[Question #12943] HIV Testing and Biotin Interference - Is there clinical evidence of this?

3 months ago

Good morning - I hate that I am back with a new question but I just stumbled upon the Biotin interference and it has me reeling. I was actively taking biotin during my testing, 5mg per day (5,000mcg as normal in hair skin nails vitamins); maybe up to 10mg but for sure 5mg. I thoroughly read through the study on this but I really want your input on if I can believe my 2018 test results or if I need to be retested:

1. It looks like the study indicates there is only interference with the fourth gen ag/ab tests when antigen is present, and no interference when only antibodies are present, even in mega doses that far exceed what I was taking. My testing was done at 7.5 months post potential exposure. Is this a time when no antigen would be present? If so, it feels like I can 100% trust the results. Have you actually ever seen someone get a false negative due to biotin?

2. I also took two oraquick tests during that time and both were negative. Since oraquick doesn't look for antigen but rather antibodies only, I dont think biotin would have any impact at all but I would like your professional opinion! I did also review the oraquick insert and they don't mention any biotin interference. I cannot find any studies on this.

3. Is it even possible that I would have HIV for 8 years and not have any symptoms? I get annual labs and my white cell count was low - but within Labcorps normal range. Of course, that scared me to death.

4. All of these tests were taken at different times of the day so it is impossible that they all directly followed 5-10mg of biotin. For example, my two oraquicks were in the evening; my lab draw was at 1p, and my other blood test was at 7a.

Thank you so much.

H. Hunter Handsfield, MD

3 months ago

Welcome back to the forum. Thank you for this question.

In considering these questions plus your four previous ones a few years ago, it is apparent you are way over-concerned and fearful of HIV and other STIs despite obvious low risk. The bottom line is that you definitely can rely on your previous negative test results. There is no possibility you have HIV.

The quick answer to the question in the title your chose is no: there is little or no clinical evidence of biotin interfering with test results; most or all research on biotin has been focused on analyzing the tests themselves; there are few if any reports of people actually having false negative results because they were taking biotin. If it occurs at all, it is very rare. In addition, anyone needing an HIV test and taking biotin, even in high doses, only need to stop taking biotin for 2-3 days before the test is done. To your numbered questions:

1. This my understanding as well; the theoretical problem with biotin is only in antigen detection, not antibody.

2. And therefore I agree that taking biotin could not have altered the reliability of your oral fluids (Oraquick) test results. On the other hand, the oral fluids test misses up to 5% of all HIV infections. If you have not had negative lab based tests, that would be a consideration. Not because there is any serious chance of infection, but only for the reassurance of the negative result.

3. It is possible but very unlikely to have HIV for 8 years and remain well. You probably would have been very ill by now, perhaps dead.

4. Time of day makes no difference in HIV test reliability or results.

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

HHH, MD

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3 months ago

I am - I know it's regret driving my obsession with this.

Is antigen gone by 7.5 months, and so I would fall into the group of people in the study that wouldn't be affected by biotin (it showed no impact to those without antigen).

Also, thank you - the timing was more about when I was testing in relation to actually taking biotin, as I know it goes away pretty fast.

Thanks so much for the quick reply.

H. Hunter Handsfield, MD

3 months ago

Antigen rarely is gone after 7 months; it is detectable in blood for life after almost all HIV infected persons. For the reasons discussed, your negative test results are reliable, within the natural limits of the oral fluids test as noted above.---

3 months ago

Thank you. I appreciate your insight and confidence!

H. Hunter Handsfield, MD

3 months ago

I'm glad to have helped. That concludes this thread. Best wishes.---