Accuracy of Adult Industry Testing Questioned by the Jilted
Analysis by Michael Whiteacre
A friend phoned this evening with some kind words about TRPWL’s coverage of the adult production moratorium that was lifted today, and along the way he mentioned a curious thread on a gossip site run out of Georgia by a feller named Mike South.
The subject was the aforementioned moratorium, and a commenter who uses the moniker “jilted” — with a writing style and penchant for typographical errors I found strangely familiar — chimed in with this:
The lifting of the non existant [sic] moratorium is based on Diann [sic] Dukes [sic] complete misunderstanding of the capabilities of the APTIMA RNA test. 9-11 day window period, BULLSHIT!!!!
I have sent Mike the details of this bullshit claim. I know Mike has been busy today so I will give him some time to post it, if he cant get around to it I will pput [sic] it in the comments here.
Long story short, APTIMA has NEVER made the 9-11 day claim, this is anecdotal evidence and best case scenario outcomes.
PERFORMERS< there is no 9-11 day window for this test, and if you are relying on this to ensure your safety you are making a HUGE mistake, not only with your own life, but the lives of everyone you have contact with.
Sounds scary, right?
It appears that Mike South read Tim Tritch’s — I mean, jilted’s comment and email, then limped onto Twitter:
I gotta tell ya, I started shakin’ like a dog shittin’ razor blades! Mike South had taken time away from opening the Christmas gift box he received from MikeSouth .com habitué Shelley Lubben to share his brand new and totally not appropriated wisdom with the world!
However, I was puzzled when a copy of a test result from a PASS-certified facility revealed the manufacturer of the APTIMA test to be listed as “Gen-Probe” not “Gentech.”
‘Well, maybe that’s a typo,’ I reckoned. ‘The adult industry must’ve got it wrong — I mean, Mike South, the man who won an AVN award for Best Amateur Porn Video in 1997 can’t be wrong! Right?”
I decided to try an figger this’un out! I was stunned, however, when a visit to the FDA website confirmed that Mr. Accuracy had gotten the name of the manufacturer wrong.
Proper Name: Human Immunodeficiency Virus Type 1 (HIV-1 Nucleic Acid Testing/Synthetic)
Tradename: APTIMA HIV-1 RNA Qualitative Assay
Manufacturer: Gen-Probe, Inc
The test’s Package Insert (PDF format – 608KB) can be downloaded here.
Incidentally, page 15 discusses reactivity, and clearly shows that it has the single shortest window period of all HIV tests.
Okay, so Mike “Top Dog” South had made a typo — maybe he was having an allergic reaction to the pink lip gloss Lubben sent him. But what about the conclusions he lifted — err, excuse me — shared with jilted? Was it possible that every doctor associated with every PASS-certified lab was lying? Could it be that infectious disease expert Dr. Peter Miao knows less about HIV testing than an IT guy turned hillbilly bukkake shooter turned failed strip club manager and blogger?
Feelin’ a mite befuddled, I figgered I was a-needin’ to do little Google search about the accuracy of PCR testing (employing the “scholarly article” option, because compared to South’s site, TRPWL is a house of learned doctors), and selected a fully-cited review article from page one of the search results.
It was a-written by Mark Ringstrom of the Wisconsin Division of Public Health, and it reads in part:
PCR detection of HIV-1 nucleic acid in vivo is considered by many to be 100% sensitive, and is often used as the gold standard by which other testing methods are compared.  … And, as a perfunctory note, the difference in performance between RNA and DNA seeking assays seems to be minimal, with historical discrepancies in sensitivity and specificity long since resolved. 
The degree to which NAT [a Nucleic Acid Test] with PCR can narrow the pre-diagnostic window has been less well studied. Given the well-defined sensitivities described above, it is clear that the length of the pre-diagnostic window is simply a function of the rapidity with which a person becomes viremic. In his review of the natural history an acute HIV infection, Kahn estimates that initial viremia occurs as early as 3 days or as late as 11 days after infection .… Three other studies indicate that detection with PCR can shorten the pre diagnostic window period to 11 days. [1,6,9] Therefore, with the window of detection ranging anywhere from 3 to 11 days post infection, a significant improvement is realized over the antibody based tests previously described.
…HIV RNA is the “first and only detectable virus-specific marker for 1 to 5 days” subsequent to viremia… 
G-o-l-l-y! So, in other words, from the published work of multiple doctors and scientists we know that:
1) Detection of HIV is indeed possible within 11 days after infection, because viremia (the presence of the virus in the bloodstream) occurs between 3 to 11 days after infection; and
2) RNA is the earliest detectable marker for the virus, and it can be detected for days earlier than any other marker.
A closer look at the data in the studies and articles cited, and other data available online, indicates that it’s generally accepted that extremely sensitive PCR testing is over 95% accurate at 10 days. (I won’t bore you with the reams of technical mumbo jumbo; instead I’ll provide, below, the full citations for every source cited supra. I have more should anyone need further convincing.)
For reference, allow me to note that:
The HIV+ performer was diagnosed on December 6, which was 15 days after the last at-risk interaction between that performer and any member of the talent pool, on November 21.
Re-testing of talent potentially exposed to HIV from the infected performer began December 7, which was 16 days after the HIV+ performer’s last at-risk interaction with another performer.
The moratorium was lifted on December 12, which is 21 days after the HIV+ performer’s last at-risk interaction with another performer.
Welcome back to work, friends.
Footnotes cited in the article quoted above.
8. Cunningham CK, Charbonneau TT, Song K, et al. Comparison of human immunodeficiency virus 1 DNA polymerase chain reaction and qualitative and quantitative RNA polymerase chain reaction in human immunodeficiency virus 1-exposed infants. Pediatr Infect Dis J. 1999;18:30-35.
28. Weber B, Gurtler L, Thorstensson R, et al. Multicenter evaluation of a new automated fourth-generation human immunodeficiency virus screening assay with a sensitive antigen detection module and high specificity. J Clin Microbiol. 2002;40:1938-1946.
An FAQ about STIs, Testing and Moratoriums