[Question #12807] Follow-up Concerns
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5 months ago
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Hello again,
I recently asked Question #12701 and have since been to urgent care to investigate my ongoing malaise/weird symptoms. I was told that yes, my 4th generation HIV test at 7 weeks was final. They also said the ER doctor who gave me that test (in October) should not have said I need confirmation after 90 days. Apparently, the ER had my timeline wrong in their notes (21 days between possible exposure and the test, instead of the actual 48). Anyway, urgent care also told me I seemed otherwise healthy and I now have a primary care apportionment scheduled soon.
I can’t get a straight answer on any potential gap between antigen decline and antibody production. When my biggest symptoms started, it was only 2 days before the test, which again was about 7 weeks after the concerning exposure (giving oral). I have seen that the gap between markers can be a week… so this has me worried again.
Thank you and apologies in advance for coming back!
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Edward W. Hook M.D.
5 months ago
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Welcome back to the Forum. I'm sorry you felt the need. In preparing to respond to your questions I reviewed your recent interactions with Dr. Handsfield and agree with all that he said. I'm sorry you have continued to focus on HIV- you don't have it. You appear to misunderstand the way that the HIV virus and and the host antibody response interact. In persons who acquire HIV, the virus becomes present and detectable in the bloodstream with a few days of acquistion of infection is always detectable using HIV RNA PCR tests within 11 days of acquistion of infection. The body begins to produce antibodies soon after infection and becomes detectable in everyone who is infected within 8 weeks of infection. Antibodies and the HIV virus, detected as the p24 antigen, can be present simultaneously. Antibodies DO NOT "turn off" the detectability of the HIV p24 antigen. There are NO instances in persons who are not taking anti-HIV medications in which 4th generation, combination HIV antibody/antigen tests are not positive. I urge you to accept that you do not have HIV. Do not be misled by internet based mis-information. EWH---
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5 months ago
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Thank you for the quick response.
HIV has only become such a focus for me for two reasons: 1) the timing is too perfect with my first msm act, and 2) I have now been feeling persistently “off” or flu-like for 2 months. As I mentioned in my previous question, I did have COVID for the first time in January. I understand that it can linger but this seems outside of that symptom description and comes and goes so strangely.
As for the testing, it is still hard for me to accept that a single test (even though 4th generation) is 100% conclusive when I took it. Could you explain your use of “8 weeks” a bit more? I still fear that I’m just someone who took longer to show it, and unluckily tested at 48 days instead of 9 weeks - 12 weeks.
I also for some reason doubt my two oraquick tests, mostly because the second had a strange small dot in the T area. Not a partial line, but a dot… I understand I am quite paranoid but the information does help me stay calm.
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Edward W. Hook M.D.
5 months ago
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I'm sorry you feel that way.
1. I don't understand what you mean by "too perfect". You have highly reliable scientific tests, alternate explanations and fail to acknowledge to possibility of co-incidence.
2. There's a big difference between "flu-like" symptoms and "feeling off". "Feeling off" could be long COVID which occurs in more than 20% of persons who have COVID. Alternatively, I would encourage you to consider the possibility of depression related to your fixation on HIV and inability to accept your test results.
If you cannot accept your test results are , test again.
The 8 week statement reflects that vast amount of data the have PROVEN that antibody detection tests for HIV diagnosis are uniformly/always positive within 8 weeks of acquistion of infection.
My sense is that you are having a lot of trouble moving on. Dr. Handsfield and I have done our best to provide information based on our study of the vast amount of high grade scientific data. If you cannot accept that, there's not much we can do. you have one follow-up remaining. I doubt that I will have much to add to further questions. After this thread is closed however, we will invoke the right to not respond to further anxiety based questions. EWH
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5 months ago
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I completely understand and won’t be submitting another question, especially with an appointment lined up soon.
So to be perfectly clear, if antibodies are always detectable within 8 weeks, is the 6 week standard for 4th generation tests based on the fact that it is also looking for the antigen? It’s frustrating how so much medical information says the antigen will drop before, say, 7 weeks in my case.
I’d just like to know why any time after 6 weeks is declared final no matter the circumstances or person.
Thank you and sorry to bother.
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Edward W. Hook M.D.
5 months ago
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Final response. The presence of virus (antigen) makes the tests uniformly become positive even in the very small proportion of cases in which antibody levels are not detectable between 6 and 8 weeks. The fact than antigen levels drop in the presence of antibody does not mean that it is not detectable.
This thread is now complete. I wish you the best with your unwarranted lack of confidence that you do not have HIV. EWH
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