[Question #10565] Second window period continuation of #10527
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21 months ago
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Dear Doctor, sorry to come Again, i was about to start feeling fine after your reassurance and the last test combo test done at 30 days which was negative. The fact i was feeling better at the time of the test (23/10) i assumed that after symptoms of ARS (if any) are over antibodies shall be detectable for sure, until i Read this article of second window period and the limitation of the 4th generation test. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4313264/
Cold you please comment on this article?
Is it possible that some body succeeded to lower the viral load to the level where p24 is not detectable and still the specific antibodies are not detectable?
Giving my exposure (receipt of fellatio) and sort/ timing of symptoms explained earlier , the only symptoms i am still having is no libido not gaining weight, do you think i should do further testing for hiv?
Can I resume unprotected sex with my wife?, thanks a lot
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21 months ago
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More one question doctor does this contradict with your statement that in case of symptoms related to ARS, the anti body shall be positive especially after some day of the onset, since ARS is the interaction of the virus with the antibodies as I understand. In the case reported in the article it looks that ARS is over and still no antibodies, please help
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H. Hunter Handsfield, MD
21 months ago
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Welcome back, but I'm sorry you found it necessary. I have reviewed your recent discussion with Dr. Hook and agree entirely with his evaluation and advice. I'm also sorry you apparently disbelieve his evaluation -- which is the only rational reason to have gone deep into the online weeds and then entirely misunderstanding the case report from nine years ago that you found. It is irrelevant to your situation.
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The supposed secondary window in that report closed after 34 days. To the extent secondary windows occur at all, they generally last only 2-3 days; it was longer in the report you cited, but since then the antibody components of the AgAb (4th generation) blood tests have been improved. Second, a single case report is very dangerous evidence: the very reason the case was reported is because it is a very rare event. To my knowledge, secondary windows no longer are known to occur -- and when they were suspected, they resolved within 3-4 days.
I'm not going to re-discuss the zero risk of the exposure you describe -- which was not the case for the patient in the case report you found. As for your symptoms, they are NOT typical for ARS, which does not cause nasal congestion, and DOES almost always include various combinations of enlarged lymph nodes body-wide, fever, and/or body-wide skin rash. The symptoms you do report are, as Dr. Hook advised, nonspecific -- meaning they do not point to any particular cause. (But perhaps it is worth mentioning that many of them are typical for the physical manifestations of anxiety and stress.)
You have described your doctor's intent to conduct additional testing. I urge you to follow that advice, expecting that any remaining tests will continue to be negative, confirming you do not have HIV. You are not going to be the first person in the world to 1) acquire proved HIV infection by receiving oral sex or 2) to take more than 45 days for the HIV AgAb (4th generation) blood test to turn positive. Perhaps it will also interest you to know that in the 20 years of this and our preceding forum, with thousands of questions from people worried about having caught HIV, not one has yet reported that s/he later tested positive. You are not going to be the first. If and when it finally happens, surely it will be from a truly risky exposure, and also will not involve anyone with an exceedingly rare testing event like a secondary window.
Please do your best to believe the reasoned, science based advice you have had both on this forum and probably from your own doctors. Also follow your doctor's advice about evaluating your symptoms after your negative HIV status has been conclusively confirmed. Try to stay mellow in the meantime!
HHH, MD
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21 months ago
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Dear Dr.Handsfield, Thanks very much for your reply, actually I have already followed the STD' doctor advise and did the combo test at 30 days mark which was negative since the first combo was at 20 days where she said it is enough given the no risk event. I will try not to be repetitive , 1) have you ever come across a negative combo at 30 days and later turned positive 2) as I understand when symptoms appear, test shall turn positive shortly, is there any reason that make a negative test done after almost 20 days of the onset of symptoms where the symptoms almost all improved and test and later be positive? 3) finally from your point of view do you suggest further testing? Thanks for your patience
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H. Hunter Handsfield, MD
21 months ago
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1) No I have not. In fact, the original advice about the AgAb ("combo") tests was that negative results are conclusive by 28 days. It was only later that rare cases taking up to 45 days were documented, resulting in the current consensus (often rounded off to 6 weeks). I have never seen nor even heard by rumor of anyone testing negative at 28-30 days who later tested positive.
2) Your negative antibody test at 20 days was solid proof that your symptoms were not due to ARS.
3) Frankly I would have recommended against any testing at all, in view of your exposure and symptoms that were not particularly suggestive of ARS. So from a medical/risk perspective, you don't need further testing. However, the questions you ask -- both the factual aspects, the tone, and your obvious concerns about it, probably you're going to need a negative result that is 100% conclusive in order to sleep soundly. But it's up to you.
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21 months ago
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Dear Doctors , Thanks for your reassurance in the past tough time, i want to inform you that after almost 45 days of my receipt of unprotected oral sex, i did an autotest VIH which is approved in europe and it was negative and same day i did an hiv test in an Accredited private lab Negative as well, as written on the report description it is 4th generation. My symptoms now sore throat since many days with mild pain around the neck and not gaining weight. My question:
1- How much conclusive my test
2- Any other test with regards to HIV is warranted, given my past set of symptoms and current ones,
3- Can i move on, and have again unprotected sex with my wife without any minimal worry to infect her
Thanks again for your support
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H. Hunter Handsfield, MD
21 months ago
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1. I'm glad to hear of your negative test result. It was conclusive: it proves both that you do not have HIV and that HIV cannot be the cause of your sore throat or any other symptoms you have now or develop in the future -- no matter how typical for a new HIV infection they might seem to be.
That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.It was conclusive: it proves both that you do not have HIV and that HIV cannot be the cause of your sore throat or any other symptoms you have now or develop in the future -- no matter how typical for a new HIV infection they might seem to be.
2. No other testing is necessary.
3. Yes you can move on and can resume unprotected sex with your wife without putting her at risk.
2. No other testing is necessary.
3. Yes you can move on and can resume unprotected sex with your wife without putting her at risk.
That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.
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