[Question #10873] Symptoms /tests

19 months ago

Hello doctors. As you all know, I have had episodes over the last few years and symptoms to go along with. I have tested multiple times negative. I also had an episode approximately seven weeks ago. With that, I tested with an RNAHIV 1/2 qualitative, as well as 4th generation at 26 days/lscorp and then another 4th generation at 44 days by quest. But worries me is that now I have thrush for the second time this year. I am so worried that prior episodes and test have missed infection as well as this new episode. Could have missed a recent infection and I need to wait longer. Also, my wife has odd symptoms, as well as my son is having odd health issues(from years ago?

1) could I be in an advanced stage of HIV, and the prior years test have missed it and now I’m having recurrent thrush?

2) it definitely is thrush as my doctor said it was. Could my recent episode seven weeks ago, be demonstrating ars this late?

3) could my 26 day RNA/4th gen as well as my 44 day fourth GEN be falsely negative?

4) as I’ve asked before, could I have some strain of HIV that is not being detected by either the PCR or multiple fourth generation tests?

5) what if any tests do I need to further do to completely eliminate the possibility of that this is HIV? Cd4?

I thank you

Edward W. Hook M.D.

19 months ago

Welcome back to the Forum although I'm sorry you felt the need. A second episode of thrush, if that is what you have is bad luck, not a sign of hiv. As I said to you about a month ago, "Symptoms are due to the presence of the HIV virus and/or antibodies to the virus. As a result, when symptoms are present, tests for HIV are virtually always positive. Your negative test at day 18 proves that your symptoms are not due to HIV...." That answer is not going to change. Currently available tests for HIV are among the most accurate, and most reliable, medications is all of medicine. You have been tested on multiple occasions- you need to believe the results. Thus, in response to your specific questions:

1) could I be in an advanced stage of HIV, and the prior years test have missed it and now I’m having recurrent thrush?

Absolutely not. Most people who have thrush do not have HIV. You've proven that you do not have HIV

2) it definitely is thrush as my doctor said it was. Could my recent episode seven weeks ago, be demonstrating ars this late?

Absolutely not. The ARS occurs within 30 days of exposure. This is far too late to be the ARS.

3) could my 26 day RNA/4th gen as well as my 44 day fourth GEN be falsely negative?

No way!!!

4) as I’ve asked before, could I have some strain of HIV that is not being detected by either the PCR or multiple fourth generation tests?

You've asked this before- my answer is not going to change. You do not have a strain of HIV that would not be detected by the testing you have had done

5) what if any tests do I need to further do to completely eliminate the possibility of that this is HIV? Cd4?

You have eliminated any chance that you have HIV from the exposure you had. You need to put your unwarranted fears aside and move forward. Further testing for HIV of any sort would be a waste of time and money.

Please try to accept that you do not have HIV. EWH

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19 months ago

Thank you for your reply. What really worries me is that over the past six years I have all these new health issues which nobody has been able to find a cause for. As I have said prior, many episodes dating back to 2013 up until my latest Nov. 30th of this year. All of my tests have been negative. What also concerns me is that I had a CD4/8 done May 2019 and it was around 1000 w/ratio of 2.1. in 10/2021 cd4 630 cd8 221 ratio 2.9. in 3/2023 repeated with cd4 525 cd8 209 w/ratio 2.5. This is a steady decline over the last 4 years.

1) Ive heard rely more on ratio, but does that decline mean much clinically with all symptoms/thrush?

2)Does the decline in cd4 cause a concern in regards to HIV?

3)If I lost antibody production, would the antigen still be detectable or not, even long term?

4)Could you have a false negative RNA at 26 days? elite controller from recent of prior exposure?

5)Is there a meaningful difference in test sensitivity on a qualitative PCR vs. quantitative viral load? one better that the other?

6)How conclusive from my November exposure are my negative--labcorp 18 day 4th gen, 26 day 4th gen and HIV 1/2 RNA qualtitative, and my 44 day Quest 4th generation?

7)Should I do a 12 week repeat 4th generation and another RNA? (if RNA, qual or quant)?

I REALLY want to figure out what is wrong with my health and nothing is providing answers. I just worry that there is something serious being missed. I appreciate your concern and time.

Edward W. Hook M.D.

19 months ago

You have interacted with Dr. Handsfield or I 9 times over the past two years, reputedly asking about the reliability of tests for HIV despite having been tests with multiple different types of tests many times. Two years ago I said "You have tested repeatedly at times when the results provide definitive results with a variety of test for HIV, all of which are negative. Science has provided us with tests for HIV which are amongst the most reliable of all tests in medicine. There is an Internet-fueled myth that subtypes, particularly those arising from Asia, may provide falsely negative tests. This is an urban myth. On those extraordinarily rare occasions when variant strains of HIV have not given clear results on testing, the results have been equivocal which, in turn, has led to further tests which provide a diagnosis. This is not been your experience. Had your tests been anything but negative further testing would’ve been performed to evaluate the reason for unexpected results." Your fixation on HIV has led to a waste of time and resources, as well as testing with unreliable peripheral tests such as the CD4 counts. THIS IS UNHEALTHY.

If your doctor cannot answer your questions, you should consult a clinical immunologist to determine if there is some other cause of what you perceive to be unusual infections.

Brief answers to your entirely repetitive questions:

1) Ive heard rely more on ratio, but does that decline mean much clinically with all symptoms/thrush?

CD4 testing is a waste of time. CD4 counts fluctuate greatly. Testing for CD4 was a waste of money and time.

2)Does the decline in cd4 cause a concern in regards to HIV?

See above.

3)If I lost antibody production, would the antigen still be detectable or not, even long term?

Yes, without a doubt.

4)Could you have a false negative RNA at 26 days? elite controller from recent of prior exposure?

No way! Elite controllers still have positive tests for antibodies and positive PCR tests.

5)Is there a meaningful difference in test sensitivity on a qualitative PCR vs. quantitative viral load? one better that the other?

No. quantitative test is preferred in evaluating the efficacy of therapy.

6)How conclusive from my November exposure are my negative--labcorp 18 day 4th gen, 26 day 4th gen and HIV 1/2 RNA qualtitative, and my 44 day Quest 4th generation?

In combination these tests are completely, 100% conclusive.

7)Should I do a 12 week repeat 4th generation and another RNA? (if RNA, qual or quant)?

No, that would be just another waste of time and resources.

You have one follow-up remaining. After that you should not ever need to return to the site with further repetitive questions. EWH

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19 months ago

Thank you again, and you're right, I don't want to EVER BE BACK HERE!! Its not that I don't believe what you say, its just that I have all these health issues without an etiology. Believe me, I want these tests to be accurate and not false.

1)Can you please educate me on why a 26 day 4th gen along with a pcr is conclusive? Would it be better to do a 6 week or longer 4th generation alongside another PCR for total confidence at a later time?

2)I get cold sores and I took 2grams BID a day the day before and 2 grams the morning of my last 4th gen test at 44 days. Could that have any effect on the results falsely?

3)When dealing with window periods, no longer at all do you have to wait 90 days? 6 WEEK ABSOLUTE for conclusive results?

4)In the medical community, in regards to HIV, what does "conclusive" actually mean? (Best we can tell)?

5)Are there any medical issues that would invalidate the testing I have had?

6)Even if this were my first post ever about this, and going years back as well as most recent, would you tell me to disregard any and all symptoms as pertaining to HIV?

7)Is there any chance with all testing over the years, but a slip up and exposure November 2023, that I could have any HIV from past or recent episodes?

8)With regards to wife, I need not mention my concerns of HIV to her with regards to her safety, health things?

9)should I 1000000% cross HIV off the differentials that is causing mine and her health issues?

10) Just a question: All replies are always from you and Dr Handsfield and no ghost writers, as I have heard on other sites?

You are a kind individual, and I am sure you have a heathy practice of patients that trust you...Keep up the good things you do!

Thank you

Edward W. Hook M.D.

19 months ago

This will be the final response- not just for this thread but for all future repetitive questions related to HIV. You do not have it. Your insistence on possibility is a waste of your time and if anything, distracts you from pursing what might be contributing to your difficulties. Brief answers to your final questions:

The virus is present in blood within 10-12 days following infection. Antibodies appear within 2-3 weeks. The cut-offs we cite have validated by innumerable scientific studies and are shared by the CDC, WHO and experts worldwide.

2)I get cold sores and I took 2grams BID a day the day before and 2 grams the morning of my last 4th gen test at 44 days. Could that have any effect on the results falsely?

No, valacyclovir has no effect on the reliability of HIV tests.

3)When dealing with window periods, no longer at all do you have to wait 90 days? 6 WEEK ABSOLUTE for conclusive results?

Correct

4)In the medical community, in regards to HIV, what does "conclusive" actually mean? (Best we can tell)?

That a person does not have HIV

5)Are there any medical issues that would invalidate the testing I have had?

None

6)Even if this were my first post ever about this, and going years back as well as most recent, would you tell me to disregard any and all symptoms as pertaining to HIV?

With your test results, yes.

7)Is there any chance with all testing over the years, but a slip up and exposure November 2023, that I could have any HIV from past or recent episodes?

No possibility whatsoever

8)With regards to wife, I need not mention my concerns of HIV to her with regards to her safety, health things?

Correct

9)should I 1000000% cross HIV off the differentials that is causing mine and her health issues?

Yes, you should have done that long ago

10) Just a question: All replies are always from you and Dr Handsfield and no ghost writers, as I have heard on other sites?

Every answer to our questions is personally answered by myself or Dr. Handsfield

Please do not return to the site. Should you, your thread will be closed without a reply and without return of your posting fee.

EWH

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