[Question #1694] Still Worried

43 months ago
Hello Drs,

I had asked a question some time back-- 

[Question #1620] Frightened still

I had a few follow up questions and some concerns.

1. Is it possible that with the overtesting that i have done--- Total of 9 4th gen tests up to the 90th day that an infection could have been missed in terms of HIV and Hepatitis?

2. Is it possible that when P24 peaks that for some reason it stays undetectable or doesnt produce enough for the test to pick it up? (There is a website i came across that said P24 may not be detectable) however if taken so many tests.

3. In regards to Hepatitis i have done on all of the 9 tests above--- For HEP B HBsAG surface antigen with Reflex to surface antigen and it has been negative every time.
4. In regards to Hep C i have done the HEP C antibody and the RNA QR PRC tests on all 9 and it has been negative.

5. Do i need to keep testing past the 90 day mark as that was my last test day after potential exposure.

What's concerning to me is that we just got out of the ER and my wifes liver enzymes were in the thousands, they started to get better each day and trended downwards. Is it possible that i could have a hepatitis infection and one of those 9 tests didnt pick it up? Or is it possible that i am immune to Hep B but still can pass it to her through sex. My wife is getting better but still has nausea, they are running all the HEP diagnostic tests and we are waiting on results.

I have been in a flux of stress/anxiety for over 3 months now and with what just happened to my wife i am even more panicking..

I hope to get some guidance from you, thank you.
43 months ago
Why do i keep reading " at 3 months you can be NEARLY certain you do not have HIV" it states that even if you took a 4th gen which i have

Do i sound like i'm just creating too much stress and anxiety over this as its a daily concern of mine along with now Hep.
Thanks,
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago

Welcome back.  I am sorry that you continue to worry about this.  I would urge you to believe your test results:  Straight to your questions:

1.  Absolutely no chance that infection was missed.  Believe your test results.

2.  The theoretical risk of having a false negative p24 test in a person with as many tests as you have had is virtually zero.  I would not worry about t this

3 and 4.  Your results provide definitive evidence that you were not infected.  No need for further concern or additional testing.

5.  NO!!!  You have tested far more than is needed to prove that you were not infected,.  I would urge you to stop and work to move forward.. 

I am confident that your wife did not get hepatitis or another STI related to the sexual encounter you reported from over 90 days.  You need to address your guilt over your misstep and move forward.   If you cannot do that on your own, my heartfelt suggestion would be to seek counseling to help you move on. 

The reason we use the terms such as "NEARLY" or "VIRTUALLY" is because in science there are no absolutes as something that no one has seen before could be detected the first time tomorrow.  That is the nature os science.  On the other hand, in your specific case, there is just no reasonable reason for you to continue to worry that you might have acquired, or transferred an acquired infection to your wife.  It is time for you to move forward.  I hope that my comments above will help you to do so.  EWH

---
43 months ago
Dr. Hook

Thank you very much for your response, i am absolutely aware that i am having guilt/worry/stress about the entire event.
I just have a few follow up questions for clarity:

REGARDS TO HIV

1. Why do some sites including CDC say that 97% of people will have detectable ab by 3 months, is this due to some people having compromised immune systems?
2. What would be examples of having to test beyond 3 months?
3. If i had an issue with my immune system would i know it over my past 38 years of life?
4. Are the immune system issues they refer to ones in which people get sick but do not recover due to issued producing AB or is it people that do not get sick often ( i really cant remember my last flu, etc) I know i've had them before however.
5. Do tests ever turn positive after 90 day negatives for HIV?

Or am i not understanding that since i have had 4th gen tests, in which CDC states "if testing within window period of 28-42 days you should retest 90 days after your exposure (That would be 90 days then)

IS 6 MONTH TESTING REQUIRED FOR ANYTHING? CHEMO PATIENTS, ORGAN TRANSPLANTS, ETC???

REGARDS TO HEP

We are waiting for the results from the hospital stay but as you can imagine my prior worry and then coupled with this bad timing of my wife getting sick it has really been hard to wrap my head around that it MUST be something that i acquired and then gave to her. I know there are  quite a few things that can increase liver enzymes outside of HEP but coupled with everything else my mind continues to go in that direction.

Only questions

1. Could it be possible i am immune to Hep A or B and that i some how got it and gave to her? I guess its an odd question since i used the word Immune
2. Is it possible that my Antigen HEP b test didnt pick up up to 90 days--- I assume not since thats what the antigen test does (test for the virus itself similar to P24
3. Is it possible Hep C RNA PCR test and antibody neg up to 90 days---Again assume same thing as Hep B question.

I know these sound repetitive and i am confident this will be my last post in regards to questions.

Thank you and I must say your's and Dr. Handsfields posts to me have given me a good relief of my worry and stress but when this thing with my wife popped up i went back into worry mode.

Great you guys here, thank you.






Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago

Straight to your questions:

HIV

1. Why do some sites including CDC say that 97% of people will have detectable ab by 3 months, is this due to some people having compromised immune systems?
This is a conservative statement which reflects the package insert of test manufacturers.  Other than as described above, essentially everyone who acquired HIV has a positive test by 8 weeks after acquisition of infection.  The three month statement, as well as the 97% percent figure are both overly conservative statements from the CDC.

2. What would be examples of having to test beyond 3 months?
For all practical purposes, only persons who have been taking anti-HIV medications need testing beyond the three month time period.

3. If i had an issue with my immune system would i know it over my past 38 years of life?
Yes, you would have had infections or other illnesses.

4. Are the immune system issues they refer to ones in which people get sick but do not recover due to issued producing AB or is it people that do not get sick often ( i really cant remember my last flu, etc) I know i've had them before however.
No sure I even follow this question.

5. Do tests ever turn positive after 90 day negatives for HIV?
No, once again.

No, six month testing is a fanciful concept promoted on the internet. There is no reason for delayed HIV testing.

HEPATITIS C
1. Could it be possible i am immune to Hep A or B and that i some how got it and gave to her? I guess its an odd question since i used the word Immune
No, if you were immune to hepatitis A or B, either due to vaccination or past infection, you could not get the infection and then transfer it to your wofe.

2. Is it possible that my Antigen HEP b test didnt pick up up to 90 days--- I assume not since thats what the antigen test does (test for the virus itself similar to P24
No, this is not possible.

3. Is it possible Hep C RNA PCR test and antibody neg up to 90 days---Again assume same thing as Hep B question.
Sigh, you really need to give up on this.  no this is not possible

EWH
---
43 months ago
Thanks for the responses, i waited a bit to ask my last question and see if my worry would subside. Was hoping not to come back and ask the last one at all.
Regardless, here i am as the only thing that keeps me worried now is my wifes condition of being in the ER, diarrehea, weakness etc. Naturally we are going to the dr's and determining the cause of all this, however it keeps my mind running.

1. You have already stated that no way infection could be missed in terms of HIV with my 9 tests (4th gens) over the 90 day duration after potential exposure. My question is, is it ever possible that someone doesn't produce P24 at all (I understand outside HIV2) but for HIV 1 does this happen? I guess what im saying is that for 100% certainty that P24 would have been there and been detected over my 24, 31, 39, 48, 55, 61, 69, 80 and 90 day tests CORRECT?

2. This anxiety keeps pushing me to want to take another test because of my wife feeling this way, is that the wrong way to think considering my testing history?

3. Is the rationale for the 3 months 97% figure perhaps based on the fact that they cannot be certain who is reading, location of individual and perhaps most importantly the available to access to the latest tests. Perhaps they consider that they do not know if someone is still taking a second gen/third or 4th so that statement covers that? 

4. Have read so much on the internet and my rational mind tells me to look at the professionals (yourself, Dr. H, Dr. Cummings, etc) and just go with whats already been said but then you come across much about hey i tested after 3 months and it was positive or no you have to wait 6 month. Should i disregard all other things read or seen on the internet.

5. Whats the latest you've heard of someone actually showing positive using a 4th gen test?

6. Do you forsee the CDC ever updating their guidelines to reflect accuracy of the 4th generation tests?

Thanks for all your help and i know this whole experience had given me a new perspective on how to live & act. Definite life changer for me.
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago

Straight to your questions:

1.  the reason the 4th generation tests evaluate for the presence of both the p24 antigen and antibodies to the virus is that after 4 weeks, one of these will be present in ALL patients.  You are playing "what if" games.  your results are DEFINITVE!

2.  Further testing is a complete waste of time and money.  You could spend your money far more productively by seeking the advice of a trained, confidential counselor who could help you work through the guilt and anxiety that have kept you testing far longer than you need to.

3.  No, the 3 month recommendation reflects conservatism on both the part of the manufacturers which is forced upon them by the FDA as well as the conservativsm of the U.S. CDC.  Here is a reply that Dr. Handsfield recently wrote following a question similar to this one - "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 any other information provided to the public. 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."

4.  The internet is not a good source for information.  Much of what you see there is taken out of context or represents misinterpretation.

5.  4th generation tests are conclusive at 4 weeks.  I have never seen a patient turn positive beyond then.

6.  See no. 3 above.

As you point out this is my third reply to your questions. therefore, as per Forum Guidelines, this thread will be closed later today.  I hope my coments have been helpful and you will be able to move forward.  My suggestion to seek counseling stands as what I think is your best way forward.  EWH

---