me. I am HIV- and told him the first time we had sex. He was pleased, but a week after a weekend of sex I learned he was POS. For once I trusted a man as he was a doctor. I was wrong. We did oral and anal but did not ejaculate inside. From the hours of play I learned he has no pre-cum issues. He said it is ok as he originally had a small viral load and has been undetectable for the 2 years since learning he was POS. Claims he cannot transmit the virus at this time. I am now conscious of everything I do with him and I'm quite confused. I realize it will take months to know the impact. It may be too late, but how terrible a risk have I experienced? Since then, I have insisted on protection. He continues to assure me that I am ok. Help. and i was shocked to read "He said it is ok as he originally had a small viral load and has been undetectable for the 2 years since learning he was POS." doc im again worried to read that he didnt get to know about his result for "2" years where u told us that we can be very certain of the result done after 6 months. ITS VERYYYYY CONFUSING. kindly help all of us here who r not able to understand this mystery. thnx

Response from Dr. Frascino

Hello,

This is one "mystery" that I certainly can solve for you! Your confusion stems from an incomplete understanding of the different types of HIV-related tests. Everything I've stated previously about HIV-antibody tests remains accurate and true. Remember, HIV-antibody tests are used to diagnose HIV disease, to determine if one has contracted the virus. If you are HIV-antibody positive, you have acquired the infection. If you test HIV-antibody negative outside of the window period (first three months after exposure), then you have not acquired the infection. These types of tests are very different from HIV viral load tests! The viral load tests reflect active HIV replication. Once an HIV-antibody positive person begins antiretroviral therapy, HIV replication is decreased. With potent effective antiretroviral combination therapy, we can often drive viral replication ("viral load") down below the level of detection of our testing assays. We refer to this as having an "undetectable viral load". Please note, even when the viral load is driven to undetectable levels by medications, the person is still HIV positive and will continue to test HIV positive on HIV-antibody testing. Consequently, your doctor-boyfriend could very well have been "undetectable" (had an undetectable HIV plasma viral load) for two years, but throughout that time he would always still test HIV positive, OK? Mystery solved! You can learn more about HIV diagnostic tests (antibody tests) versus HIV monitoring tests (RNA viral load tests) in the archives.

I'll reprint below your initial question and my response. My assessment and advice remain unchanged.

Dr. Bob

serodiscordant with an HIV+ doctor Jun 25, 2008

I met and fell for a MD (family doctor) and he with me. I am HIV- and told him the first time we had sex. He was pleased, but a week after a weekend of sex I learned he was POS. For once I trusted a man as he was a doctor. I was wrong. We did oral and anal but did not ejaculate inside. From the hours of play I learned he has no pre-cum issues. He said it is ok as he originally had a small viral load and has been undetectable for the 2 years since learning he was POS. Claims he cannot transmit the virus at this time. I am now conscious of everything I do with him and I'm quite confused. I realize it will take months to know the impact. It may be too late, but how terrible a risk have I experienced? Since then, I have insisted on protection. He continues to assure me that I am ok. Help.

Response from Dr. Frascino

Hi,

It doesn't matter if he's a doctor or a butcher, baker, candlestick maker or a rightwing family values Bible-toting GOPer or pious preacher, you need to consider all your bedmates as potentially HIV positive and take all the necessary precautions to prevent the transmission of HIV (and other STDs). As for the list above, be particularly wary of those GOPers and pious preachers!

If indeed your hot-doc is on antiretroviral drugs, which have driven his HIV plasma viral load down to undetectable levels, his chance of transmitting the virus would be significantly reduced. However, his claims that he cannot transmit the virus are untrue. Insisting on latex condoms is definitely the correct thing to do.

Regarding your HIV-acquisition risk, oral sex would carry minimal risk. Unprotected anal, however, is much riskier. That he did not ejaculate inside does decrease the risk somewhat; however, because you did have a significant exposure, HIV-antibody testing is recommended at both three and six months.

Good luck! Maybe you should advise your hot-doc to check out the information on this site.

Dr. Bob



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