[Question #12335] HIV Testing

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8 months ago
Dear Drs
Sorry I have to return to the forum as I had a new encounter to inquire on. I'm a Male who had unprotected sex with a Female escort (vaginal, anal, oral). I know this was a mistake & will use protection in the future.
My question is around HIV (will also test for other STDs soon):
I took a Labcorp HIV 1/2 RNA Qualitative as well as Labcorp 4th Gen HIV/2 (both at the 28 day post exposure mark) & both came Negative. Do I need any further HIV testing for a conclusive result (including factoring in HIV-2)? I read previously on this forum that the combo of these tests at 28 days may be conclusive (at least for HIV-1)? 
Note: around the 2 week post exposure mark I did get a cold sore on my lip (I have previous HSV-1), as well as a couple mouth ulcers, couple days of diarrhea & what looked to be a rash on my upper body &took my temp at it was 37.5C (were these symptoms typical of ARS?)
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8 months ago
Sorry I had a typo I meant as well as Labcorp 4th Gen HIV 1 & 2
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H. Hunter Handsfield, MD
8 months ago
Welcome back, but I'm sorry you found it necessary. Although this is a different exposure, it seems obvious that our previous replies about HIV testing apply no differently. 

The combination of negative HIV 1/2  RNA and AgAb (4th generation) tests is 100% conclusive at 4 weeks, both HIV1 and 2. You do not have HIV and do not need further testing. Having an oral herpes outbreak, possible skin rash or diarrhea don't change anything:  it is impossible to have symptoms due to HIV and test negative. (A temperature of 37.5C is entirely normal. 37C is not the top of the normal temperature range, just the average over the course of a day.)

Let me know if anything isn't clear.

HHH, MD
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8 months ago
Thank you for your response doctor Handsfield, very clear.

For my future reference were my described symptoms (37.5deg C aside - but more 3 mouth ulcers, 1 cold sore, 2 day diarrhea, and a rash at around 2wks) with no other symptoms present typical for ARS? I understand my testing negates it but just so I better understand moving forward.

I guess the combo of the RNA and 4th eliminates the chances of being an "elite controller" and having a false negative RNA HIV1/2 test? 
As you know the 4th gen doesn't test for HIV-2 antigen but we are still saying overall conclusive - is it because it is simply antibodies that are the focus here in this analysis of the 4th gen at 28 days in combination with the RNA?

Thank You


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H. Hunter Handsfield, MD
8 months ago
Elite controllers' blood tests are entirely typical in all respects. The RNA level often is lower than otherwise, but the standard tests still are positive. The AgAb (4th gen) tests do include HIV2 antibody, just not antigen; but your negative RNA test is conclusive all by itself.

As I said, your negative test results prove HIV isn't the cause of these or any other symptoms you have now or may develop in the future. If they continue and/or you remain concerned, see a doctor. Almost certainly they have nothing to do with your recent sexual exposure.
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8 months ago
Last follow-up:

-When you say elite controller blood tests are typical in all respects - you mean even their RNA tests will come positive? I thought they were undetectable on RNA and that's why we layer the 4th gen on top as a combination (this is where my HIV2 antigen question came into play)

-When you say my symptoms are "almost certainly" not due to my recent sexual exposure you are implying a low likelihood sexual but none-HIV  link (i.e. other STDS) I assume - because you told me 100% there is no HIV and no further testing needed on that specific front due to being conclusive? 

-Will try to ask one last time - sorry if I'm being nitpicky... I understand my symptoms are NOT HIV related from your previous comments ; however, assuming for example I hadn't tested are these symptoms as described typical of acute HIV symptoms? It will help me in the future to be able to gauge more properly and have less anxiety on a future exposure (for example I do get mouth ulcers frequently) 

Thanks again

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H. Hunter Handsfield, MD
8 months ago
Yes, most elite controllers have positive RNA tests.

I don't understand. your second question. It is certain you do not have HIV; something else is causing your symptoms, and I doubt they are due to any other infection from the sexual exposure.

"Could" your symptoms have been due to HIV, had you not been tested for it? Conceivably yes, but so what? They were not typical, but even if they were, symptoms almost never are useful indicators of new HIV infection; the identical symptoms are far more commonly due to other conditions. Always ignore symptoms and concentrate only on HIV testing:  the results ALWAYS overrule both exposure history and symptoms:  no matter how high the HIV risk at the time, and no matter how typical the symptoms seem to be, the test results override everything else.
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8 months ago
In a different conversation you had told someone that they need to have at least "three" of the four major symptoms-  fever, lymph node enlargement, sore throat (forgot what the fourth one was)  otherwise they could be "certain it's not ARS". This is why I was asking, I didn't have any of these 3 anyways and was curious about this rule of thumb for the future to quell anxiety.
...... regardless since I tested Negative I am no longer concerned...  Thank You
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H. Hunter Handsfield, MD
8 months ago
You cannot necessarily transpose the reply to every question to your own situation. I suppose that in the thread you saw I might have said the combination of all things (exposure, test results, symptoms) they could not have ARS. And I have told you to ignore symptoms if and when you are worried about HIV:  rely only on testing.

Repeated anxiety driven questions are not permitted:  this being the third time you have asked virtually the same with identical replies, it must be your last. Future questions on these topics will receive no reply and the posting fee will not be refunded. This policy is intended to reduce temptations to keep paying for questions with obvious answers, and continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thanks for your understanding. 

I do hope the discussions have been helpful. In event of future similar concerns, I would advise youth carefully re-read our replies to all three of your questions.

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