[Question #1711] Anxiety and Testing Conclusiveness - 4th Gen Duo Tests

43 months ago
Hi Dr. Hook and Dr. Handsfield,

I had a one time, single exposure; (heterosexual) in DR with a CSW. There was an instance of insertion (vag unprotected) for approx 10 seconds as we were fooling around and things just happend. I immediately wised up and put on a condom but that didn't get far as I got flaccid right after and then took a shower.

I had a full panel of std tests done 3 times (66 days, 68 days and 84 days) and it has come back negative to rule out hep abc, rpr, chlam, gonn, hsv1, hs2.

I got tested for hiv as well at week 10 twice (66 days, 68 days), and also week 12 (84 days) and also at 89 days, all non-reactive.

I have had the following types of HIV tests done (all Non-Reactive):

1. Labcorp BioRad Gen 4 antigen/antibody w/Reflex - Non Reactive - 66 days
2. Quest Diagnostics Abbott Architect Gen 4 antigen/antibody w/Reflex - Non Reactive - 68 days
3. Quest Diagnostics Abbott Architect Gen 4 antigen/antibody w/Reflex - Non Reactive - 84 days
4. Oraquick Advance Duo - Non Reactive - 89 days 

I am going to go for a 94 day test at Labcorp with the BioRad Gen 4 this coming monday; as the CDC states that 3 months after latest exposure is conclusive.

I have no immune problems, no chemo, no pep, no other reasons for delayed anything... 

I just keep reading things online (CDC, forums, research publications) and what people are posting and I am increasing my anxiety to the point where I am getting constantly worried. Some people are saying 3 months and then at 6 months for conclusiveness, etc.

I have spoken to my doctor, he states I have nothing to worry about, I have spoken to an HIV hotline counselor and they have stated I should move on, I have also spoken to Dr. Sean Cummings from freedomhealth UK and he states the "tests you have done already are absolutely good enough to firmly establish that you are HIV negative." 

I guess this anxiety is just controlling me in ways that it shouldnt.

What confidence should I have in the above tests?

Is there a possibility of a false negative in 3 blood tests?

Should I just put this to rest now and move on with my life and I am just feeding my anxiety?

Are these results conclusive? Should I test out to 6 months?

Should I take that 94 day (3 months) test for reassurance?

Thanks for your assitance in advance.

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

Welcome to our Forum, sort of.  The chance of getting HIV or any other STI from the exposure you describe is infinitesimal- most CSWs do not have HIV or other STIs, most exposures to infected persons do not lead to infection, particularly when they are as brief as yours was, and your tests have proven that you were not infected.  Currently available tests for HIV are among the ost reliable tests in all of medicine.  As I read your post and reviewed your results, it became apparent that you were asking me to confirm what you have already asked your own doctor, an HIV hotline counselor and Dr. Cummings.  In each case, they, like me have assured you that your tests clearly and without a doubt prove that you were not infected with HIV or any other STI that you were tested for from the brief encounter that you describe.  From what you have said there is absolutely no reason for further testing and no medically sound reason for you to be continuing to worry.  Paraphrasing Albert Einstein, one definition of insanity is to be doing the same thing again and again and to expect a different result. 

The is NO NEED for additional testing and to continue to test is a waste of your time and money.  My sincere advice is that you should instead seek the help of a trained, confidential counselor to help you work through whatever (guilt, shame?) that is interfering with your ability to believe your test results.  EWH

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43 months ago
Dr. Hook,

Thank you for your response.

I appreciate your direct answers from my previous post.

I would like to know the answers to the following questions, mainly for my own piece of mind:

1. What confidence should I have in the above tests at 10 weeks and 12 weeks and the lab results?

2. Is there a possibility that I tested too early (or late) and received a false negative on 3 of these 4th Gen Duo tests?

3. What is the probability that beyond 12 weeks that these results would change for me considering the 3 lab based tests?

4. Should I test at 3 months (92 days) or 6 months or is this not necessary?

I do believe my anxiety, guilt and shame are all affecting me causing me to constantly think about this. It is affecting me and I surely do recognize this. I will take your advice and seek a trained professional counselor to move on from this.

Thank you for your time regarding the above answers.

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

These follow-up questions were answered in my original post.  Therefore my response to your repetitive, anxiety-driven questions will be very brief:

1.  You should have complete confidence in these tests/lab results

2.  See no. 1 above.  Your results are reliable

3.  There is no possibility that your test results will change related to the exposure you report

4.  There is no need for further testing.

EWH

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43 months ago
Thank you for your reply Dr. Hook

The exposure I reported is the only one I have had and will ever have in my lifetime. 
I have vowed to never put myself in a situation like that again. Ever.

So in conclusion and my last and final question, from your responses you state that you have complete confidence that my non-reactive/negative  results on the 3x 4th Gen Duo's and Oraquick are conclusive to date and I require no further testing regarding this exposure? Correct?

Thank you for your time.
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago

This is the 3rd time you have asked this question and the answer has not changed.  The results you mention are conclusive for the exposure you have described.

As you know this is my 3rd reply to your questions.  Therefore as per Forum policy, this thread will be closed later today .  EWH

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43 months ago
If I need to open a new question I will -- but I also read this:

On the CDC site here under "What does a negative test result mean?" (https://www.cdc.gov/actagainstaids/basics/testing.html) it states: 

"If you get an HIV test within 3 months after a potential HIV exposure and the result is negative, get tested again in 3 more months to be sure." 

This is giving me more grief. Does this mean that since I tested at 66 days I should wait 3 months from that date to retest and that will give me a definitive answer?
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago

Test results at 66 days are reliable with virtually all approved tests.  The CDC' recommendations are overly conservative.  As Dr. Handsfield wrote just a few days ago, listing several reason why governmental agencies such as the CDC tend to be so conservative.  Here is what he said:

" 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."

These comments will end this thread.  EWH


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