[Question #12958] Follow UP HIV RNA Question

3 months ago

Hello,

One thing I forgot to add I have psoriasis and sometimes I have active psoriasis on my penis head. If I had active psoriasis and caught HIV through psoriasis could that lead to a small viral load and take longer to detect by the HIV RNA test? I took another HIV RNA Test 20 days post expsoure and it was negative. Why are the HIV RNA test not conclusive until 33 days by the CDC? What would be the scenario someone wouldn't expereince seroconversion and ARS systoms until day 28-30?

Below is my first question.

I had protected vaginal sex with a sex worker on April 11th. I did stick my finger in her vagina and butt and she scratched me on my stomach hard enough to bleed. A day or two after I started having night sweats and digestive issues and have felt feverish but I never had a fever. I do feel like I'm fighting an infection. I have polycythemia vera which already increases my inflammatory responses. I have high platelets, red blood cell counts and border line white blood cells counts from my bone marrow disease. I took a HIV RNA test 10 days and 16 days after exposure and both tests were negatived. I'm stressing out that I'm a late bloomer to seroconverison and that's why the HIV RNA test hasn't detected the virus. I had a therapeutic phlebotomy on April 18th to reduce my hematocrit. I'm not sure if this could have have an affect on testing as well.

H. Hunter Handsfield, MD

3 months ago

I reviewed your recent question with Dr. Hook and agree with all he said. I'm sorry you felt the need to return. I am paying no attention to the questions he answered and repeated here. You are way overthinking everything. You were not at significant risk for HIV Nd for sure you do not have it. There are no medical conditions, drugs, or anything else that interfere with the reliability or timing of any of the modern HIV tests, including the RNA tests. That includes polycythemia vera and ALL medical conditions associated with immune defieincy of any kind.There are no known exceptions to conclusive negative results after 11 days. I have to assume you found older CDC information, if indeed there was a statement about 33 days -- either because the test was an older one or earlier data have been superseded. With the standard modern tests, including the RNA tests, there simply is no such thing as late seroconversion. (I've never head the term "late bloomer" in this context and consider it irrelevant.)

Suck it up, believe it, stop testing, and for goodness' sake stop searching online to prove yourself right and us wrong!

HHH, MD

---

3 months ago

Thanks for the response.

You don't think it's possible to test postive after a negative HIV RNA test 20 days post expsoure? Sorry, I have really bad anxiety and have symptoms. That's why it's diffuclt for me to accept the results.

This is why I'm confused. The below statement is from the CDC website.

A NAT can usually detect HIV 10 to 33 days after exposure.

https://www.cdc.gov/hiv/testing/index.html

H. Hunter Handsfield, MD

3 months ago

"You don't think it's possible to test postive after a negative HIV RNA test 20 days post expoure?" Correct. It has never been known to happen. You will not be the first. You being anxious about it does not change the science; and it is IMPOSSIBLE to have HIV symptoms and to test negative. IT NEVER HAPPENS.

Your anxiety has led you to misunderstand the CDC site. Ten and 33 days are the times during which the test often almost always is positive; they are not the times needed to the first positive result, which never takes more than 11 days. Trust me on this: any site that says otherwise is either outdated, naive, or intentionally misleading. The only exception known is when people take anti-HIV drugs after exposure (post exposure prophylaxis, PEP), in which case the 11 day clock starts on the day of the last dose of drug.

If you ask any other questions that we have already answered the thread will immediately be closed without further reply.

Perhaps it will also help you to know that in the 21 years of this and our preceding forum, with thousands of questions from persons worried about HIV after a possible exposure, not one has yet actually turned out to be infected. You will not be the first. If and when it finally happens, surely it will be from a genuinely high risk exposure (think unprotected anal between two men), not a trivially risky event like yours; and the positive result will be on time and otherwise typical.

---
---
---
---
---

3 months ago

Thanks for the reassurance but I have a couple of follow up questions.

I think the symptoms I feel today are likely due to inflammation of the virus being in my body or cancer but not ARS and that's why my HIV RNA test is still negative after 20 days. I have read online night sweats and digestive issues can happen within the first week becaues HIV first attacks your stomach cells first and causes inflammation before ARS. Today, I'm 25 days post exposure. Is it possible that someone could still have a viral load tha's too low for the HIV RNA test to dectect by the 20th day? I keep on thinking I will get a fever or ARS symptoms on day 28-30 post exposure and that's when I would test positive. When I mentioned late bloomer I'm referring to starting ARS symptoms on day 28-30 instead of week 2 or 3.

Last follow up questions:

Is it possible that someone that's not taking PREP or PEP could still have a viral load that's too low for the HIV RNA test to dectect by the 20th day?

Can ARS symptoms not appear until day 28-30? What is the timeframe when seroconversion happens?

Sorry, I'm not trying to prove anyone wrong but there is so much conflicting information online and it's hard to know what information is correct.

H. Hunter Handsfield, MD

3 months ago

Your mind continues to work overtime and there still are indications you didn't carefully read or understand my previous replies in both this thread and your earlier one. Or maybe just don't believe my responses? You have had what I can confidently say is reasoned, science-based analysis in clear, unmistakable language.

"I think the symptoms I feel today are likely due to inflammation of the virus being in my body..." That isn't possible.

"I keep on thinking I will get a fever or ARS symptoms on day 28-30 post exposure and that's when I would test positive." Also impossible.

"When I mentioned late bloomer I'm referring to starting ARS symptoms on day 28-30..." Your test results prove this cannot be the case.

"Is it possible that someone that's not taking PREP or PEP could still have a viral load that's too low for the HIV RNA test to dectect by the 20th day?" No.

"Can ARS symptoms not appear until day 28-30? What is the timeframe when seroconversion happens?" Symptoms could start that late, but not with the earlier negative test result you had. In other words, if your symptoms were HIV, the tests would have been positive.

That concludes this thread. Please note the forum policy against repeated questions on the same topic especially when anxiety driven. This being your second on these issues, it must be your last. Such repeated questions are subject to being deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is intended to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have reduced educational value for other users, one of the forum's main purposes. Thank you for your understanding. If you still remain concerned, first go back and carefully read every word of both threads. And if that doesn't work, consider professional counseling to address the apparent underlying psychological or mental health implications of your inability to understand and believe what you have been advised. This also is a suggestion from compassion, not criticism.

Goodbye and good luck.

---