very confused, should i take hiv drugs without a Poz test?

Question

Hi Dr. Wohl, I would like to begin hiv treatment asap if necessary but I am a bit confused by information I obtained from the WEBMD website. In this site, as I paste it, they make it clear that Repeat testing over a year is necessary to rule out hiv infection if one is symptomatic. They state a line "some people won't produce antibodies at even a year, so repeat testing is needed." Is this true? How common is this? I was wondering, would it be possible rather to take DNA PCR test at six months in combination to an EIA type 1 and 2 test to rule out hiv infection? Please respond, what is your outake. I had a needlestick occupational exposure and am wondering how long i have to test out to. You are a very caring man and we all commend you on your efforts to this site.

Here I am pasting what i read from WEBMD:

How Do I Know If I Have HIV?

The only way to know for sure if you have HIV is to get an HIV test.

If you are at risk of HIV, you should have an HIV test every six months. You should also reduce your risk (see the section on Prevention).

Soon after HIV infection, the body begins to make antibodies that fight the virus. The HIV test looks for these antibodies in your blood. After about three months, most people have enough anti-HIV antibodies to test positive on standard HIV tests. Some people don't test positive for six months or even a year, so repeat testing is needed.

What combination is your choice when starting hiv treatment if necessary?

I am so confused. Should i take hiv drugs even without a poz test?

Thanks.

Warmest,

Davi

Answer

Hi Davi-

If you sustained an occupational exposure that is risky for HIV transmission you should have been offered post exposure prophylaxis if available where you live. Assuming you did not take HIV medications immediately after the needlestick the proper course is to have repeated HIV antibody tests performed.

The CDC recommends testing at 6 weeks, 12 weeks, and 6 months and that is it. Some will test out to 12 months although very, very, very few health care workers who were infected with HIV on the job convert their HIV test from negative to positive after 6 months. There are reports of delayed HIV test conversion when hepatitis C virus is also transmitted during the exposure.

Should you have an HIV viral load test done? It is not standard but many clinicians do offer this to exposed workers especially if any symptoms of acute HIV infection emerge (fever, body aches, mouth or genital ulcers, rash, sore throat). If you were infected (risk from needelestick is about 1 in 300) the viral load test would likely be detectable within days of your exposure.

I would not recommend you start HIV therapy if it is more than 72 hours post your exposure. IF you do have evidence of acute HIV infection then this could be considered. If you have an occupational health section at your workplace, please continue to work with them.

Check out the CDC website for more details: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm