[Question #1620] Frightened still

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85 months ago
Hello Dr's

I have read literally everyone of your posts but seem to be scared. My event was now 11 weeks and 3 days back. I don't recall the event due to alcohol. However I have had a very scared feeling afterwards and have tested a great deal. 

4th gen with rflx 
24,31,39,48,55,61, and 69 days. 
These have all been negative. 

What scares me is that after the 71st day I started having leg/knee/groin pain and have had body tingling for quite sometime before 71st day. 

My wife this week got a fever and a small rash on upper legs which has me thinking of taking another test. 

1. Should I take another test?

2. Could it be that antibodies just didn't form until after my 69th day test?

3. Wouldn't one of the previous tests have picked up either antigen or antibody by 69days. 

4. I understand the 3 month guideline but is that because it's based on antibody only tests and in place from testing efficiencies from years back?

5.  Should I be worried that my wife has th see things going on 24 days after we had sex?

6. Are the 3rd gen vs 4th gen antibody detection portion more advanced in the 4th gen vs 3rd gen?

This is a topic that I just cannot stop thinking about. I keep going to the web to read both your previous posts for temporary relief. 

Thank you and hope to hear back. 
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85 months ago
Forgot to ask on question and that is we had sex the day after my 55th day negative test and then I had a test on the 61st day and 69 today

 Would it be possible that if I was infected that she could have gotten it in between those negative test results ?

sorry for not asking in my previous post and thank you very much
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H. Hunter Handsfield, MD
85 months ago
Welcome to the forum. Thanks for your question.

Thanks for reviewing other questions similar to yours before posting. However, I fear you have missed a critical and highly reassuring fact, and a common theme in both my and Dr. Hook's replies about HIV exposures, symptoms, and testing:  As long as HIV testing is done sufficiently long after the last possible exposure, the results ALWAYS overrule all other factors. For the fourth generation HIV tests (combination antigen-antibody tests), that time is 4 weeks. No matter how high the exposure risk at the time, regardless of the most typical symptoms that suggest a new HIV infection, and regardless of any other tests (positive for other STDs, blood counts, immune system tests like CD4 count), the negative test results tell the truth. Three months is old news, left over from older HIV tests no longer routinely used. (The only exception is the oral fluids test, which can take up to 3 months to become positive.)

Accordingly, you have been seriously overtested. Your 31 day result was conclusive and you could have stopped testing after that. As for your symptoms, for the reasons above, they cannot be due to HIV. Even if they were typical for a new HIV infection, which they are not, they don't change my assessment that you weren't infected during the exposure 11 weeks ago.

Those comments cover your specific questions, but to be explicit:

1) You don't need more testing.
2) Antibody development is never delayed that long. If somehow that had happened, HIV antigen would have been present and the tests still would therefore be positive.
3) Yes.
4) Correct.
5) I don't understand. Your wife is "seeing things"? In any case, since you don't have HIV, you could not have infected her.
6) The antibody component of the 4th gen tests is essentially the same as the 3rd generation antibody-only test.

Finally, your follow-up question:  No. It is impossible that you had HIV despite those test results and therefore impossible you have infected your wife.

So you definitely can move on with no further worries about HIV. My only other question/concern is about other STDs. Since you don't recall the event, you should also have had a urine test for gonorrhea and chlamydia and a syphilis blood test. If not done, I would recommend them.

I hope these comments have helped. Let me know if anything isn't clear.

Best wishes--  HHH, MD

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85 months ago
Thanks Dr 
1. The question which was poorly typed was if I should be alarmed by my wife's rash on arms and upper thighs along with low fever which started 24 days after sex and 79 days after my exposure or 10 days after my last negative?

2. Have you seen 8+ week negatives later become positive after 4th gen test taken?

3. Can I resume unprotected sex with my wife even though the rash is scaring me beyond belief?

4.  Just to be certain should I move on with my near 10 week test or should I retest at 84 days according to official guidelines. I have full confidence in your years of experience. 

5. Lastly you say impossible for me to be neg at then give something I don't have to my wife. However isn't it possible that if antibody isn't there or not produced let's say hiv 2 by 70 days then it could be possible? I believe the hiv1 assessment as if no antibody then p24 would be picked up. Would 69 days be enough for hiv1 antibody?

You are both wonderful souls and thanks for helping me out through this time. 
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85 months ago
Sorry forgot to add as you had asked about other std's. I've tested full panel on all of them and they were all negative. Am I safe on all other std's to that point of 69 days. 
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H. Hunter Handsfield, MD
85 months ago
Glad to hear of your negative STD testing. So you're in the clear for all.

1,3) I haven't a clue what the cause of your wife's rash might be. It is not HIV, at least not from you. That you are "scared beyond belief" doesn't mean your wife has HIV or that it is in any way related to your extramarital exposure. If your wife's symptoms are still there or if she is concerned, she should see a doctor about it.

2) The answer to this is clear from my reply above. Not only have I not seen this . Nobody has -- it doesn't happen. 

4) Also already answered. Of course you are free to be tested for as long and as many times as you like. Assuming this is your only potential exposure, it will never become positive.

5) You don't understand how the test works -- that's not unsual, since it's a bit complex. But here it is:  When someone has new HIV, p24 antigen appears in the blood, typically 7-14 days after infection. Then antibody to p24 develops and clears p24 from the blood. For a few days, both may be present. After that, antibody only is present. In other words, it is the antibody that makes p24 go away. Therefore, it is not possible to have the antigen disappear before antibody shows up. So when somone has HIV, once the 4th gen test becomes positive -- detecting antigen, antibody, or briefly both -- it remains positive for the life of the individual. Stated another way, in contrast to what you can find online from uninformed persons, there is no "secondary window period".

Trust me on this:  you did not catch HIV. Don't confuse your shame and guilt over a sexual decision you regret (and apparently don't even remember) with the medical consequences of that decision. They aren't the same. Deal with the former as you need to, but you needn't worry about the latter. Do your best to accept the reasoned, science based reassurance you have had, for sure on this forum and, I would guess, from the doctor(s) or clinic where you were tested.

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85 months ago
Thank you Dr, it brings me ease after your comments. At this point i had gotten so worried and went for an 80 day 4th Gen test, got the results back yesterday and it was negative (non-reactive). I know what you will perhaps say, that this is close enough to the CDC guideline of 84/90/3months, is that correct?

Over the years i am certain you have dealt with many individuals with extreme anxiety and i'm wondering how they got over the fear of having to keep on retesting.

I just had  a few follow up questions and i think i will need to somehow just forget about this exposure and the fear that every little tingle or muscle ache is related to HIV.

1. I know your stance as well as Dr. Hooks along with other experts in the field (Dr. Cummings), etc that 4th gen at 28 days is conclusive and stand alone antibody is conclusive by 8 weeks. Why does CDC continue to say 90 days? Is that because some people produce antibodies by the 90th day due to factors such as:

- Immune issues
- Cancer drugs

Would there be anything in my body that would delay the production of Antibodies, i am a pretty healthy individual physically prior to this event but i know my fear/anxiety has made me feel pretty unwell over the past 3 months. Outside of that i have never been diagnosed with any immunodeficiency disorder or had cancer, etc. KEEP WORRYING I COULD BE THAT ODD CASE 

2. P24 is exclusive to HIV 1, however the 4th gen only tests for the antigen in HIV 1, how conclusive are my tests for the antibody part only for HIV2. Is there any further worry needed on my end?

3. If i were to have sex with my wife, can i be certain that i will not infect her with all these negatives? We did once as mentioned before and she got a rash 24 days later which has me scared as could this be ARS? Couldn't be right considering i have all these negatives.....(sorry you can see my mind is trying to be logical about this but apparently having a hard time)

4. Would any drugs such as for acid reflex or LPR have any bearing on the production of antibodies?

5. Would 80 days or 84/90/3 months make any difference as i tested neg at 80 days with 4th gen.

6. With these tests being negative, lets assume i had the highest RISK possible, would you still not recommend another test?

Thank you for your help and this will be the end of my questions, i appreciate your feedback tremendously.
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H. Hunter Handsfield, MD
85 months ago
1) CDC advice on time to reliable HIV testing:  The reasons for CDC's continued 3 month advice has been discussed previously on this forum, but I think it's time for a new statement that I will bookmark and save to use in response to similar questions in the future.

CDC developed its advice before 4th generation tests became available. The first reason is that many government agencies generally take conservative positions on prevention advice, and 3 months does that. Second and perhaps most important:  As a government agency, CDC's advice usually must be consistent with the official information provided by the test manufacturers in the tests' package inserts. That information is based on original research, before the tests were marketed, and much of that research is conducted in a way that probably underestimates the tests' true performance. In any case, that information cannot legally be changed unless and until the test manufacturer conducts and new research to justify the change, and that research is vetted and approved by the US Food and Drug Administration. That's a very expensive process and therefore is rarely done. Other research, or the clinical experience of experts using the tests in the real world, and theoretical considerations about how the tests work may not be used to justify a revised package insert or information provided to the public by the manufacturer, so CDC also doesn't modify their advice either. However, independent experts do not have those restrictions and can give advice based entirely on their clinical experience and their interpretation of the science of the tests and published science. That's what we do on this forum.

2) The 4th generation tests are still considered conclusive at 4 weeks for HIV2, because antibody always develops by then. And because HIV2 is so rare outside small areas of east Africa.

3) Already answered above. I haven't changed my mind.

4) There are no drugs or medications known to have any effect on 4th generation test reliability.

5) Also repeats a question above, in different words. Same answer. Any and all tests you had beyond 31 days were superfluous and that will remain true for any additional tests you may decide to do.

6) Also a repeat. See the main first paragraph of my reply above.

That completes the two follow-up comments and replies included with each question, and so ends this thread. Thanks for the thanks about our services; I'm glad to have helped.