[Question #12721] Case of delayed conversion - freaking out!!

5 months ago

Dear Doctor Handsfield and Hook, You are knowledgeable and helping society with your service. I had a handjob 6 years ago. I know your answer regarding the risk. A couple of days later I had ARS like symptoms. I had hiv 4th gen test 3 months later and another at 4 months – “not detectable" for both. Between exposure and test I was a basket case. Totally stressed out and unable to function. Needed 3 alcoholic every night to calm me and I would sweat every night. Also had a panic attack and woke up often trembling uncontrollably for 15 mins. I also had a big bleeding shaving cut on my chin which I rubbed against my dog's cheek and a minute later my daughter kissed the dog and she fell sick a week later. My fears are now inflamed as she now has swollen glands and always sick. Need your help please as this is crippling my life and only your knowledge and articulation can help me. I believe my hiv test could have been erroneous because of extreme stress on my immune system from stress and drinking for 3 months. 1) Could my extreme stress and drinking have impacted my immunity to delay seroconversion to give a false negative 2) The test were AB/AG, but unfortunately since I got my hiv test 3 months and 4 month post exposure my understanding is that the antigens would not be around even if seroconversion was delayed by weak immunity (I know antigens disappear when antibodies are produced in first few weeks post exposure they disappear after a few weeks even in absence of antibodies. So scientifically, I guess I cannot get comfort from the fact that the antigen portion of the test would have detected hiv at the 3 month mark or 4 month with delayed seroconversion? I should have tested earlier? Please advise. 3) How do I get a handle of myself and function with life 4) Do I need to retest (no exposure since the one I mentioned).

H. Hunter Handsfield, MD

5 months ago

Welcome to the forum. I was online when your question arrived: most users should not expect nearly real-time replies!

Reacting first to the title you chose for your question: With the several HIV test methods currently in routine use -- including the AgAb (4th generation) blood tests, there is no such thing as "delayed seroconversion". It simply neer happens.

As for your supossed exposures you describe no events that have any chance of getting HIV. Psychological stress, no matter how "extreme", has no effect on the reliability of the AgAb tests or the time to conclusive results. Neither to any illnesses or medications of any kind (except that anti-HIV drugs themselves can delay positie test results). Every test you have done more than 6 weeks after a possible exposure is 100% proof that you were not infected with HIV during that event. There are no exceptions. To your numbered questions:

1) No, your stress and alcohol intake have had no effect on the reliability of your negative HIV tests.

2) This question reveals a misunderstanding about the AgAb tests. There is no "secondary window", i.e. a period when the test becomes negative after a previous positive result. It is HIV antibodies that remove antigen from the blood. Once antigen then antibodies appear in the first 2-3 weeks after exposure (sometimes as late as 6 week), the AgAb tests are positive and remain positive for life. That's the beauty of the combination of antigen and antibody testing.

3) "How do I get a handle of myself...? By understanding and believing the science and your test results. If that isn't sufficient, then professional counseling would be a logical next step. Such fears in the face of overwhelming scientific evidence generally indicates an underlying mental health issue that needs professional attention.

4) It is certain you do not have HIV and you do not need any further testing.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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5 months ago

Dr. Handsfield, WHAT PRIVILEGE - thanks so much for the reply!!! Kindly follow on this thread with me. Following up to understand more please 1) Why is that psychological stress does not delay seroconversion when the immune system is under tremendous pressure - is because the production of antibodies is an independent process not impacted by stress - is it because studies have been done and there has been no such correlation or is it because hiv test is so sensitive that even with impaired and limited antibody production because of stress, there is enough antibodies for the antibody test for me what was 3 and 4 months after the risk. KINDLY HELP ME RATIONALIZE THIS PLEASE. Please, it will help me with my HEALING on the mind. 2) On there not being a second window, assuming that is what has been observed with thousands of cases? But let's just suppose the antibodies were delayed to 3 or 4 months would the antigens be there to be detected. Or is it that 3 or 4 months post exposure the AB/AG test is essentially an antibody test and in that case I need to believe the science that there would definitely antibodies present at those points, despite stress and alcohol. 3) How likely would it be for my daughter to have got HIV when she kissed the dog's cheek that had my shaving cut blood about a minute earlier, if it got into her membranes in the mouth or inner lip membranes. Thank you!!

H. Hunter Handsfield, MD

5 months ago

1) Sorry, but I can't give physiological reasons why -- what we know is that there are no medical conditions of any kind, including the most severe forms of stress or immune deficiency, that alter the reliability or timing of any HIV test. Beyond that, we are not mental health experts and do not view our role as helping people with psychological issues except by providing scientific facts and our professional judgment. Understanding and accepting this -- or "rationalizing" it, to use your word -- is your task, not ours.

2) The basic chemistry and physiology of the test prevent a second window. As you suggest yourself, if somehow antibody development were delayed (which is not known to happen), the antigen component would remain positive. Antigen become undetectable in blood only because antibody is present and removes it.

3) Nobody ever got HIV by contact with animals; and since it is proved you do not have HIV, neither your daughter nor anyone else can be infected from your blood.

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5 months ago

Last question please. I took the 4th gen hiv test in 2019 - is it the same in terms of sensitivity and accuracy as the current in 2024 / 2025. And also thank you so much for all your responses!

H. Hunter Handsfield, MD

5 months ago

There might have been minor tweaks in design of the AbAb tests over the years, but test performance is identical. All such tests are equally reliable.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has helped you. Best wishes and stay safe.

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