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Dr. Andrew Rynne

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What does sore throat with negative RNA PCR test indicate?

Answered by
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Dr. Kakkar S.

Dermatologist

Practicing since :2002

Answered : 8028 Questions

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Posted on Mon, 4 Aug 2014 in HIV and AIDS
Question: Dear Drs,
On 3rd XXXXXXX and before (about few times) had unprotected oral sex with social workers. After 23 days 4th generation combo test result is negative, after 27 days RNA PCR test result is negative, 35 days 4th generation combo teat again is also negative. But I had some symptoms (about 2 weeks until now)like sore throat, lymphs ( neck and armpit ) not feeling well, and shoulder skin rash. Am I HIV infected?
Regards.
doctor
Answered by Dr. Kakkar S. 3 hours later
Brief Answer:
90days HIV test is required

Detailed Answer:
Hello and welcome to healthcaremagic

I am Dr kakkar. I have gone through your query and I have understood it.

The recomendation is that a negative HIV test, whether it is HIV Combo test or RNA PCR test, needs to be confirmed at 90days, with an antibody based hiv test for a conclusive hiv status. This is to cover for the window period of hiv detection (for an antibody based test window period of detection of hiv is 90 days) , which is about a month for a hiv combo test (an antigen and antibody based test) and about 2weeks for a NAT(Nucleic acid based test) Or RNA PCR test.

Therefore though it is very likely that you would be hiv negative at 90 days but you still need to do a 90day test for a conclusive hiv status.

Your symptoms may be unrelated.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. 2 hours later
Dear Dr. Kakkar,
Thanks for your reply.
Is that mean my test results are not reliable?
I was very worry in the past few weeks
doctor
Answered by Dr. Kakkar S. 8 hours later
Brief Answer:
HIV test

Detailed Answer:
Hi

HIV combo is highly reliable test. It has a sensitivity of 99.8% for detection of hiv as early as 1 month after a potential exposure to a source of hiv. This increases to 99.9% at 90days. Therefore a negative test at 1 month should always be confirmed at 90days. This is a recomendation. A negative HIV combo test at 1month almost certainly rules out hiv but it still needs to be reconfimed at 90days.

RNA PCR test is not routinely performed for hiv screening. This test is mainly used to monitor viral load in those who are hiv +. It has a short window period of about2weeks for detection of hiv. Therefore it gives an early diagnosis as compared to antigen/antibody tests like HIV Combo tests. Rarely there can be false negative as well as false positive results with RNA PCR test. Therefore a negative test at 2weeks almost certainly rules out hiv but 90days testing is still the recomendation.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. 4 hours later
Dear Dr. Kakkar,
What is the accuracy of the RNA PCR test?

Since you said the combo test is around 99.8% after one month.

Regards.
doctor
Answered by Dr. Kakkar S. 54 minutes later
Brief Answer:
RNA PCR test

Detailed Answer:
Hi.

As I said before RNA PCR is highly accurate and a negative test almost rules out HIV but RNA PCR is not routinely performed for screening. The false negative rate with RNA PCR is very uncommon and probably means that the specimen was mishandled!!

You should never have ordered a RNA PCR test for screening. Having said that your viral load is undetectable that's good news since most people who are infected will have a high viral load around this time, so I strongly feel you are negative, but still you need to be sure, therefore you need to take a standard antibody test at 3 month mark then you can be very very sure.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. 36 hours later
Dear Dr Kakkar,
I did another 4th generation Elisa test yesterday , and the result is negative today. It's a 42 days test result. 23 days combo was neg; 27 days RNA PCR test was neg; 35 days combo test was neg; and today 42 days combo test is neg ( I also tested in another lab this time ).
Do you have any comment?

Regards.
doctor
Answered by Dr. Kakkar S. 2 hours later
Brief Answer:
HIV test

Detailed Answer:
Hi.

As I said before, HIV Combo test if negative at 1 month almost rules out HIV. The combo test detects HIV antigen (P24 antigen) as well as HIV antibodies.

The advantage of combo test is that it also tests for Antigens (P24 antigen) since antibodies may be undetectable early in the course of infection even though most of the individuals develop antibodies at 1 month. Since your test came back negative at 1 month therefore most likely you are negative.

However, even though most of the individuals develop antibodies at 1 month if they were to, but a small fraction may not have detectable antibodies till 3 months therefore the need to repeat the test at 90 days to be absolutely sure.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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