[Question #10748] HIV-2 concern and testing

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20 months ago
Hello Dr’s. I took multiple laboratory tests due to a concerning encounter which all came back negative: HIV 1 RNA PCR (32 days) 4th Gen AgAb (41 days, 47 days and 60 days). I am confident I am in the clear regarding HIV-1. 
However, I wanted to ask why HIV-2 doesn’t seem to be a substantial concern for the experts here and for the CDC and still advises 45 days as the conclusive window period without further need for testing. I understand it’s extremely rare in comparison to HIV-1 (mainly in places like Africa etc.) but with globalization and the fact that there ARE confirmed cases in the US and Europe.. doesn’t it still present a risk? I live in NYC and I read that there are cases here. Would the window period be 60 days or 90 days for HIV-2 if it only detects antibodies?  Should I do a final test at 90 days to completely rule out HIV-2 as well?
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H. Hunter Handsfield, MD
20 months ago
Welcome back, but I'm sorry you found it necessary.

As we discussed last time, your exposure was essentially zero risk for HIV and I would not have recommended you even be tested for it.

The information about the RNA PCR tests and HIV-2 is evolving rapidly. Some tests now used routinely in fact evaluate HIV-2 as well as HIV-1. You can check with your lab to see if that applies here. If so, you can rely on the negative result for both virus types.

In addition, the standard AgAb tests do detect HIV-2 as well as HIV-1, but are dependent solely on the antibody component. That means conclusive results by 8 weeks -- even though some resources continue to advise 3 months. In any case, in the 40 years of the HIV/AIDS pandemic, there have been fewer than 500 cases of HIV-2 diagnosed in the US. Even in NYC, it is exceedingly rare and mostly limited (according to my last understanding) to people who acquired their infections in Africa and to their regular partners (spouses, etc).

Feel free to have another test at 90 days if you wish, but honestly I see no need.

I hope these comments are helpful. Best wishes.

HHH, MD
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20 months ago
Thanks for the response. I’m sorry if this is redundant or repetitive and I do recognize that you and Dr Hook are among the top experts and trailblazers in this field… I’m just trying to take the safest course of action possible in order to ensure I am clean so I don’t possibly infect my partner . Also although my risk was low (condom intercourse) I was intoxicated so I don’t have 100% confidence in my memory.

I have confirmed with the lab that the HIV RNA test only tests for HIV 1 RNA, not HIV 2. After 4 of these tests I took I am confident that I do not have HIV 1. I however I read this paper by BHIVA regarding HIV 2 management 
and page 16 still concerns me even though I know the chance of a false negative for HIV 2 at this point is low. 

I read that HIV 2 is much less infectious in addition to being extremely rare in comparison to HIV 1. Is this a factor in why the CDC and advisors don’t stress about the full 60-90 day window for the antibody component?
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20 months ago
I would like to clarify that when I speak of these four tests I took, that includes the one RNA test and the three 4th generation tests
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H. Hunter Handsfield, MD
20 months ago
I interpret the British guidelines as consistent with our advice here -- rather than stating 8 weeks conclusive, they advise waiting 3 months. What's the big deal? You're entirely free to follow their advice if you wish. It is true that HIV-2 appears to be less transmissible than HIV-1, and it also tends to have less rapid progression of immunodeficiency. I don't know why CDC's guidelines are a bit different, but I don't see the differences as important.---
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19 months ago
Thanks for the response. One more question - I read on the website that I used to order the lab tests that they recommend 90 days because of when p24 antigen binds to the antibodies to form complexes that may not be picked up by a the test till 90 days. Is this rubbish?
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H. Hunter Handsfield, MD
19 months ago
"Rubbish" is much too strong for advice from the BHIVA (if that's your source). However, my belief is that the reasoning is highly theoretical, and I have never seen any reports of newly infected persons requiring more than 6 weeks for positive results on the AgAb tests (or 8 weeks for HIV2). But so few HIV2 cases that have been reported and diagnosed that there may be room for being conservative, maybe explaining their 90 day advice. In any case, given HIV2's rarity in North America and Europe, I see this as pretty unimportant; and what's the big deal in waiting another 4 weeks for a final test? If you ever have unprotected sex with someone born, raised and sexually active in east-central Africa, that's the time to worry about HIV2.

That concludes this thread. Please note the forum policy against repeated questions on the same topic, which may be deleted without reply and without refund of the posting fee. ASHA is not keen on getting paid for information whose answers already have been given; repeated answers often prolong anxiety rather than helping relieving it; and such questions have limited educational value for other readers, one of the forum's main goals. Thank you for your understanding. I do hope the discussions have been helpful. Merry Christmas!

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