Dr. Asmeet Kaur Sawhney
Dermatology
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Patient's Query
Hi doctor,
I had protected sex with a CSW (Commercial Sex Worker) five months before. I do not know the condom's status, either broken or ruptured. I was drunk that day, but I did not even ejaculate. Since I had a doubt, I took a test in the 4th week, HIV 1 and 2 antibody rapid tests from the laboratory, which was non-reactive. In 6th week, HIV (Human immunodeficiency Virus) 1 and 2 rapid tests were non-reactive. On the 53rd day, I had HIV 1 and 2 antibodies plus the p24 combo. The result was non-reactive. On the same day, I had HIV 1 and 2 rapid test ICT (Indirect Coombs test) methods, and the result was non-reactive. I repeated the same test on the 59th day, and the result was the same. Please advise if the mentioned tests are conclusive or if I should go for the further test. I also took the VDRL (Venereal Disease Research Laboratory) test in 4th week, which was negative. I have started getting red spot-like rashes on my body from the 8th week of exposure, and today I found a white sore on my tongue. What test should I opt for STI (Sexually Transmitted Infection) and HIV to be sure? Do ARS (Acute Retroviral Syndrome) symptoms start in the 8th week? Can a fourth-generation combo test on the 53rd day be considered good news for being HIV-negative? Please confirm it.
Hi, Welcome to icliniq.com. I can understand your concern.
You have gone for antibody testing for HIV (Human Immuno deficiency Virus) 1 and 2 many times, and it has come negative. When two tests for antibody detection based on different principles are negative, it means the individual is not having an HIV infection. You have also undergone p24 antigen detection on the 53rd day, which is also negative. This test detects HIV antigens and is useful during the window period when the patient is asymptomatic but the viral antigen load is high. The negativity of these tests also goes in favor that you have not acquired HIV infection. Since the antibodies are usually produced between 6 and 12 weeks, I would recommend you repeat the ELISA test (enzyme-linked immunosorbent assay) for HIV 1 and 2 at 12 weeks again. To be absolutely sure, you can go for a virus culture, which is undertaken only in specialized laboratories, or a polymerase chain reaction (PCR) test. But it is quite expensive. ARS (Acute retroviral syndrome) symptoms usually start after 2-4 weeks of initial exposure, and your rashes and sore tongue might be due to some other reason. Yes, it is definitely good news that your fourth-generation combo tests are negative, and since all tests are negative, it is quite conclusive that you are HIV-negative.
Patient's Query
Hi doctor,
Thank you very much for the reply.
I have few doubts now to get clarified. I have read on internet that 8 week combo test is as good as 12 week antibody-only test and rapid test with third generation gives accurate result within 8 weeks. It is only CDC (Centers for disease control and prevention) guidelines which enforce 12 weeks conclusively. How correct is this? Which generation test is the ICT(Indirect Coombs Test) rapid test? Can I start unprotective relation with my wife keeping her security in mind? Is it necessary to go for PCR (Polymerase Chain Reaction)test?
Hi, Welcome back to icliniq.com.
There is no need to go for a PCR (Polymerase Chain Reaction) test as all your screening tests are negative. Yes, a combo test is a fourth-generation test that is used for the early detection of HIV as compared to third-generation antibody tests. However, I would still recommend you to go for repeat testing at 12 weeks and then go for unprotected intercourse with your wife once it is negative. ICT (immunochromatographic test) is a third-generation test.
Regards.
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Dermatology
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