[Question #13471] Clarification on some confusing and weird answers

1 months ago

I need certain clarification on the answers given by dr HHH and dr hook.

Clarification on answers of Question #8278 [Title: HIV 1/2 reassurance] by DR HHH

1)DR HHH says in answer to question 1 : "Indeed you can.............. There are few known... (4th generation).....becoming negative, or remaining falsely negative, during the life...."

So could you give me reference of those cases who remain negative for lifetime on 4th generation test. I could not find any on the internet. Please clarify.This is a scary statement.So a 6 weeks 4th generation test is not conclusive rather 4th generation test is never conclusive since it can remain falsely negative during the life time?? OMG

2)DR HHH says in answer to Question 2: "I certainly can.....the AgAb tests do detect most HIV2 infections..."

So what do you mean here by "most". Does that mean the AgAb(4th generation) test can't detect all hiv 2 infection. This too is scary.No matter how rare an infection Hiv2 is but 4th generation test not detecting all hiv2 infection is scary. Please clarify since on several other threads you have said that 8 weeks is considered conclusive for hiv2.

1 months ago

Now Clarification on answers of Question #6349 [Title: elite controllers window period and testing] by DR Hook

3)In his answer he says "Also please remember that elite........As a result many elite controllers DO develop antibodies to HIV."

Again by "many", what do you mean. Does it mean that ALL elite controllers do not not develop antibodies to HIV. This is scary again.If not all elite controllers produce antibodies, then how come 4th generation hiv tests are conclusive at 6 weeks(as stated by dr hook and dr hhh on several threads).

4)Furthermore in his answer to question 3, he says "I am not sure....As mentioned above most elite.....Please realize that elite control....if your HIV test is negative you are almost certainly not HIV infected."

Again what do you mean by "almost certainly". Why not entirely certain???Again does that really mean that not all elite controllers test positive on standard 4th generation test.

1 months ago

I am not trying to debate or to act otherwise but you guys are the ones who says to stay off the internet , but these statements of yours are way scarier than what is there on the unfiltered internet. And please it is request not to use statements like these are older threads, asked by other users etc as the questions were straight forward but answers in these two threads seem to contradict your own answers on other threads asking similar questions.

H. Hunter Handsfield, MD

1 months ago

Welcome back, but I'm sorry you continue to have such uncertainty about these situations. And these questions, like your previous ones 9 months ago, reveal far greater concern than seems warranted. To my knowledge there has never been a well documented case of anyone with HIV who did not test positive with the AgAb (4th generation) blood test and/or the HIV RNA PCR test ("viral load" test). Also, be careful in comparing our replies across different questions. Our replies are tailored to the particular needs or questions posed by the user -- and might be slightly different between different users depending on their circumstances.

To your questions now:

1) Probably I should have written "few or none". Do not assume that just because I used "few" means there are some documented cases. I am not aware of any.

2) Until a couple years ago, the AgAb tests did not detect all HIV2 infections. Since then, most if not all manufacturers have tweaked the tests so they now detect HIV2. In any case, HIV2 is so rare in the US and other industrialized countries that it can and should be ignored. As best I know, nearly all cases in the US so far were acquired in Africa or were diagnosed in their regular sex partners.

3) I have neither the time nor intent to look at old questions to confirm what I did or didn't write. The fact is that to my knowledge, ALL elite controllers have normal antibody responses and test positive with the AgAb tests. However, many have no detectable HIV RNA in their blood and therefore test negative with the PCR test.

4) There are few absolutes in medical science. "Almost certainly" means I am unaware of any exceptions.

For the reasons in my opening comments above, I disagree that our replies contradict one another or that they are "scary." You cannot always conclude all answers to other users necessarily apply to your situation. If you have had an exposure you are concerned about, we are happy to advise on which HIV tests you should consider; and if such testing has been done, to help you understand the results and the likelihood you have HIV. Finally, it is true we advise anxious persons to limit their online searching about the medical concerns they are worried about, whether HIV or any other medical condition. That includes overly detailed searching of our responses on the forum. You seem to be a case in point: it seems you are over-reading or over-interpreting many responses you have found which are not necessarily relevant to your own risks.

Let me know if anything isn't clear.

HHH, MD

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1 months ago

1.In reply to my question 2 you are saying that tests were not able to identify hiv 2 infection until 2 years back, then why did you and dr hook use to tell on medhelp as well as on this forum that 6 weeks AgAb(4th generation) test is conclusive. On medhelp you used to say 4 weeks even for hiv2. And I am talking about your answers 10-15 years back and may be even 20 years back. Is there any article or scientific evidence regarding hiv2 infection not being detected by the standard AgAb test. Please clarify.

2.My question 3&4 pertain to answers given by dr hook. So is it possible to get his clarification for those questions regarding elite controllers. I believe your response sir but it's just that hearing his opinion might help me and others who might have read his response to question #6349.

1 months ago

3.TALKING ABOUT MY EXPOSURE : I am from India. Back in my college days from 2013 to 2016, I had sex with 9 CSWs. In 2013, with one CSW, I had lots of french kissing followed by protected sex. In feb 2016, with another csw I had very prolonged unprotected sex with french kiss and oral sex and the session lasted for 3-4 hours as I was drunk. Furthermore with the same CSW in dec 2015, I was having protected sex but in middle i saw blood inside condom and I left sex midway and left. My last exposure was in feb 2016.Others were protected sex without kissing and without oral sex.

NOW TESTS :Negative Hiv 1/2 rapid test in May 2016, Then in July 2017 Hiv CMIA(AgAb) test negative, Then in Aug 2017 Hep B and Hep C test negative(both rapid & CMIA) , Chlamydia negative, Gonorrhea positive (saw doctor and got medications), syphilis (TPHA) test negative (one in Aug 2017) and one in sep 2017). In Oct 2019 Hiv ECLIA(AgAb) negative, July 2022 Hiv ECLIA (AgAb) negative, June 2023 Hiv ECLIA (AgAb) negative, Sep 2025 : Hiv ECLIA(AgAb) negative, Hiv p24 negative, Hiv 1 RNA RT PCR : Not detected (Limit : 20 copies/ml), Hiv1 proviral DNA : Not detected (Limit : 20 copies/ml), Hiv2 RNA RT PCR : Not detected (Limit :100 IU/ml).

The latest tests in Sep 2025 were done after reading your response to question # 8278 . But now again after reading your response regarding Hiv 2 that the tests did not detect hiv2 couple of years( i.e. till 2023), I am again clueless as to what needs to be done now to rule out hiv2.

1 months ago

4.Were my tests till 2023 were invalid for hiv2. Why on the medhelp forum and and this forum you guys used to say that AgAb test is conclusive for both Hiv 1 & 2 if taken 6 weeks after exposure (On medhelp you used to say 4 weeks). Please clarify.

5.Do I need to test more. I got married in Dec 2017 and have a baby of 4 years now.

H. Hunter Handsfield, MD

1 months ago

Oh good grief. Talk about hair splitting.

1. Prior to a couple years ago, the AgAb tests picked up most HIV2 infections, but not all of them. There is not a single reported case in the US of delayed HIV2 diagnosis on account of limited performance of the tests.

2. No it is not possible to involve Dr. Hook in this discussion. And there's no need: he and I have never disagreed in our evaluations and advice to forum users.

3. You have a more or less average sexual history. In view of that history, you were over tested. In any case, your test results prove conclusively you do not have HIV, including HIV2. As for "I am again clueless as to what needs to be done to rule out hiv2" the answer is nothing. You need no further tests.

4. Your HIV tests prior til 2023 were not invalid.

5. No, you do not need further testing. If you had HIV that somehow had been missed by all those tests, then you, your wife and possibly your baby would be very ill by now and possibly dead.

Do your test to move on without further worry. My guess is that you have been told the same by your own doctors. Believe it.

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1 months ago

I was busy with something so couldn't ask final question.

1.I am male from India where hiv 2 is prevalent apart from hiv 1. Since hiv 2 is also prevalent here, which test should I undergo after a risky exposure and after how many days or weeks or months to completely rule out both hiv 1 and hiv 2 considering various hiv 1 subtypes and hiv 2. Also considering late seroconversion or any other phenomena.

2. If am testing after 3 months of an exposure with hiv 4th generation test and the result came negative. Do I need to undergo Hiv RNA PCR or Hiv proviral DNA test.

3.I am worried about blood in environment. What type of exposure with blood is considered risky.

4.In sep 2025, When I went for the blood test I saw 4-5 tiny red spots(obviously blood) inside of vaccutainer needle holder and I told the phlebotomist to change it. She told me that she currently has only one holder and then she started cleaning the red spots with cotton. But since the holder was narrow and long it might be possible that while cleaning some blood might have got on her gloves. On insisting other phlebotomist gave her new vaccutainer needle holder but she did not change the gloves. Then with same glove she took cotton and pressed it on the needle site after blood draw. Is there any risk here assuming some blood might have transferred to her gloves and then to the cotton with which she pressed my needle site(vein). Am I at risk of hiv. Is hiv testing required due to this event?

1 months ago

Continuation of question 4: Exactly after seven days I got scratchy nose(7th day after exposure), then sore throat (8th and 9th day after exposure) and then mucus from nose and nasal congestion(for 4-5 days starting from 9th day). Were these ARS symptoms

1 months ago

The time duration between blood draw of last patient and me was almost 30 minutes.However the vaccutainer needle holder after the blood draw of last patient was kept inside the drawer of a table with no ventilation for air.

H. Hunter Handsfield, MD

1 months ago

I am unfamiliar with HIV2 epidemiology in India. It likely isn't the same in all parts of such a large country. I can only advise you speak with local health authorities or physicians about recommendations for testing in your area. "Late seroconversion" is a myth with the modern HIV tests, for either HIV1 or 2. Nobody ever has been known to catch HIV by exposure to blood in the environment -- discussed in detail in your previous thread 9 months ago. The scenario you describe in question 4 does not suggest any risk for being infected with HIV. HIV symptoms do not include nasal congestions, mucus, or cough; you caught a cold -- and the symptom started too soon to be ARS (typical onset 10-20 days after exposure).

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe. Please note the forum policy against repeated questions. This is your second asking in excruciating detail about factors that carry little or no risk. Excessive questions are subject to being deleted without reply and without refund of the posting fee, so this must be your last on these topics. Thank you for your understanding. I do hope the two discussions have been helpful. Wishing you the best of health.

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