[Question #13621] Seeking Clarification on HIV-2 Detection After Reading Comment from #13471

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2 months ago
Hi Doctor, I'm sorry to trouble you again. This is not a repetitive question. I know my previous tests have already ruled out HIV and other STDs, but I recently saw a new question by other user #13471 (from just a month ago) that mentioned HIV 2 detection reliability. That comment confused me, and I would like to clarify whether any recent changes in medical affect the reliability of my own test results.

You mentioned that "until a couple of years ago, the AgAb tests did not detect all HIV-2 infections, but most manufacturers have since improved them so they now detect HIV-2" and that earlier AgAb detected most but not all HIV-2. 

This made me wonder which time period "a couple of years ago" refers to? 

For context, my tests were done between August 2024 until November 2025 (Abbott Alinity and Siemens Atellica). Q1: Are these period of 4th-generation assays fully capable of detecting  all HIV-2 infections? 

I previously tested multiple times, all of which were more that 3 months after the exposure in Malaysia. (unprotected oral, protected vaginal sex with Vietnamese sex worker) and all AgAb tests were negative; an HIV-1 RNA was also negative. I understand my results already rule out HIV, but I want to ensure there is no remaining concern specifically about HIV-2 detection after reading that very recent comment. Q2: Do I need any additional HIV-2 RNA testing? Q3: or are my AgAb results alone already 100% fully conclusive for ruling out HIV-2 and confirming that 100% I was never infected HIV-2, so that I can stop testing and not worry about this anymore in future? 

Thank you again for your time and guidance! 
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Edward W. Hook M.D.
2 months ago
Welcome back to our Forum.  I’m sorry to hear that you are having so much trouble accepting your test results.  Tests for HIV-2 performed in 2024 and 2025 detect virtually all HIV-2 infections.  You should believe the results and accept that your low risk exposure has not led to infection with any STI including HIV-2.  Further testing is not going to change this.  Thus:

1.  Yes, believe your test results.
2.  No.  HIV-2 RNA PCR would almost certainly only confirm that you were not infected 
3. See above

I encourage you to move forward.  If you are having trouble doing that, I would suggest that counseling rather than further testing will be most helpful.  EWH
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2 months ago
I think I understand, but I just want to double check, if that's okay-
1) Is it correct that my HIV AgAb tests detect HIV-1 and HIV-2 with the same reliability, and that they fully cover all 
HIV-2 infections? 

2) Is my worry about possible missed HIV-2 detection by these AgAb tests medically unfounded and driven by anxiety rather than science? 

3) Regarding your comment on "No.  HIV-2 RNA PCR would almost certainly only confirm that you were not infected": is your meaning that I do not need HIV-2 RNA testing at all, if I were to do it, it would just be a waste of money, add no new medical value, and would only re-confirm what is already established- that I was never infected? correct?

Thanks so much again! 

Quick recap for your convenience: Exposure 1: Unprotected oral/ protected vaginal. HIV AgAb at 3, 9, 10, 12, 15, 16, 18 months, HIV-1 RNA at 15 months, all negative.
Exposure 2: Fingertip contact with vaginal fluids. Exposure 3: Receiving handjob and breast sex.
I know Exposure 2 and 3 are no risk at all now. But I had HIV AgAb after the very last exposure at 4,7,16 weeks, 7, 8, 8.5, 10 months. Negative. Some Tests were performed on the same dates but appear different due to calculation from different exposure times. 
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2 months ago
Dear Dr. Hook,
Just a gentle follow-up on my previous message in case it was missed. Thank you again very much for your time and help.
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Edward W. Hook M.D.
2 months ago
Apologies- I did miss your follow-up.

1.  Correct
2.  Also correct.  I hope my comments have helped you move forward.  HIV-2 is not a realistic possibility.
3.  Also correct.  Further testing for HIV-2, IMO, would be a waste of time and money.  The results are not going to change.

Again, my apologies for missing your follow-up and thanks for the reminder.  EWH
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2 months ago

No worries at all—I fully understand how busy you are, and I appreciate your reply!  A few days ago, I saw a consultant physician in internal medicine (formerly in Infectious Diseases). He told me the same thing you did, explaining that my repeated testing was really my way of coping with guilt toward my wife, and he encouraged me to move forward. He also did not recommend or offer any additional tests, including HIV-2 RNA.

Yesterday I visited another STD clinic. That doctor also said my risk was extremely low and that HIV was impossible. He felt anxiety was the only issue but still offered a Western blot as a “final test.” I initially agreed, but after re-reading your and Dr. Hunter’s explanations that WB is outdated and not more accurate than the Ag/Ab tests I have already taken, I cancelled it this morning. I do not want anxiety guiding my decisions when medical evidence already confirms I am not infected.

I now believe I never had HIV-1 or HIV-2 and can safely have unprotected sex with my wife and try for a baby. Do you think my understanding and decision are correct?

Thanks again for all your and Dr Hunter's help—I really appreciate everything you’ve done for me!

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Edward W. Hook M.D.
2 months ago
Thanks for your thoughtful follow up.  I totally agree with your decision to cancel the Western blot.  That that clinician would suggest using that outdated test tells you that this is not a field he follows closely..  I agree with your plans to resume your normal sex life with your wife and to move forward without concern. I wish you the best and hope you have happy holidays. EWH.---