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HIV Transmission and Education >> Am I Infected?

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Richard
Unregistered

TESTING DURING WINDOW PERIOD AND AFTER
      #30908 - 03/30/02 05:20 PM

The most common question in last two years since this forum exist was and is about testing and window period (during the last four months I think I red hundreds of posts here going back to the begining).

I was journalist by prefoession and worked as such for 8-10 years. I studied in Europe and moved to Australia - so don;t judge me by my English please as it is not my language by birth. Thereason why I am saying this is for everybody to understand that being journalist (might be like any other profession) but requires one to have a wide knowledge and proper research before it gets into publishing an article about any subject. Even I am not working now as journo - it is still in me to research, gain knowledge etc before I make any statement.

During my fear of HIV, I have visisted 8 different doctors of which 4 of them where HIV specialist, one with PHD and each one of them with more than 5 years of experience up to a 15+ years in ID experience.

I have performed any single test that exist for HIV. 7 Elisa, PCR RNA, DNA and p24 Antigen. I have performed CT Cell count, full blood count, liver blood count and finally HCV RNA (PCR test for Hep C).

I have 25 - exactly 25 slipps (paper work) of lab results just counted them now.

I have placed number of questions to different experts on the web from Body and Hopkins and received the answers from: Dr. Joel Gallant (3 times), Dr. Andrew Piva, Dr. Robert Frascino, Dr. Susan Little (2 times), Dr. Benjamin Young, Dr. Cal Cohen...)

OK. enough of that journalist problem is always there - they intend to write a lot. Getting to testing.

Take in consideration that you are the most demanding person in the world and you would like to find out your status right now - you don;t care about time and money needed to perform those tests so you are like me and want to go full on with testing so you know your status, but not going to be extremely obssesed with it and run tests on weekly bass as I did.

ELISA:

If I have a choice I would always go for 3rd generation Elisa. The first test I would perfom at 4 weeks, second at 6 weeks and last at 12+ weeks.

Antibodies starts production just few days after virus hits the body (Dr. Holodniy), it is just matter of having enough antibodies to be detected by Elisa - the more sensitive Elisa, the better detection in those early stages 4/6 weeks 12 weeks one won;t matter.

Most people will show positive at 4 weeks, and almost all people will show positive by 6 weeks (Dr. Barttlet - Hopkins).

p24 ANTIGEN

P24 Antigen does not stay long time in the body - and it is also approved test for diagnose used mainly for screaning of the bllod. Antigen is present in very early stages and dessapears after enough antibodies are produced - it comes back thogh again in late stage of AIDS. (Dr Holodny).

I would performed p24 Antigen ine the period of 1-5 weeks only once. It is not as sensitive as other tests but very helpfull - and it can miss a lot so it is not reliable but it is a very good sign.

PCR

PCR is the most sensitive tests realted to HIV, much more than any other including Elisa. It has 100% sensitivity and 95% specifity. Meaning that it is sensitive but not specific as it can produce false positive result. If it does it is usualy in small number like less than 1/2000 copies - so the test with those numbers is repeated in the lab to make sure. If it shows over that numbers it is consider positive.

There are two major PCR test RNA and DNA. RNA should be performed from week 3/4 to week 8 for most accurate reuslt and DNA can be produced at any point of time after few days.
RNA is mostly used because it is esear to perform - all the lab settings are there due to measuring viral load of positive patients and it is prefered test for number of doctors. Even it has not been approved by FDA it is used by any doctor in US, Australia and the rest of the world.

According to lot of doctors in USA RNA is >98% accurate and DNA is >99% (Dr. Barttlet.

It is very advisable to accompany PCR test with Elisa that increasse the percentage of accuracy combined together.

CT CELL COUNT

Though CT cell counts does not mean much - in the setting of above tests CT counts can give you some answers and they should be performed 4-8 weeks from infection.

It is usual that after infection Viral Load is highest and CT4 (normal 500-1600) is lowest in that period of time (4-8 weeks) than the body settle launch counter attack and the situation gets reveresed after 2/3 months, CT4 goes back up and viral load goes down. Considering that we never knew about our CT cell numbers before we look at percentage that should be normaly around 50%+. In newly infected people percentage will go down to 20s.

It is also importnat to look at CD4/CD8 Ratio. When infection occures Virus targets CD4 cells and destroys them, and body launchis attack with CD8 cells that kill the virus - so there is enormous production of CD8 cells at that time - the number should go in thousands (usualy and normal CD8 number is 200-800 in Australia and I noticed that labs numbers in US are almost the same maybe 10% variation in some cases.
The ration of CD4/CD8 in initial infection with infected people is less than 1, with uninfected people is well over 1, and can be over 4 (the normal number of this ratio is 1-3). If it is over 4 means nothing and no infection - if it is under 1 - it is almost for sure something is going on.

FULL BLOOD TEST

Full blood test is the only one that will never give you any indication and it should not be looked at in any way as they flactuate enormously during one day let alone during weeks. Particurarly is bad because in some HIV infected people white cell can go higher, and in other can go lower and in most of them stay normal for years. So, any changes will tell you nothing.

HOME ACCESS

My knowledge about Home Access is the weakest considering we don;t have home Access in Australia - just thinking of maybe start importing (only joking).

But with limited knowledge Home Access is very good performed after 3 months. Most of Australian lab experts and Cerology Directors will tell you here "When we talk about 6 months window period we talk about 1st Generation Elisa that has been performed in the past."

Now, I don't know how much the first generation has been improved since that past.

But I know that I would at any point of time use 3rg generation if I would have chance for it - money should not matter.

Home Access company is stating that one should repeat test at 6 months. This observation in my opinion (have in mind that above observations are part of the facts - and Home Access is the only opinion) is that they have to make sure that they don;t get in trouble - and loose the business so they decided to be on the safe side - so that in every situation in case it occures they are covered.

You can compare Home Access with Specialists statement in Australia for 3rd generation that state:

"WE KNOW THAT WITH 3RD GENERATION ELISA WE CAN DETECT EVERYBODY THAT IS INFECTED IN 6 WEEKS. THE REASON WHY WE SAY 12 WEEKS IS THAT AT OUR GUDILENS MEETING WE DECIDED TO DOUBLE WHAT WE KNOW - JUST IN CASE".

Hope this long observation can help somebody.




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Anonymous
Unregistered

Re: TESTING DURING WINDOW PERIOD AND AFTER new
      #30923 - 03/30/02 08:06 PM

Here is something I dont understand.

But with limited knowledge Home Access is very good performed after 3 months. Most of Australian lab
experts and Cerology Directors will tell you here "When we talk about 6 months window period we talk about
1st Generation Elisa that has been performed in the past."

From what ive read, there is only 7-10 days difference between 1st and 3rd generation tests. So if almost everytone sero's at 6 weeks with first, wouldent it be reasonable to assume that with 1st gen testing most will sero' at 8 weeks?? BTW, most labs in the US use 1st generation tests, so everyone here should test out to 6 months. In addition, the 3rd generation only decreases the window period for subtype B. For all other subtypes the 3-6 month window period stands. Anyways good post.



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Richard
Unregistered

Re: TESTING DURING WINDOW PERIOD AND AFTER new
      #30924 - 03/30/02 08:27 PM

Just to clerify for complete understanding.

Sometimes due to my limited knowledge of English - and it happens to me all the time - people don;t understand what I was trying to say - or understand differently what Imeant to say.

Getting back to what you have pointed re Home Access.

You are right that you have read that difference between 1st and 3rd is just about week, and that only applies to a first few weeks, later on when there are enough antibodies there is no need for sensiivity as such (after 3 months).

As fas as the statement:

Most of Australian lab
experts and Cerology Directors will tell you here "When we talk about 6 months window period we talk about
1st Generation Elisa that has been performed in the past."

I meant to make difference between 1st generation Elisa performed say 10 years ago, and the same 1st generation Elisa perform now. Even if it is the same name, it is not the same test, as over period of time the assay they performed test with have changed, the sensitivity, experience and knowledge has changed, the technology that perform the test have changed.

In other words - since there is lot of different information on the net, sometimes old, it is important to know this. Because sometimes you might read something on the net not realising that is for example 10 years old.

It is the fact that most of US lab perform 1st generation test - but they do that because it is sufficiant.

In Australia all the lab can only use 3rd Generation.

It is also important to understand that lot of US labs also use 4th Generation Elisa too.

4th Generation Elisa is combination of 3rd Generation and p24 Antigen in one assay and one test.

Hope this clears my statement little bit better.



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Anonymous
Unregistered

Re: TESTING DURING WINDOW PERIOD AND AFTER new
      #31008 - 04/01/02 07:52 AM

richard it's Serology (as in serum) not Cerology as in cereal...



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