[Question #2036] HIV RISK 2

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83 months ago
Dear Dr HHH, 
I hope your doing well.  Again thank you for the great work you do here.
I'm the one who posted here last week in regards to my HIV statue, remember the guy in London who tested negative at 72 days and was linked to Freedom Health and Dr Cummings,
However, Dr HHH the reason I post again is because I do not feel well. I tested Negative again at 12 weeks (84 days) which most guidelines consider it as conclusive.
But I have been experiencing a massive and disturbing headache in the past two days when I was happy accepting my 12 weeks negative result, then this headache terrifies me! I read on google that people continuously have tested negative for more than 14 and 15 weeks until they were tested Positive in the end. 
How come you experts rely on 4 weeks and 6 weeks test results when there are cases who test positive later than 3 months ? even if that was rare, shouldn't we worry about their partners at least who might get infected because of relying on a false negative ?
Doctor HHH, believe me I'm so scared and would like to book a ticket to US now just to see you so you can answer my questions!
Waiting up to 6 months for conclusive result will result in me failing this year in Uni, it is not easy to study for finals while being so scared.  
Dear Dr, sometimes Dr Bob used to differentiate between someone who had an intercourse with an HIV + partner and a partner of unknown status in regards to window period ?  What does a possible exposure mean then ? Doesn't it mean an an episode when you are possible to get infected from ? 
I'd really appreciate it if you answer me early.
Thanks again
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H. Hunter Handsfield, MD
83 months ago
Welcome back. But I'm sorry to see you felt the need.

I don't think I can answer your main question, or reassure you in more conclusive terms, than I did last time. Here is the main paragraph from that reply:

"One of the most consistent themes on this forum, and among HIV experts in general, is that the HIV blood tests (especially the 4th generation or "duo" tests) are among the most accurate diagnostic tests ever developed, for any medical condition; and therefore, assuming enough time has passed after exposure (4 weeks for the duo tests), the results always overrule all other considerations:  no matter how high the risk of HIV at the time of exposure and no matter how typical symptoms may seem to be for a new HIV infection, the test results rule. Your exposure probably wasn't very high risk, since HIV remains rare in women like your partner (sexually acquired HIV is very uncommon in London women), and your symptoms are not typical for a new HIV infection and started much too long after the exposure. But even if they had been high risk and typical, your test results prove without doubt that you do not have HIV. Indeed, you were rather seriously overtested:  the 25 day result was close to 100% reliable and the 31 day test definitely conclusive. All others were superfluous. There is no such thing as "haven't produced antibodies yet"; but even if that happened, the duo test not only evaluates antibodies, but also detects HIV itself. It is impossible to have HIV and have a negative duo test more than about 4 weeks after infection."

I'll add that headache is rarely a symptom of HIV and certianly never the only or main symptom. But even if it were typical, the comments above tell you that HIV is not possibly the cause.

As for why the advised window period are different now than in the past, and for most of the differences between some experts versus others, I also don't think I can do better than this reply from your previous thread:

"Previous advice about waiting 3 months was based on older antibody-only tests that haven't been in use for almost 20 years. If you want to confirm this, call and discuss with an expert clinic, such as a nearby NHS GUM clinics, or London's excellent Freedom Health private sexual health clinics."

There has never been a report of anyone in whom it took 3 months, let alone 14-15 weeks, for the 4th generation (antigen-antibody) tests that you had to become positive. People who said otherwise on the web either are lying, are mistaken about when they were infected (most people with new HIV infections have had multiple exposures and can't really tell when and where they caught it), or had older tests, certainly not a modern 4th gen test.

As for different window periods depending on risk, Dr. Hook and I have always had a similar perspective as Dr. Bob Frascino. (This gets into the statistical weeds.) Consider someone with a truly high risk exposure, say 1 chance in 100 of catching HIV. If that person has a test that is 99% reliable, e.g. an antibody-only test at 6 weeks, a negative result drops his risk from 1 in 100 to 1 in 10,000. That's a lot better, but probably not good enough. (Would you play Russian roulette with a pistol with 1 in 10,000 loaded chambers? Probably not.) Now consider someone potentially exposed but at much lower risk, say 1 chance in 100,000 of being infected. A negative result with the same test drops his risk to 1 in 10 million. That's low enough to be considered zero for practical purposes -- you might even be tempted to play RR at those odds, if the payoff were were high enough ($10 million?). Identical test, but much greater reassurance for the low risk exposure versus the riskier one.

You do not need any more testing at 6 months or any other time, and I know Dr. Cummings did not recommend that. Why does it even enter your mind?

Please note the forum does not permit repeated questions on the same topic or exposure. This will have to be your last one; future new questions about this exposure, testing, and your fears about HIV will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers; because experience shows that continued answers tend to prolong users' anxieties; and because such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand. 

Cheers--  HHH, MD
   
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83 months ago
Thank you Dr HHH, I promise that will be the last post regarding this episode.

Thank you very much for putting all the statistics together to reassure me,
just to clarify, the partner was not from UK, she was from one of the Scandinavian countries where the HIV cases are even rarer than what we have here, but she didn't seem clean at all.

Not trying to ask the same question in other words but your answer will be very important for me, as I took the 4th Gen Duo at 12 weeks not 90 days and as I have not been tested with PCR RNA so far, do you believe for peace in mind I should get tested once again after or at 90 days with PCR ?

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H. Hunter Handsfield, MD
83 months ago
I already said you do not need, and you should not have, any more HIV testing of any kind. And you have also been told repeatedly that the duo (4th gen) tests are conclusive any time more than 4 weeks after exposure, so your question about 12 weeks vs 90 days is irrelevant.

The extent of your obsession with this, and your inability or unwillingness to accept and believe the repeated, expert, science based advice you have had -- both on this forum and at Freedom Health (from the boss, no less) -- are evidence an unresolved psychological issue. I suspect you are going to continue to worry and obsess about this despite these words and all that have gone before, and that this is going to eat at you until and unless you get professional counseling about it. I hope I'm wrong, but I doubt it, and I do hope you will seek out a counselor. I suggest it from compassion, not criticism.

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83 months ago
Dear Dr HHH,

I totally agree with you, it is going to eat at me and I need to start consuelling no doubt.
But do you think I would worry out of the blue ? If I was a healthy and happy man like 13 weeks ago, why would I even doubt about HIV ? I would just leave it behind me.  I promised myself to leave this behind and move on since my 25 days hiv test result but here I am 9 weeks later with the same mentality, fear and physical disorder. 

Dr HHH, I have no doubt about your expertise and intellegence regarding HIV testing, I find myself a nut when I remember I'm not believing all these experts advising me.  
I do not want to stand against the science and test accuracy because there have been alot of effort and research to make them available for us, I just have some questions.
In regards to the amazing 4th Gen Duo test,
On Freedom Health forum, one of the experts I guess Dr Jose stated that the antigen can still be there up to 6 months, so it is true that there can be a delay in Antibody production up to 6 months.  But! Antigen test alone has still not been approved to be an HIV diagnosing test as it can miss detecting the protien24 easily. So, there can be a scenario when antigen is there but not enough to be detected and antibodies are not produced enough yet to fight the virus, this is when both of them can not be detected and you test negative. 


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H. Hunter Handsfield, MD
83 months ago
You are misinterpreting something you read on the Freedom Health site. Everybody knows that p24 antigen can persist up to 6 months. That doesn't mean antibody is absent. Both typically are present for at least a few weeks and often a few months. The "scenario" you cite has no scientific basis and does not occur.

The very fact that you are compulsively searching for nonexistent needles in the haystack -- i.e. detailed online searching, and finding support for your anxieties -- is additional evidence of the underlying mental health concerns.

To your best to move on. Good luck.

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