MEDHELP 翻译 NO.5（北京22岁的女孩发生了无套的KJ和XJ）
Dear Dr. Sean,Hope you are well and thank you for helping all of us here in the forum.
I am in a situation fairly typical of a significant group of posters here. I am a straight male who had a one time unprotected oral and unprotected vaginal sexual encounter with a 22 year old girl from Beijing. Not sure if relevant but she is an educated girl who claimed she only had 2 previous sexual partners.
I had tested myself for HIV and other STDs prior to this encounter and was negative on all counts. After this said encounter, I asked the girl if she had checked herself before and she said she has not.
Exactly 7 days (and 6 hours) after the encounter, I took a PCR RNA HIV test which has a limit of detection (LoD) of 100 IU/ml. I have been reassured by the doctor administrating that test that a result from this test 7 days post encounter is as conclusive as i need to worry myself with. Now I have read countless articles on the Internet since to verify this and cannot seem to reconcile the doctor's advice with what I see in other scholarly articles.
Questions:
1. Isn't the eclipse period for any PCR RNA tests between 7 - 21 days with a median of 10 days?
2. I notice you start testing patients at your clinic with a PCR RNA test 7 days post exposure. What kind of ballpark accuracy (75%? 90% more, less?) would you prescribe to a negative result from such a test?
3. From previous posts you replied to, you seem confident of a negative PCR RNA result post 7 days. This seems contrary to the prescribed eclipse period I read about in (1) and also different from the CDC's recommended 9-11 day wait. Would you mind helping me reconcile this please?
4. For my piece of mind, can you please help me understand the overall risk I am in for HIV, in terms of the patients you see? i.e. how many heterosexual men have contracted HIV from a one off unprotected vaginal exposure?
Thank you very much for your help
亲爱的Sean医生
希望您安好并感谢您对论坛里所有人的帮助。
我的情况和论坛里大家的典型情况差不多。我是异性恋，我和一个来自北京22岁的女孩发生了无套的KJ和XJ。我不确定这些是不是有关系，但她说她是有学历的女孩之前只有两个性伙伴。在这次发生之前，我所有的STDS测试都是阴性。这次可悲的境遇之后，我问她她之前有检测过么，她说她没有。
这件事发生7天后，我进行了RNA/PCR测试。我被测试我的医生鼓励说这个测试在7天以后的结果是准确的。之后我在网上阅读了大量资料来确认这位医生的说法，似乎网上的学术资料并不认同医生的建议。
我的问题是：
1.是不是在7-21天内，RNA/PCR测试在第十天测试出的是个中间值呢？
2.我注意到您测试您的病人时，使用RNA/PCR技术在行为发生7天后。这个测试的大致准确率是多少？您会认同这时的阴性测试结果么？
3.从您之前的回复来看，您似乎对7天后RNA/PCR阴性结果非常地肯定。这似乎和我阅读的有关窗口期的资料有矛盾，也和CDC（疾病预防控制中心）推荐的等待9-11天不同。能请您再解释一下么？
4.为了能让我安心，依照您所见过的病人，能请您帮助我了解一下总体上我感染HIV的风险么？一个异性恋的男人经过无套XJ感染HIV的概率有多大？
非常感谢您的帮助。
医生：
hello,
Thank you for your post and welcome to our forum. I will try to answer each of your questions here below:
1.) That is correct. However HIV RNA is already detectable at 7 days with a high level of reliability of around 99%.
2.) Our lab gives us figures of an accuracy of 99% at 7 days.
3.) We follow UK guidelines. At 7 days, it has an estimated reliability of 99%, which increases with time and after 10 days, this would be over 99%. If we combine this with a relatively low risk sexual encounter like yours, we could consider a negative result to be conclusive. However current UK guidelines would still recommend a follow-up HIV Duo test affter 4 weeks, even though in practical terms this might not be necessary.
4.) The estimated risk of a heterosexual man having unprotected vaginal intercourse with a known HIV positive woman is less than 1 in 1,000. If the status of the lady is unknown and this is in the UK, this will be less than 1 in 1 million as there are only about 40,000 women who are positive in this country.
Best wisehs,
Dr José
您好，
感谢您的上传并且欢迎来到我们的论坛。我将在下面试着回答您的每一个问题：
1.这是对的。但是HIV RNA 已经可以在7天后检测到，并且准确率是99%
2.我们的实验室给我们的数值是7天后准确率99%
3.我们按照英国的指导。在7天时，这个测试结果的预计准确率是99%，当时间推移到10天时，这个结果的准确率大于99%。如果我们结合您的相对低风险的行为，我们可以认为一个阴性的结果是决定性的。但是，现在英国STDS指导上仍然建议一个4周以后跟进的HIV联合测试，即便在一些特别的例子里是不必要的。
4.一个异性恋男性和一个已知HIV阳性的女性发生XJ感染的概率小于1/1,000.如果在英国，一个女性是否是HIV阳性的情况未知的情况下，这个数值将小于1/1,000,000，因为在英国只有大概40，000名女性成HIV阳性。
祝好
Dr José 呵呵没事的 :L:L:L:L:L:L:L:L:L:L
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