[Question #13090] Study Showing Exogenous Testosterone Potential Effect on HIV Test
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2 months ago
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Hi,
I know in the past it was answered that anabolic steroids would not have an affect on hiv testing. However, I inadvertently came across this study.
A couple questions:
1) Apparently testosterone is immunosuppressive. I’ve been actively taking testosterone for every std test I’ve had done since my low risk exposure (blacked out but was told I received oral from someone hiv positive). Would this affect a test over 1 year after the exposure or is it just for primary hiv testing? Looks like the guy in the study went well before the window period. I’ve had other potential exposures as well if you look at my question history and was on testosterone every time I tested. Want to ensure that these tests are most likely accurate.
2) I’m guessing this is extremely rare - are there any studies on the percentages that being on testosterone could cause a false negative?
3) Since it only states primary hiv infection in the study - how long is primary hiv infection? I see a few weeks and all but doesn’t say an exact timeline when the next phase begins?
4) I guess to be 100% sure I could take a pcr test because this man was still testing positive for viral load despite having false negatives on other tests. But would that even be necessary since it’s been almost 2 years for me since exposure?
Thank you.
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2 months ago
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I should add. Basically been on testosterone replacement therapy levels since late 2020. Feel really good on it and do not want to come off. Even if I do - believe the ester I’m on is at least a 45 day half life. That’s why I’m asking all of this as well. Really hope it isn’t necessary to come off of it. As I can at least keep it in therapeutic dose range. Thanks
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H. Hunter Handsfield, MD
2 months ago
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Welcome back to the forum. You've been warned about multiple anxiety driven questions but it's been several months and this is a new situation. Still, I find it a bit implausible that you "inadvertently" found this report!
In any case, that search has misled you. It seems you partly understand it isn't relevant to routine testing for HIV in people at risk. First, they used the wrong test to start -- he had a falsely negative standalone antibody test, not the normal antigen-antibody (AgAb) test. Given the patient's high viral load by PCR, undoubtedly the Ag component would have made the test positive; the minor diagnostic delay reported would not have occurred anywhere in the US or other industrialized country where AgAb testing is routine. And it's also true, as you seem to understand, that the situation is entirely irrelevant in terms of detecting longstanding HIV infection.
1) Testosterone is not immunosuppressive and that is not the reason the guy in the report had a false negative antibody test. You don't have to be immunosuppressed to have the test results and outcome of the case report. There are NO medications of any ki -- nd that interfere with the timing or reliability of HIV testing -- none at all.
2) This never happens.
3) Primary HIV infection means the first 2-3 weeks of new HIV.
4) You don't need PCR testing; you already have conclusive proof you do not have HIV.
Trust me on this: there is NOTHING you will think of that will require clarification of the reliability of the HIV tests you have had. You really need to stop looking online for such information or exceptions to the rule.
HHH, MD
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2 months ago
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Thanks. You say testosterone is not immunosuppressive but the study says that androgens including testosterone has been known to play an immunosuppressive role and cites it sources? you say no medications of any kind would interfere with the result but wouldn’t prep or pep? If there are 1 offs where it could delay seroconversion - what do you think would be the longest it would delay it? obviously you’re the expert here and have a lot more knowledge/credentials than me on this. trying to understand why you’re saying some things that directly contradict what’s said in the study.
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H. Hunter Handsfield, MD
2 months ago
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Testosterone is not generally considered to have significant immunosuppressive properties. It probably partly explains the less vigorous immune responses to some conditions among males compared with females but this is not the sort of thing that could have any effect on antibody tests for HIV or especially on the AgAb or PCR test. And although I know nothing about the authors of your report and their immunologic expertise, it's an obscure report in an obscure journal, and only a single case report; it decidedly is not a research "study" and not to be relied on as an important resource about testosterone's immunologic effects, if any. You're overthinking an issue that has absolutely no relevance to your health.
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Trust me on this: nobody in the world has ever had a false negative HIV test on account on treatment with testosterone or other androgens. Once again, there are NO drugs or medical conditions that interfere with the standard HIV blood tests, apart from HIV drugs themselves when taken for PEP (which we don't need to say specifically every time the issue comes up).
I suggest you entirely stop searching online about any of these issues. You can be sure you will never find anything that could possibly change our assessment of your situation or advice about it. It isn't worth your time or emotional energy.
That completes the two follow-up comments and replies included with each question and so ends this thread. It has become apparent that this has all been just another anxiety driven and somewhat irrational concerns. As you previously have been informed, repeated anxiety driven questions are subject to deletion without reply and without refund of the posting fee. From here on that policy will be strictly enforced. I do hope this final discussion has been helpful.
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