guidlines

to use.
Hi Dr
After reading the BASHH guidlines I found this paragraph which says that even if you test with a 4th Gen you should still get a final 3 month test to definitively exclude HIV infection,its at in the bottom paragraph.I dont understand how you can say 4 weeks????
The recommended first-line assay is one which tests for HIV antibody AND p24 antigen simultaneously.
These are termed fourth generation assays, and have the advantage of reducing the time between
infection and testing HIV positive to ONE MONTH which is one to two weeks earlier than with sensitive third
generation (antibody only detection) assays [22]. It is reasonable to expect universal provision of these
assays, although they are not offered by all primary screening laboratories.

Section 6 Post test discussion

Post-test discussion for individuals who test HIV negative

The need for a repeat HIV test if still within the window period after a specific exposure should be
discussed. Although fourth generation tests shorten the time from exposure to seroconversion a repeat test
at three months is still recommended to definitively exclude HIV infection.

[Dr Sean]

Hello,

Thank you for the question - its a good one.

Its all in the wording - and consistent with our position. We have always maintained - and you can browse through all our Forum responses - that if there is a high risk episode (identified by us,not the patient who's perception is very often different) and a high index of suspicion then a further test needs to be done and we encourage it.

This is also entirely consistent with the paragraph you identify :-

The need for a repeat HIV test if still within the window period after a specific exposure should be
discussed. Although fourth generation tests shorten the time from exposure to seroconversion a repeat test
at three months is still recommended to definitively exclude HIV infection.

A specific exposure in our considered view - which includes doctors with a combined exposure to HIV and diagnosis of in excess of a hundred years with huge numbers of individual tests - is a high risk exposure not the majority of minimal but percieved risk.

You may not agree with it but thats our stance and so far, in our combined enormous experience it has been borne out.

Best regards, Sean