Q. What is the accuracy of HIV RNA TMA test result being negative?

Answered by
Dr. Ravinder Kaur Sachdeva
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Mar 11, 2020 and last reviewed on: Mar 14, 2020

Hello doctor,

I am in 24th-day post possible HIV exposure. It was a broken condom with a sex worker. On day 6 I started experiencing pain in my legs which has continued until this day. I have also gone through a period of intense stomach gurgling, and shoulder and neck pain. I have monitored my temperature and have been normal until yesterday. On day 23, where I woke up to 100 degree temperature that lasted all day. Last night I experienced bed sweats. I did an HIV RNA TMA test by LabCorp at day 8 and 16, both are negative. Can I have comfort in the results of these tests as being negative? I plan to retest, but I am getting conflicting answers on the timing and accuracy of this test. The most recent consultation said these tests were the best out there and I can rely on the results I have. Your professional opinion is much appreciated.

Dr. Ravinder Kaur Sachdeva

HIV/AIDS Specialist
#

Hi,

Welcome to icliniq.com.

The test which you underwent on day 8 and 16 was definitely the best available test for that duration and you can surely rely upon the results. This test is highly sensitive for this duration to catch the infection if there had been any exposure.

As far as the timing of this test is concerned it is conclusive as early as 7-14 days post-infection. Unlike the other tests, this will always give a positive result as long as there is HIV in someone's blood.

Also, if there had been an HIV infection, HIV antibodies must be present in the person's blood. Studies have shown that the majority of the HIV antibodies develop in two to eight weeks period if there had been any exposure to HIV.

Furthermore, I suggest you to undergo an HIV antibody test also and at this time you can undertake fourth generation HIV rapid test. This is again a highly sensitive and specific test and gives accurate result. If the same is negative, then you repeat the rapid HIV antibody test at three months.

I hope this helps.


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Thank you doctor,

I will follow up with the fourth generation test. In your opinion, my RNA results are valid and I can relax? I believe I am having multiple symptoms due to anxiety, i.e. leg muscle, neck, and shoulder pain. I had a high temperature yesterday, but today seems back to normal.

Dr. Ravinder Kaur Sachdeva

HIV/AIDS Specialist
#

Hello,

Welcome back to icliniq.com.

The symptoms which you are having could have multiple reasons. Each individual has a different window period. The window period refers to the maximum time for a person's body to create HIV antibodies after HIV infection. It takes around two to twelve weeks for a person to make enough antibodies for an antibody test to detect infection. So an antibody response can be detected as early as two weeks in a few persons and 99.9% of people who get infected with HIV develop antibodies by 12 weeks. At four weeks, the HIV antibody test will be able to detect infection in 95% of people​.

HIV antibody test is the most widely used HIV test. Once a person develops HIV antibodies, they will be there for the rest of person's life. Meaning thereby, an HIV antibody test will always give a positive result for someone who has been infected with HIV.

Since you have done HIV RNA on day 16 (in early period of the presence of HIV in the blood), but this test is not categorized as stand-alone test to diagnose HIV infection, serology will help in confirmation about being infected or not. Therefore, I suggest you to follow up with the HIV antibody test.

I hope this helps.


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Thank you doctor,

I have a follow-up question to the previous string to hopefully ease my mind. Today I had the HIV antigen antibody fourth-generation test at 24 days post possible exposure. Yesterday at 23 days I had a fever of 100 degrees all day, today it is averaging about 99.2 degrees, but I feel weak and tired. This seems to fit in the two to four weeks post-exposure time frame pretty close.

My question is in reference to the HIV RNA TMA tests done at 8 and 16 days, both negative. If indeed I was having symptoms of ARS (sore leg muscles, sore neck, shoulders, gurgling stomach) at 6 days, in theory, would not that mean my body was fighting the HIV and the test would detect it?

Dr. Ravinder Kaur Sachdeva

HIV/AIDS Specialist
#

Hi,

Welcome back to icliniq.com.

I want to acknowledge that you are the most curious patient of mine. Firstly, I want to tell for your fever thingy, that checking yourself for the symptoms is completely an unreliable way to tell whether there is HIV or not. The recent HIV symptoms are hard to tell apart from the symptoms of other infections.

The majority of the people with HIV do not notice or feel any symptom at all with HIV. The occurrence of the symptoms in your case can just be coincidental finding or some other viral illness or for that case there are numerous causes. One should not just go with the assumptions of HIV if some of the symptoms are there.

Millions of people each year have fever, tiredness, lethargy, body pain, neck or shoulder pain or soreness. It is not surprising that symptoms of HIV infection are just like symptoms of pharyngitis, tonsillitis, or chest infection.

The tests available these days are highly reliable, chances of false negative tests in such a scenario of fever or with symptoms cannot be there. The only way to tell that if HIV is there or not, is to take the recommended test.

I hope this helps.


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Thank you doctor,

I did get the results of the fourth generation test and it was negative. Although, I also did a CBC and several abnormalities were shown. I have attached two CBC reports taken within one week's time. Here were the big differences:

WBC 4.3 to 3.6

Absolute lymphocytes 1.2 to .6

There were also abnormalities with protein and ketones. Also, there was a low Bun/Creatinine ratio and chloride/serum level. Any insight would be much appreciated.

Tests done are Day 8 HIV RNA TMA, Day 15 HIV RNA TMA, and Day 23 Fourth generation.

Dr. Ravinder Kaur Sachdeva

HIV/AIDS Specialist
#

Hello,

Welcome back to icliiq.com.

It is great that your Day 23 fourth generation test is negative. One more sigh of relief. For your other questions following are the answers:

Any infection can cause a decrease or increase in the white blood cell count. You can get it rechecked at an interval of one week. HIV per se will take many years to decrease lymphocyte count and usually will still not affect the total count.

For ketone and protein abnormalities, I advise you to get fasting blood sugar levels. Get your blood pressure examined.

Do not worry for low serum BUN/ creatinine ratio, if your actual bun and creatinine values are normal, it is fine.

For low serum chloride, take adequate electrolytes.

You have crossed the first hurdle. Next is to go for testing at third month only. No need to repeat the test in between.

I hope this helps.


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Thank you doctor,

I did not have a full 12-hour fast on this test, only about 8. I understand this will mess with the glucose level. Could non-fasting affect any other levels?

Dr. Ravinder Kaur Sachdeva

HIV/AIDS Specialist
#

Hello,

Welcome back to icliniq.com.

Usually, this duration serves the purpose for good results, however in your case, since some of the results were deranged I would suggest to repeat the tests including a fasting blood sugar after a gap of three to four weeks without trying to change your dietary habits too much.

I hope this helps.


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