[Question #107] Hiv false negative

38 months ago
I have taken Humira for almost 10 years, on and off, for my psoriasis and psoriatic arthritis.  I stopped taking it Sept/Oct 2013 for upcoming surgery. I started back on the Humira , taking only 1 shot in March 2014. I was also one prednisone almost the entire month of March 2014. In April 2014 I had a high risk exposure for HIV. I started showing symptoms a couple weeks after which lasted for at least a couple months. Sore throat, headaches, fungal infections, swollen lymph nodes in neck, armpits and groin, fever, sore neck,fatigue, rash, weightloss, etc. I tested negative with antibody test at 1,2,3,4,6 and 8 months. I had a negative RNA PCR test at 5 weeks. I had a negative Gen 4 Duo test at 51 days. I also had a negative RNA PCR test at 12 months. I have had no other exposures since April 2014. Within the last 3 weeks I've developed the same symptoms only much worse. Could the prednisone, Humira, autoimmune disease have delayed antibody production and caused false negative results? I stopped the Humira March 2014, the exposure was April 2014 and I tested negative with antibody testing out to 8 months, might have been 6 months, but I think it was 8 months. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Welcome to the forum. Thanks for your question.

I understand your concern and why your symptoms are somewhat alarming. However, you definitely do not have HIV. I will review several reasons.

First, the HIV tests are among the most accurate diagnostic tests ever developed, for any medical condition. If enough time has passed since the last possible exposure (and there's been plenty of time in your case), the results always overrule all other considerations: no matter how high the risk at the time, and no matter how typical the symptoms, the test results tell the truth.

Second, the kind of immune suppression from cytokine inhibitors such as adalimumab (Humira®) do not suppress blood tests of the type used for HIV diagnosis. (I speak from both professional knowledge and personal experience. Like you, my wife has psoriatic arthritis and has been taking adalimumab for 10+ years. Great drug, by the way!)

Third, even if there were some immune suppression that affected HIV and its diagnostic tests, it would only suppress the development of antibody. That in turn would result in an INCREASE in the ability to detect the virus. In other words, if somehow the above points were wrong, you would still have positive results -- perhaps even more strongly positive -- for PCR and p24 antigen (one component of the duo test). Bottom line: If there were any effect of adalimumab, it would be to increase detection accuracy of HIV, not decrease it.

For all those reasons, you can be 100% certain you didn't catch HIV back in 2014. In fact, once you had either the negative duo test at 51 days, and a negative antibody test at 2 and 3 months, it was conclusive. All tests after those were superfluous.

So all is well. No more HIV testing, please! Work with your doctor about your symptoms if they continue, but you can be confident HIV isn't the cause.

I hope these comments have been helpful. Best wishes and stay safe!

HHH, MD



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38 months ago
I get what your saying about the duo and pcr test. I'm a little confused about the Humira though and the prednisone. Would they or would they not affect the antibody tests I had done? It's a concern because from what I've been able to find, there hasn't been any research on the affects of Humira on HIV testing. Also I was on prednisone for a month before the exposure. I think 20 mg twice a day then tapered down to 10mg twice a day. Would the RNA PCR test at 5 weeks and 12 months have been able to detect the virus? I've read that some people don't have a detectable viral load at 12 months, even not people not taking the meds for HIV. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
First, as noted in a brief closing comment on thread #117, apologies for the inordinate delay in responding to this follow-up question. The forum is new and some of the procedures are still being worked out, including flagging or otherwise notifying moderators when follow-up comments are posted. Assuming you would not have posted the new question if this one had been properly answered, and your concerns and questions identical in both threads, the admin staff will be reimburing your fee for #117.

I'll also reiterate one of the forum's policies, which is clear (or is supposed to be) when questions are posted. Within the STD and HIV Prevention categories, Dr. Hook and I take questions interchangeably depending on our own availability, without regard to requests for either of us. We have been close colleagues for over 3 decades, and although our online writing styles are somewhat different, our expertise is identical and our scientific knowledge, opinions, and advice are always identical. You can be sure Dr. Hook's replies on both this thread and your second one would not be different than mine. Apologies also for any confusion or concern on this point.

To your follow-up comment above:  The kind of immune suppression caused by adalimumab (Humira) and related biological anti-inflammatory drugs, and by prednison, has no effect on antibody production. Humira in particular is a monoclonal antibody specific to a particular inflammatory cytokine protein called tumor necrosis factor (TNF), which contributes to the inflammation associated with psoriasis, psoriatic arthritis, and other conditions. It cannot have any effect on HIV diagnosistic tests. Prednisone's anti-inflammatory effect is somewhat broader, but it has little or no effect on antibody production in response to any infection.

As I tried to explain above, the two basic types of tests for HIV infection -- detecting the virus directly (DNA by PCR, p24 antigen) and tests for antibody, the body's immune reaction to the virus -- are not independent of one another. It is true that some people with HIV have no detectable antiben or DNA in their blood. However, after infection has been established more than 4 weeks, it is the antibody itself that clears HIV and its markers from the blood. Every single one of the people with undetectable virus (DNA/RNA by PCR) or p24 antigen, does have measurable antibody. And vice versa: if somehow antibody is absent, then DNA/RNA or p24 WILL be present. There are no exceptions, regardless of any kind of immunosuppressive therapy.

I hope this clarifies things. (I'll also flag it to refer other users with similar questions about HIV diagnosis in general and about the DUO test in particular.) But please let me know if you still have any uncertainties about all this. In the meantime, you truly can go forward with 100% confidence you do not have HIV. There are many medical conditions other than HIV that could explain the various symptoms you have had. The test results rule!

And please accept my apology again for the delay in responding in this thread. You'll be hearing from ASHA customer service about reimbursement for your second thread.

Best wishes and stay safe--  HHH, MD


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38 months ago
I did leave out some important information. I did have sex with a woman August 3rd 2015. I started having symptoms like a week following. It started with painful urination. Then my eyes started to itch. Then I started having fevers. I developed a bad sore throat unlike any I've ever had. It's been sore for at least 3 weeks. It's sore at the base of my neck on the left side. Then my neck started to hurt really bad and hurt for weeks. I developed swollen lymph nodes in my neck, armpits and near groin at the top of my thighs. They hurt and have been swollen for 3 weeks. I developed red and brown spots on my body. My skin is itching. The bottoms of my feet itch. My ears are bothering me and feel full. I'm very fatigued and get dizzy. I have bronchitis now. I don't have any appetite and have lost 15 pounds in 3 weeks. I did take an Hiv 4th gen test 29 days after this exposure. It was negative. I'm seriously concerned that I have Hiv. That either I've had it since April 2014 and it didn't show up or I just it on Aug 3rd. 
1. Did I mention how much my muscles have atrophied in the last 13 months following my exposure April 2014. I've lost probably 40% of my muscle mass and what's left is soft. Ive seen a Neurologist and muscle diseases have been ruled out. I'm concerned because I've read that Hiv can cause that.
2.I'm also concerned because I've seen alot of doctors and No one has been able to figure out what's wrong.
3.what are the chances that I've had it since April 2014 and it didn't show up.
4. I took an hiv gen 4 test 29 days after having sex on August 3rd. How reliable is that negative result, especially being that I've been so sick since that incident
5. That same test was taken 16 1/2 months after the incident in April 2014. I'm wondering how sensitive the gen 4 is at that timeframe. Would that definitely ruled out hiv from my exposure in April 2014
6. I'm a mess doc. I've just got a really bad feeling.
Thank you for your time. I hope this is really Dr. Hunter Hansfield that I'm chatting with. No offense...but I have my doubts.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
This additional information does not change my opinions or advice. The answers to these questions are obvious from all that has been said up til now, so my replies are brief.

1,2,6. HIV can cause muscle wasting. So can a hundred other medical conditions, most of them more common than HIV. That "no one has been able to figure out what's wrong" doesn't mean it's HIV. My bet is that you are experiencing the physical manifestations of depression or other mental health condition, which is the usual meaning of statements like "I'm a mess doc."

3. No chance. Read my previous replies.

4,5. The 4th gen HIV tests are 100% reliable any time 4 weeks or more after the last possible exposure, and remain 100% reliable for life. How many times and in how many ways can this be repeated so you will accept and believe it?

I don't know why you might suspect someone other than I might be responding. That fear, plus your obvious despair ("I'm a mess doc"), plus the entire tone of this discussion, plus your apparent inability to accept and believe the repeated, science-based reassurance you have had, undoubtedly from your own doctors as well as my replies, all reinforce my comment above about depression or other psycological/emotional problem. You should discuss these feelings forthrightly with your doctors, and or seek professional counseling. I suggest it from compassion, not criticism.

Forum policy permits two follow-up comments/questions and replies for the original posting fee, so that completes this thread. If you have further questions or concerns, you'll need to start a new thread. But I advise against it. The replies and advice will not change.

I do hope all this has been at least somewhat helpful. That's our goal. Best wishes and stay safe--

HHH, MD
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