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Jun 1, 2011

Hey Dr. Bob!

Firstly, I want to give you a quick shout out and some love for your advice on here. Thank you very much.

My question is concerning this other site that seems to be popular amongst the concerned masses.

There are a few Dr's, who's resumes state they are HIV specialists, that for the most part give the exact same information that you give. (however they do lack your charm)

The one thing that stands out though is their recommendation for a definitive testing dates.

An example or two -

3) From a risk standpoint or your symptoms, you do not need HIV testing. However, if my words don't settle your fears about it, you could have an HIV antibody test 6-8 weeks after the event, or a combo test (HIV antibody plus p24 antigen), which gives definitive results at 4 weeks. (This is not code to suggest I really believe there was a significant risk of HIV. I do not. I suggest testing only if you need the negative result for reassurance.) ~DR. Handsfield

Clasical ARS is a syndrome with high fever, severe musscle and joint aches and a rash which may not be obvious. It is pretty dramatic.

At 4 weeks 90% of tests would be positive, at 5 weeks 95% and at 8 weeks virtually all persons with newly acquired HIV would have positive tests. EWH

Dr. Hook


These are just a couple examples, but there are many that are quite similar in regards to them stating that a 6-8 week test is definitive.

I wonder about the percentages stated by Dr. Hook and Dr. Handsfield as well.

Would you agree that most people that would test positive will test positive between 4-6 weeks? And that getting a test at that time would be "encouraging?"

I recognize that the CDC and yourself state that 12 weeks is necessary, and I believe that to be true as well in regards to being better safe than sorry.

But testing neg at, say, 5 weeks...according to Dr. Hook, more than 90% that would be positive would show. And if a person gets a neg test, one should feel more confident? Or is that simply too soon and the percentages really arent applicable? ie "Testing neg at 5 weeks is the same as testing neg at 11 weeks...its not 12 weeks, everything is the same regardless"

Thanks for you time Doc!


Response from Dr. Frascino

Hello Joe,

Thanks for your question and kind comment about my charm. I'm pleased to hear other reputable HIV-information Web sites are providing "for the most part the exact same information" that you are finding here. (It really isn't rocket science.) 
 Your assessment regarding my recommendation for testing is correct. I have continued to use the CDC published guidelines that HIV-antibody tests taken prior to the three-month mark are not completely definitive and conclusive. (You'd be amazed at the number of anxious wrecks who write in complaining that I shouldn't use three months but rather the older standard of six months for all HIV-screening tests!) This is somewhat of a confusing topic because we have developed more sophisticated testing assays (third- and fourth-generation HIV-antibody tests, rapid tests, qualitative NAAT RNA, etc.); however, the published guidelines have not changed in many years. I've written a blog that discusses this conundrum, but it hasn't been posted yet, as the folks at Body Central wanted me to address a specific topic for my next installment. But stay tuned; it will eventually be posted. What I can tell you is that I'm in absolute agreement with the other physicians that the vast, vast majority of HIVers will have detectable levels of anti-HIV antibodies in their blood within four to six week following HIV primary infection. However, is that good enough? The consequences of missing a true positive test could be catastrophic. Consequently erring on the side of caution is warranted. That said, I would certainly consider a negative HIV antibody test between 6 and 12 weeks extremely encouraging if not totally WOO-HOO-able. I've addressed this topic numerous times before. You can review those comments in the archives.

Hope that helps!

Dr. Bob

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