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3 month and 6 month test guidelines for occupational and non-occupational exposures

May 1, 2010

Dr. Vegas here again. Another question. I have the impression from reading your forum and from discussing this with other HIV MD's that the 3 month antibody test is pretty definitive. That is, if the 3 month test is negative after an exposure then a 6 month test will be negative. Putting it another way, if a 3 month test is negative then one can reassure the patient that they can relax.

However, the most recent CDC occupational guidelines of 2005 recommend that a 6 month test be done and we are still doing this in our clinic. I have been reassuring patients with a negative 3 month test based on this possibly false assumption I have.

So what is correct in 2010? Can a patient with a negative 3 month HIV antibody subsequently have a positive 6 month antibody test? (assuming a single exposure at time zero). Can it really take up to 6 months to become antibody positive? If yes, how common is this? Our clinic may still have to do a 6 month test based on the guidelines, however, I am interested in the insight of someone who looks after HIV patients every day. Thanks.

Response from Dr. Frascino

Hello Vegas-Doc,

I've discussed this topic numerous times over the years. Check out the archives for a more detailed discussion.

Briefly, IMHO (which I recently learned from my young niece means "in my humble opinion") a negative FDA-approved HIV-antibody test at the three-month mark should be considered definitive, barring extenuating circumstances. (I've discussed these at length in the archives as well.)

The CDC is basically in agreement, particularly if new generation tests are used. They still recommend a six-month follow-up test for occupational exposures and when there has been a "significant exposure" to a source patient who is confirmed to be HIV infected. There is certainly no harm in doing a six-month follow-up test if you either don't have time to screen for extenuating circumstances or feel ill-equipped to evaluate these rare occurrences.

Dr. Bob

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