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Thanks for your additional insight and knowledge, Roger Klorese. It’s my understanding that the Alere Determine is the only fourth-gen antibody/antigen rapid test that has a CLIA waiver allowing for its use outside a lab--for example at a community testing site--and that the CLIA waiver is a recent development. Thanks for pointing out the other tests, which I failed to mention. Your comment does underscore the complexity and nuances inherent in HIV testing. I would have been happy if the “Looking” episode simply mentioned the window period—which would likely be relevant in Patrick's situation—going into the differences between antigens and antibodies would have been an added bonus. Conveying this information to the community at large is no easy task, but I do believe our health care workers, advocates, journalists—and yes, even script writers on gay TV shows—can rise to the challenge if we push ourselves.
Actually, my experience is very different in terms of how typical gay men deal with and understand testing. Lots of guys think the world of testing is what it was twenty years ago, with three-month window periods and two-week waits for results. Lots of guys think we test for the virus - so the testing-for-antibodies bit is actually useful information. Saying we test for the virus because we test for P4 antigen is confusing and inaccurate - it would be confused with a viral RNA assay like the porn industry uses. The Alere Determine is hardly the only fourth-generation HIV antibody and antigen test -- my clinic uses Abbott's fourth-gen test. But what they have in common is that they should show results for 99% of us or more within three to four weeks. So simply having Paddy say the unprotected act that made him uncomfortable happened six weeks ago made enough of this point without dialog lecturing on window periods. The bottom line, though, is that even supplying those details does take us to the level of the After-School Special about which you're concerned.
Trenton, though I did not see the referenced episode, I couldn't agree more with your personal observations! It sounds as if there was no authentic medical research, or consultation, with real professionals, in writing/producing this episode. That's a shame! This could be a great format for factually based HIV education and awareness, interfaced in a scripted, fictional TV show. It's done all the time in Hollywood. Further, sexually active gay men SHOULD STILL be held to the HIGHEST standard of understanding this disease---which has taken so many of our gay brothers. Yes, there are varying degrees of risky behavior. And many people agree, some of the riskiest allow for the most intimacy and fun. But the realization is...risk, is risk, is risk...however great or small! And as we experience our sexual behaviors, AND ENJOY THEM, it's wise for us all to understand those risks and act responsibly; not only for ourselves, but for our sexual partners as well. Those who are currently "negative" should understand...THERE IS NOTHING FUN ABOUT HIV!
Jeton Ademaj
To Roger and Trenton, I'm delighted fellow PHAG and ACT UPer James Krellenstein convinced the CDC to grant a CLIA waiver for 4th generation testing at point of care...but I wanted to note that not all 4th gen tests meet the standards Roger mentioned. Personally, developments associated with the Ebola crisis have caused me to revisit my hope for rapid PCR viral load testing for HIV becoming a point of care standard someday soon...to learn THAT DAY based on actual viral DNA, as opposed to antibodies and viral proteins much later. It would be amazing to turn early treatment enrollment into early and effective PEP for many instead. The Looking episode itself was a cascade of douchechills, even as I agree with Roger's description of attitudes and awareness in the wider community. My hubby enjoys it, for me it's still a treacly trifle...but happy wife, happy life. ;-)
January 23, 2015