Confused by an older post by Dr. Handsfield, M.D

[sora44]

Dear Drs,

First of all thank you so much for your great support with my first post on this website and it hugely helped me with going on with my life.

Nevertheless, I was reading this post: http://www.medhelp.org/posts/HIV---Prevention/Hi--Help-discuss-some-questions-i-have/show/1177982

In it, it was stated that at high risk exposures normally you recommend further testing at 3 months point.

So my two main questions are:

1- If 4th generation test is 100 % conclusive at 4 weeks+ time point as stated many times in your great forum why the need to test again after three months after high risk exposure ?

2- For my exposure, which I hope you do not mind repeating that was less than one minute unprotected vaginal intercourse with a girl ( am circumcised male ) who had unprotected intercourse with an injection drug user 6 weeks before our encounter. Her test with fourth generation test came back negative after 6 weeks. In my and her case I think this is considered a high risk exposure nevertheless I got clear recommendation that no further testing is needed.

I understand that this post was in 2010 but it would really be helpful to understand more.

My other two non-main questions:

1- Is hepatitis C really sexually transmitted ? ( As she is HCV positive ) and I understand this has no effect on the HIV test results.

2- About the healthcare system in Germany, do you think its advanced enough for such tests to be 100 % precise ?

Thanks a lot

I understand this is my last question in the next 6 months but I really do appreciate your great support it helped me through one of the most intense moments in my life.

[Edward W Hook, MD]

Yes, you have summarized the message that I have (apparently unsuccessfully) tried to get to you several times before accurately.  

Your anxiety is getting the best of you.  Your repetitive questions are fueling your anxiety, not helping.  I will not take part in fueling your anxiety further. this will be my final reply.  Please, no further questions until October 2014.  EWH

[sora44]

So in conclusion :)

If I were one of your patients and my partner got a negative results with 4th generation test at 6 weeks exactly you would not recommend any more tests and let me go on with my life normally at which I can have unprotected sex without the fear of being positive and spreading the disease around ?

Sorry but my anxiety is stronger than me :)

[Edward W Hook, MD]

Get over it.  You are over-reacting.  I would not retest is I were you. EWH

[sora44]

I know this will sound silly but SHOULD in your previous post made me more anxious than ever :)

Should I retest then ?

[Edward W Hook, MD]

While there is no perfect test, a negative 4th generation test at 4+ weeks should be considered conclusive.  EWH

[sora44]

So in conclusion in 2014 a fourth generation test at 4 weeks plus is 100 % conclusive ?


I admit your last replies helped me a lot but anxiety keeps coming and going from time to time but not as huge as it was before I posted my first question.

[Edward W Hook, MD]

I'm sorry that you continue to worry about the exposure that you originally asked.  As you point out, the response you cite is more than four years old and since then tests have continued to improve so that current, 4th generation tests provide definitive answers weeks earlier than the 3rd generation tests referred to in the response you refer to.  Further and importantly, I do not consider your exposure to be high risk at all.  Your partner had a negative 4th generation test 6 weeks after her last exposure to a somewhat higher risk partner. Her negative test trumps the characteristics of her partner however and makes her risk for infection far lower than an "average" person who has not been tested.  In my opinion, the exposure to you describe was NO RISK for HIV based on the facts that it was a BRIEF exposure to a partner who is PROVEN not to have HIV from her most recent sexual encounter.  For those reason I see no reason for concern.

As for your further, lingering questions:
1- Is hepatitis C really sexually transmitted ? ( As she is HCV positive ) and I understand this has no effect on the HIV test results.
Hepatitis C has no known effect on HIV test performance.  Hepatitis C may be rarely transmitted through anal intercourse, most likely relating to the relatively traumatic nature of rectal intercourse.  there is no evidence that vaginal intercourse leads to any meaningful risk for infection.

2- About the healthcare system in Germany, do you think its advanced enough for such tests to be 100 % precise ?
For a variety of complex reasons no test is 100% precise anywhere. There are very rare problems which occur in the multistep process of testing.  These errors are minimized by global standards on testing and test procedures and careful quality control  HIV test are among the most accurate tests ever manufactured and should be believed.  The German laboratory system is highly evolved and produces results which you should have confident in.

I hope these comments will be helpful to you. I thnik you are worrying needlessly.EWH