[Question #10941] 4th gen duo false positive HIV follow up
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18 months ago
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Hello, I had took a 4th gen duo HIV test on January 19th 2024 which came back negative. I had received oral sex with a cut on my penis 42 days prior to that. I’ve always had an irrational ocd and fear of HIV so I tested again to be outside of the window period of 45 days for the duo which I tested on the 47th day.. five days later and it came back reactive for antigens but negative for antibodies. I had the confirmation test Qualitative RNA and it came back not detected. So I tested again exactly 1 week later on the 54th day it came back non reactive/negative. Am I for sure in the clear after the negative HIV 4th gen duo after 54 days and after the not detected qualitative RNA PCR test? What could have caused the false positive on the 47th day even though I had tested 5 days prior negative? I haven’t had any recent exposures or anything since December 6th, 2023. And sorry if I come off as super paranoid, but out of curiosity, is it possible for HIV to randomly show up years later on a test (3-5+ years if you weren’t aware) even if you tested negative on all multiple 4th gen test including antibodies but for it to randomly show up as a P24 antigen years later on the test. Is that possible? I was doing some reading on an elite controller, but I know that is very rare. I’ve taken multiple 4th gen duo test since the end of 2021 (about 8-9) and all of them came back non reactive. Overall I’m a healthy, fit man and just looking for some extra reassurance. Looking forward to hearing back from one you of guys, thank you.
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Edward W. Hook M.D.
18 months ago
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Welcome to our forum. Thanks for your questions.
Please don’t consider this a reprimand, however, your experience demonstrates one of the downsides of over-testing for HIV. From time to time, for reasons that nobody understands, tests will be falsely positive. Your experiences are rather typical for those unlucky enough to be in your shoes. When persons have falsely positive4th generation HIV tests, more often than not. It is the HIV P24 antigen which gives the false positive, results, not the antibody test. Your subsequent tests prove conclusively that you do not have HIV and you are simply the victim of bad luck. Please don’t let this experience shake you. Further testing is not necessary. The laboratory, even on your initial test, did a good job, following proper procedures to prove that your test was falsely positive. Your subsequent tests serve confirm this. There is no reason for further testing unless you put yourself at risk going forward.
The issue of elite controllers is a true phenomenon which is extraordinarily rare, and is the subject of a huge amount of Internet based disinformation. Person who are elite controllers, always have positive tests as they have both antibodies and circulating virus. Your test prove that you are not an elite controller.
I wish you the best. I hope that the information I’ve have provided will help you to move forward without continuing concern. Take care. EWH.
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18 months ago
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All of that makes sense, thank you for replying back to me. I do some more questions if you don’t mind me asking..
I do understand how the 4th gen duo test works but I have some more questions about it. So do some of these 4th gen HIV duo test have a “second window period” ? Like for example, if you have a delay of P24 Antigens to appear in your blood after the window period of 45 days, or another example would be in my situation since I had a false positive test at 47 days, (2 days after window period) despite me testing negative on my subsequent tests, would I still have to worry about an antibody test later on down the line even though my current P24 and antibodies were negative on my test at 54 days? Or can there be a delay of when P24 is negative on the test for 1-3 weeks after I tested negative on the 54th day subsequent to the false positive 47th day test.. and then after that antibodies can form?
I know this may sound pretty far fetched, but at the same time I’m just very curious to hear from an expert. Not going to lie, the false positive did shake me up quite a bit so despite my negative subsequent test, I still have some anxiety and curiosity at the same time.
I’m asking all of this because I saw where some sites were saying that you can develop antibodies even when P24 is not detectable anymore. Apparently it has happened before but most likely pretty rare. That’s when they called it the second window period. Is that true by any chance or possible? I’m aware that without P24 Antigens, Antibodies aren’t able to form period right? Again I’m Sorry for all of these extra questions, I’m just very curious to know. Hope to hear back from you soon. Thanks.
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Edward W. Hook M.D.
17 months ago
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Your follow-up suggests that you have been reading about falsely positive tests on the internet. I wish that were not the case. Much of what one finds there is is misleading, either because it is out of date, taken out of context, misinterpreted, or just plain wrong. The idea of a "2nd window" is an example of this.
When a person acquires HIV the first evidence of infection in the blood is the presence of the virus itself which is detected by tests for p24 antigen. After that, the infected person's body starts to make antibodies. Rarely there may be a brief period when the antibody present binds up the p24 antigen which would otherwise be detected, making the test transiently negative. Very soon after this, if it happens at all, the amount of both antibody and sometimes the antigen are present in sufficient quantities to be detected again. This largely theoretical occurrence is what gives rise to the so-called "2nd window" occurring after the brief period in which neither antibody nor antigen is detected by the test (both a present, just not detectable for a VERY brief period). Such a phenomenon, if it occurs at all lasts a matter of hours, not days or weeks. It is not a concern in your situation and serves only to unnecessarily fuel your unwarranted anxiety.
I hope this explanation of this largely THEORETICAL, over-hyped issue is helpful. Please don't worry and please stay off the internet. EWH
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