[Question #1502] Clarity

45 months ago
Hello Dr,

I had asked a question last week and was given a great deal of clarity, thank you for that. 

I am asking this time around in regards to actual testing. As I understand test results rule over any symptoms however I still feel a level of un easiness which is why I'm here. 

1. If a person was to have been infected with HIV then a 4 th gen would pick up antigen or antibody by 4 weeks? From my understanding the antigen is high for the first few weeks at least. 

2. I had 4 4th gen tests done at 24, 31, 39 and 48 days. Can I really move on? Should I forget about this event now?

3. I developed a sore throats today and some red blotches around my body. I realize that could have always been there (blotches) and I am now just noticing them. Does sore throat bother you in any way at the 8th week?

4. Would another test do anything or should I even consider it?

5. Please provide any information on why you both consider conclusiveness of 4th gen at 4 weeks on a scientific level vs. just a statement. 
(I think that could help other reader as well)

Also today is post 54 days after possible exposure which I cannot fully remember. Let's say it was the highest risk and the tests came back as they did. 

I'm sure the response will be around repetitive questions but I needed a bit more clarity. 

Thank you and I will donate after these last threads. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
You are re-asking the sme quesitons in different words. They were either answered last time or the answers are obvious from that discussion. So my replies are succinct.

1) Yes, true.

2,4) Those results are conclusive and you definitely can forget it and move on.

3) Test results like yours overrule everything else, no matter the symptoms or exposure history. Your sore throat has nothing to do with HIV or your sexual exposure, except maybe the result of anxiety about it.

5) This has been discussed many times on the forum. It is the antibody that makes antigen go away. By 4 weeks, the blood ALWAYS contains HIV p24 antigen, antibody, or both, and hence the test is conclusive any time, life long, after 4 weeks.

Regards--  HHH, MD

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45 months ago
Dr, Thank you 

I guess my anxiety which i know is there is because we are trying for a child and i cannot fathom of any risk that i may give to my partner.
You've said this before and sounds silly asking again, your opinion is with the tests that i can be 100% confident that i wouldn't affect my partner or potential child?

I have read why CDC and others want to see a test at 3 months but if P24 is tested for in the 4th gen why would they keep suggesting that? I mean based on your experience it seems are you are very conclusive that 4 weeks + is all thats needed with a 4th gen. 

Is it because some people may create the antigen after 4-5-6 weeks and they cant risk that, or is it because they are factoring in people on PEP, or have immune system problems.

I have read on aids map the following and they state the word "SOME" however that contradicts the word "ALL" with have the antigen show up by 4weeks as you have stated several times.

Testing for p24 detects some cases of HIV infection before antibodies are produced, shortening the window period in which people may test negative despite having infection.

Not all tests distinguish between samples that are positive for antibody and samples that are positive for p24. Therefore, although they may help identify people with primary infection, they do not distinguish between primary and chronic infection.


This is my last question and i do not expect to post here again as this mistake will never be made again.


Thank you,

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
CDC continues to have hyper-conservative policies about HIV testing. But trust me on this:  nobody every turns positive if they have had a negative 4th generation HIV test at 4+ weeks after being infected. But you're free to keep testing as many times or whenever you like. It will be a waste of time and money, but if you would be still further reassured by testing at 3+ months, feel free. I certainly wouldn't do it if somehow I were in your situation.

The statement about distinguishing chronic from acute infection is true but irrelevant in your case.

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45 months ago
Please close after this as I had asked two questions and didn't get a direct answer. 
Thanks again for your help and question 1 is just crucial to my mental health   Don't need long answers, sorry if sound like a nuisance. 

1. we are trying for a child and i cannot fathom of any risk that i may give to my partner.
You've said this before and sounds silly asking again, your opinion is with the tests that i can be 100% confident that i wouldn't affect my partner or potential child?


2. Can people create the antigen after 4-5-6 weeks and they cant risk that, or is it because they are factoring in people on PEP, or have immune system problems.

Im out of your hair. 
Thanks again
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
I disagree you "didn't get a direct answer".  All your questions were answered in your previous thread or this one.

1) This makes no difference in my replies or the chance you might be infected. 

2) In theory, if PEP is given and doesn't work, it could delay appearcnce of p24 antigen in the blood. If some sort of "immune system problem" had any effect, it would make p24 antigen appear even sooner than normal, or give a more strongly positive test result. It could delay antibody development, but the overall effect on the 4th generation tests probably would be nil. Here too, there are no reports that this has ever actually happened to anyone.

Note the forum policy that prohibits repeated anxiety driven questions. Such questions have no value for other readers, one of our main goals; and ASHA does not want to keep accepting payment from compulsive searches for the same answers. Therefore, this will be your last thread on this topic. Any future ones will be deleted without reply and without refund of the posting fee. It is a policy based on compassion, not criticism.

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