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Updates on HIV testing Window Period

27th June 2013 was National HIV Testing Day in the US.

There were a lot of activities to promote HIV testing.

What I found interesting and also should be of interest to many readers of this blog is the HIV Testing Factsheet published by the CDC.

I have attached a copy here.

HIV-Testing-US-508

HIV Signs and Symptoms

The HIV Window Period and Test Accuracy

HIV PEP Post Exposure Prophylaxis

Please allow me to highlight some points in this factsheet:

1. The factsheet says that antibodies to HIV typically develop between 2 to 8 weeks after exposure to the virus. This we already know but I am glad there is more official recognition of this fact. So for those of you who are still sweating over your 3 months HIV test, stop sweating.

2. The factsheet also states that the P24 antigen can be detected within 4 to 7 days before antibodies appear. In other words, as early as 1 week from infection. This should also give comfort and reassurance to those of you who have undergone the Combo/Duo test at 3 to 4 weeks from exposure.

3. The factsheet also states that an RNA test can detect the HIV virus 10 to 15 days after exposure. I personally think that this should be the standard of care. Unfortunately, the RNA test in Singapore is costly and has a very long turn-around time. Our clinic in Thailand will be able to run this test at less than half of Singapore’s cost with a 1 to 2 days turnaround time.

Overall, I hope this factsheet published by the US CDC which is easily the most conservative medical institution I know, will give everyone some relief and reassurance.

Click on the picture for the latest information on the HIV testing Window Period

Click on the picture for the latest information on the HIV testing Window Period

 

 

 

 

 

 

 

 

 

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Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.

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579 Comments

  1. Suddenly an HIV patient coughed out with blood. I felt a small amount of saliva/water(I don’t know which one specifically) landed over my left brow.It has been 2 weeks since the incident.I had an HIV 1/2 Rapid Test done and it was (-) at 14 days exposure. Is there a need for me to repaet the test or be worried ab

  2. Hello Doctor, may i know is the 4th Gen HIV RAPID test conclusive after 28 days? I heard that rapid test is inferior to lab test, should i retest? My previous result is negative.

    • As a general guide yes the 4th Gen is conclusive after 28 days. However, there are many different types and brands with differing sensitivities. You should check with the doctor doing the test for you.

  3. dr. I have had a protected sex with csw 6 month ago. after 5 month I take a 2nd genaration antybody test and it was negative. at 6 month I took a aboot architect test is negative also after 6 month i. e. 186 day I took a test by immunochromotography method is also negative . dr plz tell me am I free from hiv .is there any need to test.

    • I think you should verify the accuracy of your test results with the doctor who did the tests for you. He will be in the best position to tell you if your tests are conclusive or not.

  4. Kevin918

    Hello Dr.

    I have tested Negative on Alere Determine HIV1/2 Ag/Ab Combo Fingerprick whole blood after almost 3 years of my exposure unprotected for less then a minute in August 2013. How reliable and accurate my test and result? Am I conclusive or need to test again? I haven’t had any potential or high risk exposure after that incident.

    Thank you.

    • The combo test should be conclusive 28 days post exposure. Please verify this with the doctor who did the test for you.

  5. Hi doc, I had an unprotected sex on d 14th if may, with a man I’m not sure if his HIV status. . I went to a lab on d 7th of d following month to be tested nd it came out negative. I went to a govt hospitals to get tested with hiv1/2 finger prick strip 9weeks 3days after exposure nd came out positive . later went in for anoda test on d 11thweek after exposure nd it also came out been negative. The question is: can I rely on d results or I shkd still have anoda test done . What generation test is the hiv1/2 conducted in govt. Hospitals. Tnx sir.

    • Technically speaking HIV tests can only considered conclusive at 3 months. So your test at 11 weeks is very good but not quite good enough. Next time you get tested, please verify the accuracy of your HIV test and the need for further testing with the doctor conducting the test for you. They are in the best position to advise you.

  6. I had the alere determine at 29 days and it was non reactive but I’m having swelling in lymph nodes and other symptoms. Is the alere determine accurate at 29 days?

    • No it is not. You need to repeat it at 3 months. Please verify this with your doctor.

      • Thanks doc. I knew it wasn’t conclusive but it’s not even accurate. Now I’m really worried . I was hoping 4 weeks would at least be a good indicator.

  7. Dear Doc. Tan,

    I have tested on 80th day of post exposure with a sex worker (protective insertive vaginal but not sure about leakage or damage) by Abbott Architect Plus HIV 1 & 2 ag/ab Combo (CMIA) Test with a negative result (0.17).

    1. Is it 4th generation Test?
    2. Is it 100% conclusive?
    3. Further Test (after 90 days) is required?

    Please help me. I am very worried. & the last one,

    4. Deep lip kisses (only) may put us on a risk to get HIV?

    I solicit your kind reply on above. Have a nice day.

    Thanks & Regards

    • 1. Yes it is.
      2. In my view it is.
      3. Not in my view
      4. Not in my view

  8. Hi Doc…can i ask how accurate eliza test in day 133?

  9. Had all the symptom after a broken condom incident my gf had all symptoms 2 tested only using an antibody test many times its been CLOSE 2 20 weeks now im not a worried RYT NOW HAV ABDOMINAL PAIN CNT DU ANYTHIN ABT IT COZ IM BROKE IS A 4 AND HALF TEST REALIABLE? IF U WER ME WUD U HV MOVED ON?

    • drtan

      You have had multiple negative HIV antibody tests up to 20 weeks post exposure? So why are you still worried about HIV? You think all your tests are wrong? I don’t find that logical thinking. You obviously have symptoms. Stop worrying about HIV and find out what is really causing your symptoms before it does you real damage.

      • Chris

        Hello Dr Tan,

        I have had exposure with CSW and broke in condom during insertive vaginal sex on 14/3/2016 and I have conducted an ag/ab ELISA test on 4th week exposure, it came up non reactive. Then I conducted another ag/ab test on 6th week it came up non reactive. However, I have experienced too many symptoms such as dry mouth, random rashes, muscle ache, muscle twitching to take HIV out of my mind. Today I conducted a 9th week rapid test which is negative in a government hospital but the doctor told me 6 months is the golden period for HIV antibodies to turn up. I know antibodies vary person to person but
        1)can I ask you that what is the longest window period you have personally encountered.
        2)assuming that these symptoms are caused by HIV virus, wouldn’t the test shows positive?
        3)will cd4 test help me in determining my status in the event that my antibodies has yet to be detected

        • 1) What we have encountered is irrelevant. Based on your test results, you are HIV negative.
          2) You are right. You just said it yourself that you do not have HIV.
          3) You have done Ag/Ab test in week 4 and week 6 which are both negative. HIV Ag appears as early as 2 weeks post exposure.

  10. europeam_dutch

    Hi Doctor,

    I had protected oral sex with a CSW on April 7,2016. She gave me a handjob with her bare hands and sucked my nipples for around 1-2 minutes. I wore a condom when she gave me oral sex. I did not suck her nipples nor did I give her oral sex. I also did not have any vaginal or anal sex even though I had a condom on. I lied naked with her while wearing a condom for 15-20 minutes and then let her go without having any penetrative sex. Am I at risk if she had bleeding gums and while sucking my nipples blood in her mouth came in contact with some very small invisible cut around my nipple?i did not have any injury before the encounter nor did i see any after she left and when i checked my nipples. i got scared later and on april 18 10 days after the exposure i got an hiv-1 rna pcr test done which was target not detected and on may 6 29 days later i got an hiv duo test which was non reactive with index value 0.07. do i need further testing? does it rule out both hiv-1 and hiv-2?

    • drtan

      You were not at risk of HIV in the first place. Anyway, your Duo test at 28 days is conclusive. You should stop worrying.

  11. David

    Hi doctor,
    I happened on 25/2/2016 oral sex without condom.Than 1/3/2016 go to hiv test positive of the CMIA test,Elisa test is negative.After i go another lab test on 8/3/2016,30/3/2016,3/5/2016 ELISA hiv 1+2(ab+ag) is negativa.now i can exclude hiv or not?There CMIA test is a mistake?

    • Based on your description, you do not have HIV. There is no reason why you should think the test is a mistake.

      • David

        not a mistake,is false positive.but lab said cmia test had 99.8% accuracy,elisa is 99.2%. then window period for some 2-5year.now i scared ,doctor.

        • David

          my english is not good ,i hope u understand.also to be added lab said someone cmia positive,elisa negative will remain so test result,is that right?i was hiv carriers ?

  12. Hello Doc,

    I had unprotected Sex on 1st March, then on 18th March morning i went for HIV test, Lab conduct three methods of testing, CMIA, ELFA and IMMUNOCHROMATOGRAPHY test, all three test show non-reactive. Please advise if i can find the results conclusive.
    Thanks,
    regards,

    • It is not conclusive although it is a good indicator that you have not been infected with HIV. I suggest you get yourself tested again on day 28.

  13. Sir I had unprotected sex with a man for minute 34 monthd back and I washed it I have tested on Elisa and cima one month back they are non reactive for HIV 1/2 but I have symptoms headache nueropathy like muscle weakness and gastric problems from last two year but are not solved pl help me what I should do I am so worried what should I do

    • HIV tests at close to 3 years post exposure are accurate. Unless there is a reason for your to suspect the conduct of the test was not done properly. You should be looking for another cause of your symptoms and not just focus on HIV.

  14. Hello doctor, I had an unprotected exposure with a csw 5 months back. Yesterday got my Western blot and pcr for 1&2 negative. I had all the ars symptoms including rashes fever white tongue etc.
    Lower detection for HIV 2 pcr was 900 copies/ml. Is it possible that viral load for HIV 2 is below 900 and antibody is negative after 5 months ? Can seroconversion happen so late? I had easinophilia as an infant.

    • Why do you torture yourself with such tests and complicated interpretations at 5 months post exposure? Just go get a straightforward HIV antibody test for HIV 1+2 and know if you are infected or not.

      • Sir I had tested negative for HIV duo test for HIV 1&2 at 19 weeks and was negative. Is it also conclusive for HIV 2 despite all the symptoms? I heard HIV 2 seroconversion is quite longer. Please help.

  15. Hi doc,
    i have unprotected sex with hiv unknown status person.i tested 7 ,9,11 weeks anti hiv1/2 p24 antigen test.the results came back non reaction.7 weeks western blot tested result is non reaction too.but some doctors and nurses said those results are not accurate.retest at 6 months.why i dont known.now i am so worry for my hiv status.i will test at 90 days? Or 6 months?do i need hiv viral load test?please reply me kindly.i am very thank you so much.i live in developing country so that most of the people dont know precise about hiv.i need your help,please

  16. Sir
    i have unprotected sex with hiv unknown status person.i tested 7 ,9,11 weeks anti hiv1/2 p24 antigen test.the results came back non reaction.7 weeks western blot tested result is non reaction too.but some doctors and nurses said thhose results are not accurate.retest at 6 months.why i dont known.now i am so worry for my hiv status.i will test at 90 days? Or 6 months?do i need hiv viral load test?90days negative result can be change later?please reply me kindly.i am very thank you so much.i live in developing country so that most of the people dont know precise about hiv.i need your help,please

  17. Hi doc,

    I had protected sex with a csw in oct. I had done 6 tests since then. 4 duo test at day 30, 56,77,87 respectively and DNA pcr at day 87 and finally antibody test at 18 weeks. I had all the ars symptoms in these 3 months except rashes.

    Offlate I have also developed rashes all over my body and my doc has advised me to get viral load test now. I am in week 19 now.
    Can HIV rashes come so late after 3.5 months? Have you seen or heard anybody turning positive after 18 week negative? Or is my result conclusive ?

    • I honestly do not know why your Doctor is asking you to do a viral load test. Ask him why he thinks the 6 tests you have already done are not conclusive. Personally I do not see any logical reason to think your tests are inaccurate. And therefore no logical reason to think you could be infected with HIV. And therefore the rashes you are currently having has nothing to do with HIV. Logically.

      • Hi doc,

        Thanks for your advice. My doc says since the rashes have come, he doesn’t want to take any chances. He said 90% of people convert by 3rd week and rest may take up to 6 months. He says if it is not due to HIV it will be due to pityriosis rosia.

        I am very scared and expecting the result of viral load today. Is my 87th day DNA pcr for 1&2 undetectable and duo test negative on 87th day not conclusive? Also I did antibody test in 18th week (last week) and was negative with the same cmia value as as previous tests. Can seroconversion happen so late ? Have you come across a case or heard about it? I am having this rashes all over my trunk,shoulders and back for the past two-three weeks and seem to reduce now after taking medication.
        Please help!!

        • Hi doc,

          Looking forward for your reply 🙁
          Please help

          • I got my viral load for HIV 1 as undetectable yesterday.

            Pcr and Elisa negative after 18 weeks conclusive ?

        • Your tests on day 87 are conclusive.
          Based on your results, you do not have HIV. Your rash has nothing to do with HIV.

          • Thank you doc !

          • The 133 days (19 week) duo test & rna pcr for 1&2 negative. I had protected sex but there was fluid exchange with her and I had all the symptoms (viral fever after 3 weeks, sore throat more than 3 times in 3 months, white tongue most of the time and finally rashes after 3.5 month all over my trunk,shoulders, back and thigh, weight loss has been more than 4 kgs within a month without any workout.

            Even with these symptoms can I consider myself conclusive? Or should I wait for 6 month test ?

          • Based on your results, you do not have HIV. Repeat the test only if you are still worried.

          • Hi doc I beg you to please reply to my below message

  18. William Duncan

    I had unprotected oral sex with an hiv+ guy but who is undetectable and been on meds for a year. There was no exchange of bodily fluids and I took oraquick hiv-1/hiv-2 oral swab test at 3 & 4 weeks which came up negative. How reliable is this test period and at the 28 day mark is my negative test result reliable?

  19. hello Dr

    about eight weeks ago, I had a protected sex
    with a casual sex worker who told me she
    doesn’t have hiv. during the intercourse, I
    mistakingly used my thumb that has a knife cut
    (0.5cm ) on it to adjust the condom. I was also
    on oral prednisone 5mg during that time. three
    weeks after stopping prednisone and three weeks
    after the intercourse, I developed a swollen
    lymph node at the sternoclavicular joint, fatigue
    and body aches. both the body aches and fatigue
    had stopped but the lymph node is still there
    swollen.
    NB:the lymph node was tender for the first two
    days. and was verified using ultrasound to be
    1.5cm.
    pls was I exposed to hiv?

    I recently got tested at 52days, is it a conclusive test?

    • The fact is you had sex with a sex worker. The condom reduced your risk but not to zero. A test at 52 days is not conclusive.

  20. hiv test at 4 months then 5 months and then at 6 months after unprotected insertive vaginal sex with a girl of unknown hiv status , and the results of tests are negative . my question is , are my tests upto 6 months conclusive ? what if might get hcv from the same sex encounter as i didnt do hcv test … does hcv delays hiv window period ? and if might get hcv then still my negative hiv tests upto 6 months conclusive? or do i need to test again? and the tests i did were hiv antibody tests(blood drawn from vein)at a hospital …and can a man get hcv from a woman in vaginal sex ?… please reply soon doc

  21. hi doc ,i had unprotected insertive vaginal sex(ejaculated inside) with a girl of unknown hiv status…. i took test at hospital in china after 4.5 months and then again at 6 months ,test results are negative … so my question is that my 4.5 and 6 months negative hiv tests are 100 conclusive? can i move on with my life?and marry? or do i need to test again?.. please reply soon doc , i am too much tensed.

    • Yes they are. That is assuming the tests you did are of appropriate sensitivity and specificity and were conducted properly.

      • doc thanks for your reply …. doc i took test at 4.5 months then at 168(24 weeks) days and last test on 6 months exactly, and results of these tests are negative ….so is it 100 percent conclusive? can i move on with my life and marry now? …..the test i did are in reputed hospital of this city …. plz doc answer … i am really really tensed…

      • doc i asked the hospital where i took tests .. the test they used are gold colloidal method(blood drawn from vein)….. so are my test results of 4.5 months and 5.5 months and 6 months 100 percent conclusive?can i move on with my life now?

        • We really cannot give you this kind of verification of your results over the internet. Please speak to the doctor in the hospital that did the test for you.

  22. Dear Dr,

    Please advice me for my situation.

    Two days before night I kissed on cheek of CSW,but unfortunately I had one cracked line on my lips,I was not sure whether it was bleeding or not.i kissed her on cheek only just for second only.I think she had few pimples on her cheek.

    1)am I at risk of hiv?
    2Do I need hiv testing for this?

    Thank you.

  23. Hello Dr,

    after my 6 month high risk exposure today I took Determine hiv 1&2 antibody finger prick rapid test, but I noticed that lab technician after put my blood in strip he was trying to find buffer solution, after 1-2 minutes he put UNIGOLD buffer solution alere determine hiv 1&2 rapid test-My result was weakly positive( Control line is clearly visible and patient line very slightly visible). then I tested again with another determine rapid strip with determine buffer solution- the result was negative also mu unigold rapid hiv test negative.

    I am worrying about my weakly positive result.

    1.Can we use another buffer solution on Alere determine hiv rapid test(example: unigold buffer solution on determine test) will it bring accurate result?

    2.Why I got weakly positive result with my first test?due to different buffer solution?

    3.my hiv tests are conclusive?
    4.do I need to repeat my hiv test?

    Thanks

    3.

    • The WHO guidelines states that if you have 1 positive HIV test, this should be confirmed with 2 more HIV tests using different methods. From what I can see you had 1 positive Determine test (possibly run erroneously because a different brand chase buffer was used) followed by 2 negative results (Determine and Unigold). So by definition, you do not have HIV. That said, all HIV positive tests must be followed up by a HIV specialist. So please see a HIV specialist to get this sorted out.

      • Dear Dr Tan,

        Thanks for your answers, but unfortunately I did not mentioned few details in my query, this weakly positive rapid hiv result I got after 13 months from my exposure,

        1.within 12 months i took multiple HIV tests,my all hiv results were negative including antigen, antibody and pcr. after 13th months,due to weakly positive test(possibility of different chase buffer was used) do I need to repeat my hiv tests?(on the same day rapid tests was repeated-all negative,next day-4th gen elisa-negative)

        2.now exactly 13 months 10 days,if I need to repeat my hiv tests which test you recommend to get conclusive results.

        Thanks

        Thanks

        • 1. In my opinion, your “weakly positive” test result was a false positive. If you are concerned, get another test done to be sure.
          2. HIV antibody test

    • Receiving unprotected oral sex I did several test including rapid HIV combo and lab combo at June, August and November al negative and more than 30 antibodies negative in the last 8 month but PCR positive in August after 4 month of my exposure in August. Am i infected? Can this be a false positive? Am so scared? Does low viral load of 2000 copies together with HIV combo negative at 8 month negative conclusive

  24. Good Evening Doc I just wanted to ask how accurate it is If i Got tested on the 34th day since unprotected contact. The test was Immuno Assay and the results for HIV-1 antigen and Antibody/ HIV-2 antibody screening test are Nonreactive.

  25. one time unprotected insertive vaginal sex with a girl, hiv antibody test at hospital result is negative at 119 days (4.25 months) is it conclusive? or retest at six months? about six month i read that its for people who are immunosuppressed ,chemotherapy etc … and normal people tested negative at 3 months are conclusive ,, is it true?

  26. I am Murthy from India.I had unprotected vaginal sex with a married women having 3 yr son.I never had any sexual contact with others in between time and her hiv status on 20/2/2015 is negative .I had sexual contact with her on 24/07/2014.I suffer from following symptoms from 15/08/2014 to till now and don’t go away: one day fever,sore throat,joint pains,indigestion ,weight loss 4/67kgs,night sweats,rash on body,fungal infections in groins.
    I feel these symptoms are HIV related then I go to HIV testing in ictc government labs in India.my HIV antibody test results are :
    At 1.5 month HIV comb aids ab NEGATIVE
    At 3 rdMonth HIV sd bioline ab NEGATIVE
    At 6 th month HIV tridot ab NEGATIVE and 6.5 month HIV 1 RNA PCR qualitative real time pcr result:NOT DETECTED.
    At 9 month HIV 1&2 sd bioline finger prick ab NEGATIVE
    At 12th month HIV tridot ab NEGATIVE
    At 15 month HIV sd bioline NEGATIVE
    At 17th month HIV sd bioline finger prick ab NEGATIVE.
    Why all 3 rd gen antibody HIV shows still negative if these symptoms are HIV related or if these related to HIV then please tell me correct way to diagnose it.
    Please tell me correct answer whether it is or not HIV .am I 100% rule out HIV infection in my body.
    Thank you sir

    • The answer to your concerns is very simple: You DO NOT have HIV. Why are you so convinced that your symptoms are due to HIV? Your test results are telling you clearly that you do not have HIV! Your symptoms may be due to other illness. Please consult your doctor to get yourself checked, instead of doing HIV tests again and again.

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