[Question #10201] HIV Fear

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25 months ago
Hello Doctor, first of all thank you so much for taking time to answer my questions. I (29M) had a possible exposure to a SW on the 11th of April with unprotected vaginal sex. 2 weeks after this I started having a sore throat (my voice even became), some mouth ulcers and night sweats  for 3 or 4 days. These symptoms subsided in 5/6 days. 

I had 5 HIV tests in total:

- Alere Rapid 4th gen test at 22 days
- HIV 1/2 PCR test at 35 days
- Alere Rapid 4th gen test at 45 days
- HIV CMIA 4th gen lab test at 62 days
- HIV CMIA 4th gen lab test at 92 days 

All of these were negative. I'm still worried that I might turn positive due to the symptoms that I had, and also because a general practice doctor that I contacted told me I should test at 6 months, which contradicts the guidelines that I've been reading that say 3 months is enough.

- I'm located in Portugal, where HIV-2 is also present, are the tests that I had conclusive?

- I've heard that HIV-2 doesnt have as much viral load as HIV-1, I'm afraid the PCR test wouldnt be able to detect it at 35 days, what do you think?

- Can I resume my normal sex life with my wife?

- Do I have to/is it required to test at 6 months? Im suffering with anxiety and 3 more months of this will be extremely hard to endure. 

- Is there any case where a person was negative at 3 month and turned positive at 6?

Thank you so much for your help. 
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Edward W. Hook M.D.
25 months ago
Welcome to our forum. Thanks for your questions. I’ll be glad to comment. The short answer is that you have absolutely proven that you did not acquire HIV from the exposure you described. 

The results of your PCR tests are conclusive for HIV-1 ( but not HIV-2) and your fourth generation tests at 45, 62, and 95 days absolutely prove that you did not acquire HIV-1 or HIV-2 from the encounter you described. You can believe these test results. There is no reason for continuing concern, nor is there any reason for further testing.

You can certainly resume normal, unprotected, sexual activity with your wife without concern that you might be transmitting HIV to her from the encounter you described.

There is no reason for additional testing at six months. That recommendation is out of date. Similarly, there are no instances of a person who has acquired, had a -4th generation combination HIV antigen/antibody test, such as you have had becoming positive after having a negative test.  Results are conclusive anytime more than six weeks following an exposure. I urge you to put any concerns that you might have aside and move forward without worry. EWH.
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25 months ago
Thank you so much for your reply Doctor it really helps a lot.

1 - Can you just please elaborate on the part where you mention that "PCR tests are conclusive for HIV-1 ( but not HIV-2)"? Why would that be?

2 - Also, a question that I've been having with myself is the following: if the symptoms that I experienced at 2 weeks post exposure were either because of HIV 1 or 2, the PCR would be able to detect viral load at 35 days. Is this assumption correct? 

3 - Viral Load or Antigens only go down because of antibodie formation correct?

4 - What would be the window period for the HIV-2 then? Is the window period 3 months?

Finally, not really a question, but just to thank you for all the answers Doctor as I understand some might be a bit repetitive. 
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25 months ago
Oh Sorry, also, just a question I forgot to add

If you had to put this in percentage wise, what would you say would be the chances of my tests turning positive if I were to test again later? (related to this exposure)
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Edward W. Hook M.D.
25 months ago
1 - Can you just please elaborate on the part where you mention that "PCR tests are conclusive for HIV-1 ( but not HIV-2)"? Why would that be?
PCR tests only detect one strain of HIV, HIV-1.  They are not designed to detect HIV-2.

2 - Also, a question that I've been having with myself is the following: if the symptoms that I experienced at 2 weeks post exposure were either because of HIV 1 or 2, the PCR would be able to detect viral load at 35 days. Is this assumption correct? 
If your symptoms were due to HIV, your test would be positive.  Symptoms occur because of the interaction of the HIV virus with antibodies and, as a result, in person with symptoms tests are ALWAYS positive.  Once the tests are positive, they remain positive

3 - Viral Load or Antigens only go down because of antibodie formation correct?
Correct

4 - What would be the window period for the HIV-2 then? Is the window period 3 months?
First, remember that while HIV-2 may occur in Portugal, it is rare.  Second, HIV-2 would be detected with testing any time more than 6 weeks after an exposure. Your results prove that you do not have HIV-2.

Finally, the chance that you will test positive for HIV from infection acquired at the exposure you describe is 0.

Please don't worry.  EWH
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25 months ago
Doctor, once again thanks for your reply.
Looking at the report sent by the lab, it states that this PCR was indeed for HIV 1 and 2, so thats my confusion...I just want to clarify this part with you. Not much is known about HIV-2, but since its progression is slower, antibody formation should also be slower per my logic, but obviously I rely a lot more on the opinion of an expert like you.

1 - The PCR clearly states that this was a test designed for HIV 1 and 2. Is this a lie by the lab? Or, if it really is what the lab says, would this also be conclusive for HIV-2 given the slower progression of the disease andlower viral load?

2- Also, I figured that those symptoms are clearly unrelated to HIV because I would have to be positive by now if they were, given the tests that I've done and the extended timing. But, can HIV-2 show up at a later time in terms of symptoms and antibodies?  since it depends only on the antibodies to be detected, does 6 weeks really apply to this? Wouldnt the window period be different given this fact?

3 - In this case, the symptoms worry me just because of the timing they happened in. Do they sound like ARS? I did not have fever or any pain in the body nor did I have  swollen lymph nodes (i usually get them because of colds). I also did not experience any type of tiredness. 

4 - Did you or doctor HHH ever come across a case where someone had symptoms at 2/3 weeks but only tested positive several weeks later for antibodies?

5-  Lastly, I take by your responses that I do not have to test again after my latest 4th gen lab test at 92- days and I can 1000000% rule out HIV correct? I can put this behind and live my normal life?

Thank you so much for your patience Doctor Edward and for all your help. You don't know how much this means to me and to the lives of the ones that re going through mental hell due to anxiety. I really appreciate it. 

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Edward W. Hook M.D.
25 months ago
We provide up to 3 responses to each client's questions.  This somewhat repetitive follow-up will be the last response I will respond to.  After this response the thread will be closed without further responses


1 - The PCR clearly states that this was a test designed for HIV 1 and 2. Is this a lie by the lab? Or, if it really is what the lab says, would this also be conclusive for HIV-2 given the slower progression of the disease andlower viral load?
If the PCR targeted both HIV-1 and HIV-2, then you were tested for both and found to be negative.  Here in the US, PCR tests only target HIV-1 but it is possible that the lab you used targeted both viruses.

2- Also, I figured that those symptoms are clearly unrelated to HIV because I would have to be positive by now if they were, given the tests that I've done and the extended timing. But, can HIV-2 show up at a later time in terms of symptoms and antibodies?  since it depends only on the antibodies to be detected, does 6 weeks really apply to this? Wouldnt the window period be different given this fact?
Sigh- you are having trouble accepting that you do not have HIV of any sort.  Believe your multiple test results

3 - In this case, the symptoms worry me just because of the timing they happened in. Do they sound like ARS? I did not have fever or any pain in the body nor did I have  swollen lymph nodes (i usually get them because of colds). I also did not experience any type of tiredness. 
Your symptoms sound nothing like the ARS which is a severe illness with simultaneous HIGH fever, severe muscle and joint pain, and severe sore throat all occurring at about the same time.

4 - Did you or doctor HHH ever come across a case where someone had symptoms at 2/3 weeks but only tested positive several weeks later for antibodies?
NEVER!

5-  Lastly, I take by your responses that I do not have to test again after my latest 4th gen lab test at 92- days and I can 1000000% rule out HIV correct? I can put this behind and live my normal life?
One last time, believe your test results.  They prove that you were not infected by the encounter you have described.

This completes this thread.  I encourage you to move on and put your unwarranted fears behind you.  EWH
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