[Question #10600] Lots of tests- still worried about hiv variants

21 months ago

Dr Hook, I hope you can give me your advice. My story goes back 6+ year/longer. My last exposure was with a Chinese massage girl in Jan 2018, but there were exposures back to 2010. We engaged in risky unprotected behavior. I have had COUNTLESS tests over the past 6+yrs. My last set of tests were two weeks ago. Hiv-1 RNA, HIV 1/2qual RNA, and the 5th generation bioplex. All neg. This year alone, I’ve also had Insti,oraquick,dbs, and LabCorp 4th gen. I still have loads of symptoms. My last blood test from a few weeks ago also had routine labs. All were normal except high calcitonin. I have new thyroid mass which I have appt for this week. Also, had thrush this year!!! My cd4 was 535 (51%) with 2.1 ratio with cd8.

1)could I be immuno def. And labs not picking up hiv? Too advanced to find?

2)could I have type that tests not picking up(exposures from China girls)since test primed for UStates?

3)would other labs be out of range if bad hiv?

4)now have new anemia too-hiv-concern?

5)are there times where you just can’t diagnose because of type of hiv 1 or 2 or pt not producing antibodies and viral load not picking up because of possibility hiv-2?

6)new thyroid mass concern for advanced hiv not found?

7)am I 100% free of hiv with ALL Tests(rna, dna, rapids, architect last year,bioplex, centaur,)over the last six years? I think about 12 different kinds over these years and around 60 in all.

8)anything left I can do, things just don’t add up that smart people can’t figure this out.

9)is hiv still a possibility with all tests?

Thank you. I may need to clarify from your answers.

Edward W. Hook M.D.

21 months ago

Welcome to our Forum. Thanks for your confidence in our service. I will do my best to convince you that you were not infected with HIV of any sort by the multiple encounters you describe. Before I get to your specific questions, let me provide you with why I am confident that you do not have HIV from these encounters. First, I note that while you indicate that this woman was a commercial sex worker, you do not mention her HIV status. That being the case, it is unlikely that she had HIV- most CSWs do not. Even if she did have HIV, most encounters do not result in transmission of infection. The statistical risk for a man acquiring HIV from an untreated HIV-infected person is less than 1 transmission for every more than 1200 encounters and that estimate is, if anything, conservative. Finally, you indicate that you have been tested on multiple occasions over the years with uniformly negative results. Let me remind you that the testing you describe looked for evidence of infection in not one but at least 3 different ways, looking for antibodies to infection, looking for viral protein (the antigen) and looking for viral RNA via PCR. Each o these tests is highly reliable and taken in combination, particularly if tested on more than one occasion, there is simply no way that you have HIV. With that, I'll now work through your specific questions:

1)could I be immuno def. And labs not picking up hiv? Too advanced to find?

No, this is a scientific impossibility. There is no such thing as being too immunosuppressed to have a positive test since some of the tests you had looked for the virus itself an are not influenced by whether or not you are immunosuppressed.

2)could I have type that tests not picking up(exposures from China girls)since test primed for UStates?

No, again, that is impossible. The idea that some infections are not detected by testing is an internet myth.

3)would other labs be out of range if bad hiv?

Persons can have HIV for years without any other lab abnormalities however, as the infection progresses, years after infection other, non-specific lab abnormalities occur

4)now have new anemia too-hiv-concern?

No, anemia is a non-specific problem which can have hundreds of possible causes.

5)are there times where you just can’t diagnose because of type of hiv 1 or 2 or pt not producing antibodies and viral load not picking up because of possibility hiv-2?

See my comments above. If you did not produce HIV antibodies, you would be VERY (life threateningly) sick and your tests for the virus (HIV antigen and PCR tests) would be sky high.

6)new thyroid mass concern for advanced hiv not found?

7)am I 100% free of hiv with ALL Tests(rna, dna, rapids, architect last year,bioplex, centaur,)over the last six years? I think about 12 different kinds over these years and around 60 in all.

Yes, you are 100% HIV free

8)anything left I can do, things just don’t add up that smart people can’t figure this out.

If you are ill or have symptoms, you should work with your doctor to look for non-HIV causes of your problems.

9)is hiv still a possibility with all tests?

Absolutely not.

You did not follow out Forum rules about question length. You have two follow-ups but any follow-up questions MUST be brief and non-repetitive. EWH

---

21 months ago

Thank you Dr Hook. A lot here is always about new infections and not possibly longstanding.

1)are the tests/timeframes just as accurate or more the longer you have HIV?(more or less likely to miss?

2)if tests are designed for a particular type of hiv, then how would a test pick up?(common markers? Proteins?

3)If a rare form of hiv-1 or hiv-2, that viral load can’t pick up/measure, then how do they monitor therapy? Especially with hiv-1?

4)Have you seen first hand or read of a case where the viral load misses an odd variant(mine was Cobas hiv-1(good test)?

5)are there any better/more tests that may shed any more confidence on the situation?

6)no matter what symptoms I have, ABSOLUTELY forget hiv?

7) with all these tests over the last 6-10 years(oraquick,insti,surecheck, architect,advia centaur, bioplex, Abbott prism,stand alone geenius, MPX HIV, proviral hiv-2 dna,Roche viral load, Roche hiv-1/2 qualitative, Abbott viral load) is there ANY WAY that ALL tests could miss infection because of type of hiv subtype or variant?

I’ve done my reading and not much on missed subtypes with serology/molecular, but I worry and want to put this behind me once and for all.

Thank you

Edward W. Hook M.D.

21 months ago

You are continuing to worry needlessly, asking questions which appear to reflect either misinformation you have picked up somewhere (the internet) or mistrust of what are some of the most reliable tests in all of medicine. As I indicated above, answers will be brief:

1)are the tests/timeframes just as accurate or more the longer you have HIV?(more or less likely to miss?

Tests are more accurate the longer a person is infected. Once a person has HIV, their test remain positive for life.

2)if tests are designed for a particular type of hiv, then how would a test pick up?(common markers? Proteins?

Current tests detect all strains of HIV. They detect both HIV antibodies and HIV antigen (viral proteins). In addition, HIV RNA tests deect viral genetic material.

3)If a rare form of hiv-1 or hiv-2, that viral load can’t pick up/measure, then how do they monitor therapy? Especially with hiv-1?

Tests which would not be picked up by the tests you have had do NOT exist.

4)Have you seen first hand or read of a case where the viral load misses an odd variant(mine was Cobas hiv-1(good test)?

5)are there any better/more tests that may shed any more confidence on the situation?

6)no matter what symptoms I have, ABSOLUTELY forget hiv?

Persons with symptoms due to HIV always have positive tests. You need to believe your tests and look for other causes of your symptoms

Absolutely not.

I am not sure why you are having so much difficulty accepting that you do not have HIV. You have proven without a doubt that you do not have HIV. Further testing is a waste of time and resources. If you have specific symptoms which are troubling you, my advice is to work with a trusted health care provider to determine what is causing those symptoms. It is NOT HIV. EWH

---

20 months ago

Thank you for your reply.

1)I see some antibody/antigen cover group m/o with some m groups a-j and some a-h. Does that make a meaningful difference on whether antibodies would be detected?

2)no matter what was the source(region of the world), if I had hiv of any sort, it would show positive on many if not all the tests I had?

3)can the viral load test be falsely negative because of subtype?

4)the roche qualitative hiv 1/2 insert says it can be falsely negative because of rare subtypes. How does one confirm that it is a valid result?

5)how are rare types of hiv identified and named if tests don’t pick up on routine testing or molecular?

6)no chance modern medicine testing has failed me?

7)anything more I can do to l eliminate slim chance I have some odd subtype or for some reason my body is not showing antibodies or positive on Quant/Qual pcr?

Thank you for you insights. I just want my physical pain to go away.

Take care

Edward W. Hook M.D.

20 months ago

I'm so sorry that you are unable to accept the FACT that you do not have HIV. Many of your final follow-up questions are redundant. I will provide brief final answers and then the thread will be closed. Let me remind you that repetitive anxiety-driven questions such as yours may be closed without a response and without return of your posting fee if you return to the Forum. We do this out of concern for you, nothing more.

In reply:

1)I see some antibody/antigen cover group m/o with some m groups a-j and some a-h. Does that make a meaningful difference on whether antibodies would be detected?

No! Antibodies from each of the groups you mention are detected by current tests (as is the p24 antigen which is common to all HIV subtypes)

2)no matter what was the source(region of the world), if I had hiv of any sort, it would show positive on many if not all the tests I had?

Correct

3)can the viral load test be falsely negative because of subtype?

Some older HIV PCR tests detect HIV-1 but not HIV-2 however your other tests for HIV antibody and HIV antigen would have been positive if you were infected.

4)the roche qualitative hiv 1/2 insert says it can be falsely negative because of rare subtypes. How does one confirm that it is a valid result?

With combination HIV antibody/antigen tests of the sort you have already had no multiple occasions.

5)how are rare types of hiv identified and named if tests don’t pick up on routine testing or molecular?

See reply 4 above. If you were HIV infected you would have had positive tests.

6)no chance modern medicine testing has failed me?

Absolutely not

7)anything more I can do to l eliminate slim chance I have some odd subtype or for some reason my body is not showing antibodies or positive on Quant/Qual pcr?

You have done more than what needs to be done repeatedly. You need to give up on HIV and work to determine what is really causing your symptoms rather than wasting time, energy, and other resources on pursuit of an HIV diagnosis. You do not have HIV.

I strongly recommend that you seek counseling to help unravel what sort of guilt and mis-information is leading you astray.

EWH

---