Anonymous
I recently had unprotected oral with a man almost 3 weeks ago, I immediately regretted it afterwards and had him do a HIV test. The results came back as "inconclusive" on ELISA and positive on CMIA. His last sexual encounter was "weeks ago" before me and he tested negative last July.

I've heard that CMIA was more accurate than ELISA and I'm very worried. What are the chances that it was a false positive?
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Anonymous
Hi and welcome to the Helpline,

It sounds like you are feeling quite worried about your risk of acquiring HIV from this situation.

The ELISA is a 3rd generation test which tests for antibodies which are developed in most people 21-15 days after acquiring HIV. With this test, while 95% of infections are dectectable within 4-6 weeks, officially conclusive results are only obtainable after 3 months. At 3 months after a possible exposure 99.8% of infections are detectable with this test. I am not sure what "inconclusive" means exactly in regards to this test as I am not a doctor. I would advise you and your friend to have a speak with the healthcare professionals who administered this test for information about this.

The CMIA, or 4th generation test, is different from the 3rd generation test in that it has another component. One part of the 4th generation is an antibody test, like the 3rd generation. But there is also an antigen test; It tests for antigens which are only detectable immediately after acquiring HIV and in the first few weeks. Most HIV specialists consider this test conclusive at 6 weeks, and at 12 weeks the accuracy is 99.9%.

Now, let's talk about your actual risk from this exposure. Giving oral sex is considered a Low Risk activity. What this means is that there have been a few reports of infection attributed to these activities, but these infections usually happen under certain identifiable conditions. For oral sex, these conditions would be if your partner ejaculates in the mouth or you've had fresh major dental work. Also, your saliva contains enzymes which help to damage the HIV virus enough so that it cannot transmit. Receiving oral sex is considered a Negligible Risk. This means that while there is a hypothetical potential for HIV transmission, there has never been a confirmed report.

It's up to you to look at your encounter and determine whether or not your want to get tested yourself. If you think that there is risk enough that you could have acquired HIV then it's time for you, and not your partner, to get tested.

I wish you the best and you are very welcome to post again if you have any other questions.


Sabina

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