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Window Period
Jan 12, 2010

Dear Doctor Bob, so much has been said about window period and I know it is a tough issue to be 100% sure about. But, in your clinical practice experience, have you ever seen any late seroconverters? I mean, people who took longer than 12 weeks to show up antibodies? I would appreciate so much having your answer. Best wishes!

Response from Dr. Frascino

Hi,

This question comes up frequently. (See below for an example from the archives.) Using the newer generation (3rd and 4th) HIV-antibody testing assays and without extenuating circumstances, I have not seen anyone test HIV-antibody negative at three months and subsequently test positive. However, the CDC and others still recommend testing out to six months for certain types of exposures, including occupational exposures, post-PEP screening and testing after a significant exposure to someone confirmed to be HIV infected. I recommend following these guidelines.

Dr. Bob

a garbage question May 16, 2009

Hey Dr. Bob,

I have a quick qeustion for you. After a negative 3 month elisa test, what are the odds of delayed seroconversion. I have looked through your site, and you mention multiple times that a 6 month test is warranted for high risk exposures and occupational exposures. What about your own personal experience. Have you ever seen anybody who was negative at 3 months, and positive on further testing?? I know that the guidelines are conservative and recommend 6 months, but I would love to hear about your own personal experiences, as I'm sure you've seen many different people get tested for possible exposures. I ask these questions because I work in a healthcare facility and I had an incident where I thought while cleaning the garbage that I may have gotten pricked by a unknown needle but there was no wound although I did have a superficial scratch. The incident has been reported, and I will follow their recommendations to testing, but do you think that if my 3 month test is negative then I am safe to have sex with my wife again without worrying? I'd love your thoughts on the matter. I love your column and am so grateful for all of your help. Thanks for always being there when needed.

Response from Dr. Frascino

Hi,

Using the newer generation HIV-antibody tests I have not seen anyone test negative at three months and subsequently test positive unless there were extenuating circumstances. However, at least for now the guidelines' recommendation for a follow-up test at the six-month mark for occupational exposures and non-occupational exposures with a documented significant high risk remain in effect.

Your occupational risk is negligible at best. However, I would advise you use latex condoms for penetrative sex until your six-month test reconfirms your HIV-negative status. It's a relatively small and temporary inconvenience that will provide an extra layer of security, both physically and psychologically.

Good luck. Be well. (I'm quite confident you are indeed well.)

Dr. Bob

have you ever seen Jun 18, 2009

hello dr bob, i must say that i have converted your forum in my very first page everytime i connect to the internet. maybe could be from psychologically point of view a little worrying hahaha. i just convinced that your words are better than any yoga session. i have a punctual question for you.. and hre it comes in all your experience years, have you ever seen seroconvertions after testing negative at 4-6 weeks? i read you say the majority reveals their status at this time, it is vast majority? it`s just im really really scared about testing again.. and i had a very low risk episode, however sometimes mind becomes perverse :S

Response from Dr. Frascino

Hi,

Better than any yoga session??? OK, if you say so. I was in a yoga class this week that nearly did me in! I didn't mind the "I need an Advil pose," but started to get worried when I got to the "I'm going to piss my pants pose" and I quietly snuck out of class when we got to the "you've got to be kidding me pose."

As for your question "Have I even seen seroconversion after someone tested negative at four to six weeks," the answer is yes! Remember, HIV-antibody tests taken prior to the three-month mark are not considered to be definitive or conclusive. Improvements in HIV-antibody testing have helped to pick up HIV-infected individuals earlier. However, the three-month guideline remains in effect, at least for now.

If indeed you had a "very low risk" episode, you should not be fearful of getting a definitive three-month test.

Good luck.

Dr. Bob



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