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Family Physician
Family Physician, Doctor
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Experience:  Emergency Medicine and Family Practice for over 26 years
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I have a question regarding my hiv testing, both antibody and

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I have a question regarding my hiv testing, both antibody and PCR DNA tests I've done and would like some information regarding when and if I need to test again. The risks were women I had met at a bar and I didn't know them or what their health status was. I have tried to reach both partners and have not been able to contact them as this occurred as I was working out of state at the time.

Below is a timeline of the risks and the tests I've had done.

I had two possible risks, one on March 10th, I used a condom for vaginal sex but no protection for oral sex, both ways. Five days later I had a soar throat, fever, and what appeared to be thrush (which I have time to time). I took antibiotics and got well quick and no other symptoms. I was diagnosed with strep throat even though no throat culture was done.

The second possible risk was on April 13th, again I used protection for vaginal sex but not for oral sex, both ways. I did have not had any further symptoms since after the March 10th symptoms.

I started reading about thrush and found that with the other symptoms this was a symptom of possible hiv exposure, I believe referred to as ARS. I went in for an hiv antibody test on May 13th (64 days after the first possible exposure, 30 days from the second) and the result was negative.

After reading online I realized this was probably too quick for a definitive test and that a PCR DNA test would be more accurate for early detection, so I had the PCR DNA done on May 22nd. While waiting for the test results, the next day (May 23rd) I actually went to an std testing facility to actually talk to someone in the industry about hiv testing and risks (extreme anxiety) and had another antibody test done which was also negative. This was also negative and was 74 days after first possible exposure and 40 days from second exposure. The nurse told me that my tests for the first possible exposure was surely accurate (98%+) at this timeline and that the PCR would confirm the second exposure. Two days later the results came in from the PCR test and they were also negative. The nurse at the std clinic said in the event that the PCR test was negative I really didn't need to get tested again being as my risk was extremely low.

I don't have any problems getting tested as often as needed, but would really like some assurance from another source what these negative tests confirm or do not confirm and when and if I need to get tested again.

In also take methotrexate (six 2.5mg once a week) for RA, and also use an Advair inhaler for asthma. I had also taken oral steroids during the March 10th risk time.

Thanks in advance for your assistance.
Thank you for your question:

The official recommendation of the CDC is that antibody tests should be done following any exposure periodically until 6 months.

There are many experts in the field that believe a negative antibody test (particularly paired with a negative PCR) at 3 months can be considered definitive.

The fact that you are taking methotrexate could theoretically delay antibody production, so I do believe retesting at 6 months following the 2nd exposure would be the safest approach - giving you a true definitive negative.
Family Physician and 3 other Medical Specialists are ready to help you
Customer: replied 4 years ago.
Thank you for the quick response. I have read that that the six month rule is the standard for the most definitive answer, but was confused with the PCR test being the quick test for early detection. Could the methotrexate alter the PCR test as well?
I don't know that there is any evidence that the methotrexate would influence the PCR test.

Negative antibody and PCR test are very reassuring, but the current CDC recommendations is still for antibody testing at 6 months.
Customer: replied 4 years ago.
Thank you for your advice. I will retest along the guidelines from the CDC recommendations per your advice, especially due to the methotrexate issue of potentially delaying antibody production. The confusing part is the accuracy or benefit of having the PCR test at all, which seemed like the most effective test I could have had done at the time. Any insight on the benefit of me taking this test?

My 90 days from the first exposure, which is when the symptoms occurred will be up in two weeks and I will retest at that time and once a month thereafter until I meet the six month period for the second exposure.

Customer: replied 4 years ago.
Thank you for your time and professionalism, it is truly appreciated. The service you provide is not only appreciated, but a valuable service to those who are anxious and concerned. Being that I have not been sexually active for many years until recently, and also a cancer survivor has made me a little paranoid and cautious. I think my lack of understanding about how hiv can be transmitted, regardless of low or high risk was my biggest mistake, but moving forward, hoping I do end of negative through this testing window, I will be more cautious.

Again, thank you very much!