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HIV RNA Test Reliability at 13-14 Days

Question: 

Hi,

I had unprotected oral sex with a person of unknown HIV status about three weeks ago (both giving and receiving). One week after exposure, I had a 4th generation test that came back negative. 13-14 days after exposure I had a HIV 1 RNA, QN PCR test with sensitivity to <20 (copies/mL) that came back Not Detected.

At three weeks, I am now feeling a bit off -- slight fever, body aches, red blotchy palms, some unexplained rashes on my arm.

Can I take any comfort in my HIV RNA test?

Also, I want to get tested again soon (the anxiety is killing me). Should I take a 4th Generation test, or try to take another HIV RNA test?

Answer: 

Hi there, and thanks a lot for contacting the AIDS Vancouver Helpline for your HIV/AIDS related health information. It seems you have some questions about a test you've had after a recent encounter. We're happy to answer your question for you.

Giving oral sex is considered a low risk activity. Receiving oral sex is considered a negligible risk activity. Low risk means that while transmissions are possible, they require specific circumstances to occur (like you having recently had major dental surgery, for example). Negligible risk means that while transmissions are theoretically possible, they have never been shown to actually occur.

Here is a bit more information on the tests you've had:

Test Name
Method
Window Period
Conditions
4th Generation EIA Blood test that looks for antibodies AND p24 protein antigens. Commonly referred to as the "combination," "combo" or "DUO" test. P24 protein is detectable immediately after infection but only for the first few weeks. The antibody (ab) test has a window period of 4-12 weeks post exposure. This test is widely available in North America. Most HIV specialists consider this test to be conclusive at 6 weeks but official HIV testing guidelines still recommend re-testing at 12 weeks for conclusive results. Conclusive at 3 months post exposure.
NAAT (PCR RNA & DNA) Nucleic-Acid Amplification Testing (NAAT) looks for the genetic material of HIV and tests for it with a Polymerase Chain Reaction (PCR) test. 2-3 weeks post exposure NAAT tests generally take two forms: DNA PCR and RNA PCR tests. DNA PCR NAAT tests are usually used for screening babies of HIV+ mothers. RNA PCR NAAT tests are often used to screen blood or organ donations. Both measure the viral load of a positive person’s blood. Conclusive at 3 months post exposure.

You'll see in the chart that both of these tests are considered conclusive, meaning their results are taken as accurate, 3 months post exposure. You've had these tests at 1 week and 2 weeks post exposure, so too soon to demonstrate your status conclusively after this encounter. That said, it's important to keep in mind the risks involved in this encounter when deciding on going for testing, as it was low risk. That said, we at AIDS Vancouver recommend routine testing for all sexually active people, so it's great you've gone for a test.

As for the symptoms you are experiencing, we at AIDS Vancouver are not healthcare providers, so cannot comment on them. However, HIV infections are never diagnosed based on symptoms alone, simply because the symptoms of an HIV infection are quite common to many other common medical conditions. Testing is the only way to diagnose an HIV infection. If you're concerned about any symptoms you're experiencing, we'd encourage you to see a healthcare provider.

If you want to know your status conclusively, you need to wait until at least 3 months after this encounter (but again, consider the risks involved).

Thanks for contacting the AIDS Vancouver Helpline with your question, we hope it has been answered fully.

Trevor

AIDS Vancouver Helpline/Online
helpline.aidsvancouver.org