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HIV from receptive anal broken condom
Dr HHH:
Three weeks ago, I had a sexual encounter with another man. We used a condom but after anal sex and ejaculation (I was the receptive partner) we found out that the condom had broken during intercourse (not sure at what point it broke but I don't know that that matters). He said he was HIV- and we quickly purchased and performed a Home OraQuick HIV test which produced a negative result. To be doubly certain, he also took an HIV antibody blood test at his local clinic which confirmed that he was negative (ie. HIV 1/O/2 Ab Qual Non-Reactive) so I am somewhat reassured that he was indeed negative at the time of exposure.
My question is, given the high risk activity (ie. receptive anal sex, broken condom):
1) What is the risk of HIV transmission?
2) Given that he tested negative on the day of exposure, is likelihood of HIV transmission high or low or possible?
3) What level of assurance can I give an OraQuick HIV Home Test at 3 weeks or should I not bother until 4 weeks post-exposure?
Thank you.
Three weeks ago, I had a sexual encounter with another man. We used a condom but after anal sex and ejaculation (I was the receptive partner) we found out that the condom had broken during intercourse (not sure at what point it broke but I don't know that that matters). He said he was HIV- and we quickly purchased and performed a Home OraQuick HIV test which produced a negative result. To be doubly certain, he also took an HIV antibody blood test at his local clinic which confirmed that he was negative (ie. HIV 1/O/2 Ab Qual Non-Reactive) so I am somewhat reassured that he was indeed negative at the time of exposure.
My question is, given the high risk activity (ie. receptive anal sex, broken condom):
1) What is the risk of HIV transmission?
2) Given that he tested negative on the day of exposure, is likelihood of HIV transmission high or low or possible?
3) What level of assurance can I give an OraQuick HIV Home Test at 3 weeks or should I not bother until 4 weeks post-exposure?
Thank you.
Move on, we only deal with approved HIV tests and are not interested in any of your person opinions.
Again -- I never asked about approval, asked about reliability. The FDA approvals process does not speak to reliability but rather, in this case, to the general use of a test for diagnostics purposes. Such an approval has to take into consideration many elements beyond the reliability of the test such as public policy and budgetary considerations. Thank you.
Thanks -- somewhat useful as hearing contrary opinions is never unwelcome but I'll take my personal doctor's, Dr HHH's, the MedHelp article by Dr. Gonzalez-Garcia entitled "What is the best HIV Test?", AIDS Vancouver's, and several other expert opinions as somewhat more reliable since I have zero idea when Mr Klein uttered his statement and whether it is in any way reflective of current medical opinion on this matter.
For example, from the University of New Hampshire Health Services Department:
HIV DNA PCR Test
There is a new technology for the early detection of HIV after 28 days of exposure called HIV DNA PCR. This test looks for the DNA copy of the HIV virus itself in your blood. It is extremely accurate and sensitive.
PCR Blood Test
The Polymerase Chain Reaction (PCR) test screens for genetic material associated with HIV rather than HIV antibodies, and can detect HIV in the blood within two or three weeks of infection. The PCR test is also known as an HIV nucleic acid amplification test (NAAT).
Proviral HIV DNA by PCR
The HIV Proviral DNA by PCR is the most sensitive test for detecting infection. While most healthy individuals are accustomed to waiting 3 months for a conclusive result, the HIV Proviral DNA can provide conclusive results after only 28 days.
The DNA PCR is an antigen test, that is, a test that looks directly for the virus. This test is conclusive well before the antibody test because it is not dependant on an antibody response. It is looking for the actual genetic material of HIV, called "proviral DNA." If the specimen contains a particular HIV segment, it will be synthetically amplified (multiplied) so that it's easily detected. If even a small amount of virus is present in the specimen it is easily detected by this test. During acute infection (a few days to weeks after exposure), and before the body creates an immune response, HIV replicates to one of the highest levels throughout the entire illness. During the first two to four weeks, plasma viremia levels can be as high as 1 million copies per milliliter of whole blood.
The DNA PCR only needs 10 copies for detection. Although the manufacturer recommends testing after 28 days for conclusive results, a DNA PCR can clearly be used well before that time as a strong indicator. For patients with a high level of anxiety or strong reason to suspect infection, the DNA PCR and other PCR based techniques can be useful even days after exposure, not only to help rule out infection, but also to help support decisions about post exposure prophylaxis therapy.
***
The Wisconsin State Department of Health Services states:
What is PCR DNA testing?
The HIV Polymerase Chain Reaction (PCR) DNA test is a type of nucleic acid amplification (NAAT) blood test that detects and amplifies HIV DNA from a sample containing nucleic acids. It can be used to detect
acute HIV infection.
What is acute HIV infection?
Acute HIV infection is the initial stage of HIV infection prior to antibody response.
What is the window period for detecting HIV with PCR DNA?
Proviral DNA is present within hours of infection, but reaches detectable levels around 10 days after infection. In some persons it may take up to 21 days to reach detectable levels.
***
From AIDS Vancouver (dated March 13, 2013):
An RNA test detects viral RNA in blood of individuals who have not formed detectable antibody levels yet. This test is usually given at 10 - 12 days. In Vancouver it is only available to men who have sex with men (MSM). Follow up with Antibody test at 12 weeks is sometimes necessary, depending when the test was taken. Accuracy rates are 90% at 10-12 days, 95-98% at 6 weeks, and 99% at 12 weeks. An HIV Negative test at 22 days is a great indication that you do not have HIV.
A PCR DNA test has a window period of between two to three weeks of exposure and has a reliability rate of 99.6%.
***
It would seem to me then that there is a general concensus, notwithstanding the wise words of Mr Klein that DNA PCR testing is appropriate and useful in providing at least a highly reliable if not definitive indication of HIV infection with the degree of reliability dependant on when the test is taking place post-exposure. In the case of a PCR DNA test at two to three weeks post-exposure, AIDS Vancouver cites a reliability rate of 99.6% while Dr HHH cites a reliability rate of greater than 95%.
For example, from the University of New Hampshire Health Services Department:
HIV DNA PCR Test
There is a new technology for the early detection of HIV after 28 days of exposure called HIV DNA PCR. This test looks for the DNA copy of the HIV virus itself in your blood. It is extremely accurate and sensitive.
PCR Blood Test
The Polymerase Chain Reaction (PCR) test screens for genetic material associated with HIV rather than HIV antibodies, and can detect HIV in the blood within two or three weeks of infection. The PCR test is also known as an HIV nucleic acid amplification test (NAAT).
Proviral HIV DNA by PCR
The HIV Proviral DNA by PCR is the most sensitive test for detecting infection. While most healthy individuals are accustomed to waiting 3 months for a conclusive result, the HIV Proviral DNA can provide conclusive results after only 28 days.
The DNA PCR is an antigen test, that is, a test that looks directly for the virus. This test is conclusive well before the antibody test because it is not dependant on an antibody response. It is looking for the actual genetic material of HIV, called "proviral DNA." If the specimen contains a particular HIV segment, it will be synthetically amplified (multiplied) so that it's easily detected. If even a small amount of virus is present in the specimen it is easily detected by this test. During acute infection (a few days to weeks after exposure), and before the body creates an immune response, HIV replicates to one of the highest levels throughout the entire illness. During the first two to four weeks, plasma viremia levels can be as high as 1 million copies per milliliter of whole blood.
The DNA PCR only needs 10 copies for detection. Although the manufacturer recommends testing after 28 days for conclusive results, a DNA PCR can clearly be used well before that time as a strong indicator. For patients with a high level of anxiety or strong reason to suspect infection, the DNA PCR and other PCR based techniques can be useful even days after exposure, not only to help rule out infection, but also to help support decisions about post exposure prophylaxis therapy.
***
The Wisconsin State Department of Health Services states:
What is PCR DNA testing?
The HIV Polymerase Chain Reaction (PCR) DNA test is a type of nucleic acid amplification (NAAT) blood test that detects and amplifies HIV DNA from a sample containing nucleic acids. It can be used to detect
acute HIV infection.
What is acute HIV infection?
Acute HIV infection is the initial stage of HIV infection prior to antibody response.
What is the window period for detecting HIV with PCR DNA?
Proviral DNA is present within hours of infection, but reaches detectable levels around 10 days after infection. In some persons it may take up to 21 days to reach detectable levels.
***
From AIDS Vancouver (dated March 13, 2013):
An RNA test detects viral RNA in blood of individuals who have not formed detectable antibody levels yet. This test is usually given at 10 - 12 days. In Vancouver it is only available to men who have sex with men (MSM). Follow up with Antibody test at 12 weeks is sometimes necessary, depending when the test was taken. Accuracy rates are 90% at 10-12 days, 95-98% at 6 weeks, and 99% at 12 weeks. An HIV Negative test at 22 days is a great indication that you do not have HIV.
A PCR DNA test has a window period of between two to three weeks of exposure and has a reliability rate of 99.6%.
***
It would seem to me then that there is a general concensus, notwithstanding the wise words of Mr Klein that DNA PCR testing is appropriate and useful in providing at least a highly reliable if not definitive indication of HIV infection with the degree of reliability dependant on when the test is taking place post-exposure. In the case of a PCR DNA test at two to three weeks post-exposure, AIDS Vancouver cites a reliability rate of 99.6% while Dr HHH cites a reliability rate of greater than 95%.
PCR-DNA tests are not approved for screening or diagnosing HIV.
PCR-DNA Tests
Neither the Abbott RealTime nor the Roche COBAS AmpliPrep/COBAS TaqMan HIV-1 assay is intended to be used as a donor screening test for HIV-1 or as a diagnostic test to confirm the presence of HIV-1 infection.
Richard Klein
HIV/AIDS Program Director
FDA Office of Special Health Issues
PCR-DNA Tests
Neither the Abbott RealTime nor the Roche COBAS AmpliPrep/COBAS TaqMan HIV-1 assay is intended to be used as a donor screening test for HIV-1 or as a diagnostic test to confirm the presence of HIV-1 infection.
Richard Klein
HIV/AIDS Program Director
FDA Office of Special Health Issues
Just an update. Took an HIV DNA PCR test at 22 days. Results came back negative which Dr HHH considers about 95% reliable. He suggested another antibody test 4 weeks or more post exposure for 100% reliability. All in all, it was what was expected given the circumstances of the exposure.
If you want a doctor to answer you questions you'll need to post in their forum and pay the fee.
The only way to know your status is you test and obtain your conclusive test result. Guessing won't tell you anything about your status nor is HIV something you guess about. You were protected until the condom failed which makes it a lessor risk but still a risk.
Thanks -- I'm not sure you understand what I'm asking. I AM concerned about my status which is why I've asked the questions I have.
I am asking about likelihood of exposure given that the insertive partner was tested on two separate occasions using two different methods and on both occasions tested negative. So perhaps Dr HHH can provide his insight on likelihood of exposure under these circumstances.
Again, I am well aware this was a high risk exposure and I am well aware that I have to be concerned about my status.
I am attempting to quantify the level of risk if that is empirically quantifiable under the circumstances.
Again -- I didn't invent the number cited by Dr HHH about exposure risk being 1 in 100 or 1% for unprotected receptive anal sex. I have seen that from Dr HHH on this very forum. And given that the risk is 1 in 100, you are absolutely correct that there is a risk from a single exposure...that 1 in 100 risk certainly would confirm that. So what I am interested in is the the level of risk involved here.
I am asking about likelihood of exposure given that the insertive partner was tested on two separate occasions using two different methods and on both occasions tested negative. So perhaps Dr HHH can provide his insight on likelihood of exposure under these circumstances.
Again, I am well aware this was a high risk exposure and I am well aware that I have to be concerned about my status.
I am attempting to quantify the level of risk if that is empirically quantifiable under the circumstances.
Again -- I didn't invent the number cited by Dr HHH about exposure risk being 1 in 100 or 1% for unprotected receptive anal sex. I have seen that from Dr HHH on this very forum. And given that the risk is 1 in 100, you are absolutely correct that there is a risk from a single exposure...that 1 in 100 risk certainly would confirm that. So what I am interested in is the the level of risk involved here.
The trouble and fallacy of using numbers is you don't know if you are 1 or 100 and yes people have contracted HIV on their first exposure. As for the other person's test, do you know that he hasn't had any unprotected sex within 3 months of that test result? You can't take their word and you need to be concerned with your status.
Thanks. I know it is a high risk exposure. The insertive partner did test negative using BOTH the OraSure Rapid HIV test and a traditional antibody blood test from his clinic so I am certain that he was testing negative at the time of exposure.
I was also tested before the exposure using a traditional antibody blood test at a clinic and was also negative.
I am trying to understand the risk of HIV transmission but take your point that it is pointless to use an OraSure Rapid HIV test for another 9 weeks (ie. 3 months post-exposure). I will, however, get a traditional antibody blood test at my clinic next week (ie. 4 weeks post-exposure). All that said, I am trying to understand (from you or Dr. HHH) what the original risk of exposure is given the facts above. Dr. HHH has stated before that the risk of transmission from any single act of receptive, unprotected anal sex is about 1 in 100 or 1%. Would he or anyone have any opinion of the risk of such when someone has tested negative (non-reactive) using both an OraSure Rapid HIV test (ie. virtually confirming no HIV infection 3 months from the test) or the traditional clinic HIV antibody blood test.
Thank you.
I was also tested before the exposure using a traditional antibody blood test at a clinic and was also negative.
I am trying to understand the risk of HIV transmission but take your point that it is pointless to use an OraSure Rapid HIV test for another 9 weeks (ie. 3 months post-exposure). I will, however, get a traditional antibody blood test at my clinic next week (ie. 4 weeks post-exposure). All that said, I am trying to understand (from you or Dr. HHH) what the original risk of exposure is given the facts above. Dr. HHH has stated before that the risk of transmission from any single act of receptive, unprotected anal sex is about 1 in 100 or 1%. Would he or anyone have any opinion of the risk of such when someone has tested negative (non-reactive) using both an OraSure Rapid HIV test (ie. virtually confirming no HIV infection 3 months from the test) or the traditional clinic HIV antibody blood test.
Thank you.
Anal sex is one of the highest exposures and Oraquick tests are not able to give a conclusive negative test earlier than 3 months post exposure.
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