[Question #2329] Labs

46 months ago
Hi Doctors - I am following up from a few weeks ago..I am a female who had a one time isolated risk: unprotected vaginal sex. 

It seems that many people on this forum have a difficult time accepting negative results. Probably because if the test, for whatever reason is inaccurate, then the consequences are great...Acquiring HIV without knowing it. 

I'm nearly 6-7 months removed from my exposure. I have had swollen glands in my neck and chin area for approx 7 weeks now. 
Yesterday, my ENT Doctor advised that I remove one enlarged lymph node from my neck to biopsy and test for cancer/lymphoma (a common symptom for chronic HIV stage). 
I'm going in a few weeks for this procedure. On top of this, this last month I've been extremely fatigued. This is rare for me as I'm usually always moving and full of energy. 
I still can't help but think that my glands and fatigue are possibly due to HIV infection. Even after a 37 day and a 6 month non-reactive result. Trusting results isn't as easy when you are experiencing similar symptoms as HIV. 

Both blood tests were done with my family doctor and sent to LabCorp. I'm familiar with 4th generation tests. However, the exact name of the test I was given: 
Human Immunodeficiency Virus 1/O/2 (HIV-1/O/2) Antigen/Antibody (Fourth Generation) Preliminary Test With Cascade Reflex to Supplementary Testing.

Q1) Is this test described above basically just the 4th gen test? I'm not sure what all of the other terminology/lingo means. I just want to make sure I received the correct test. 

Q2) Can you explain to us how lab companies like LabCorp test serum? Is it a very in depth process or fool proof?

Q3) Is it a doctor who performs the lab test or a technician? Are the testing instruments regulated and checked to ensure they are working effectively? 

Q4) What margin of error exists in the lab technician and/or the lab testing equipment? 

I think I would feel more comfortable knowing how accurate the testing process is from start to finish. 

I'm sure I speak on behalf of many forum visitors when I say thank you for your custom, personal answers to all of our questions...

Thx, Arizona Female 
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
Welcome back to the Forum. I can appreciate how one might have a degree of mistrust of the reliability of any single lab test, particularly when the potential result has serious consequences.  As, amongst other things, a laboratory director as well as a clinician, I can tell you that oversight of laboratory procedures is highly regulated on a regular basis, requiring annual inspection by external evaluators as well as careful documentation over the course of the year that all procedures are carefully followed.  In addition, the tests themselves also have controls built into them to prove that the test itself is working correctly.  While I acknowledge that on any single test, a lab (technician) error might occur, the probability of that happening twice on any two occasions for separate test specimens is tiny.  Now, following that general comment, let's address your specific questions:

Q1) Is this test described above basically just the 4th gen test? I'm not sure what all of the other terminology/lingo means. I just want to make sure I received the correct test. 
Boy, they really use obscure wording, don't they?  What they are describing is a standard 4th generation test (the Human Immunodeficiency Virus 1/O/2 (HIV-1/O/2) Antigen/Antibody (Fourth Generation) Preliminary Test) and then if that test is positive, follow that with a second unrelated test (this is the "cascade testing").  What they use as the 2nd test for "cascade testing, which is only done on specimens that are positive on the 4th generation test is not stated,

Q2) Can you explain to us how lab companies like LabCorp test serum? Is it a very in depth process or fool proof?
As noted above, the process is highly regulated.  There are steps used to avoid error and in large labs like LabCorp sometimes the machines that do the testing are automated as this results in even less error than with human lab techs.  It is close to fool proof and, as I mentioned, for someone to make the error twice on two separate specimens collected at different times is effectively zero.

Q3) Is it a doctor who performs the lab test or a technician? Are the testing instruments regulated and checked to ensure they are working effectively? 
See above.  I think I answered the question

Q4) What margin of error exists in the lab technician and/or the lab testing equipment?
See above.

I hope that these responses and explanations are helpful.  EWH
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46 months ago
Thanks for a speedy response, Dr. Hook. 
I appreciate the inside scoop on testing labs. 

Follow up:
Q1)So if I had a negative test at 37 days and again in 6 months, can I safely leave this forum and never visit again? Nothing personal
 of course! 

Q2)With all of my lymph node problems as explained in the previous message, do I need to inform my ENT to order another HIV test or can I keep all of this confidential? 

I suppose I can't 100% count on that 37 day result because it was technically inside of 6 weeks....So, having all of my lymph symptoms and for, forum sake purposes, let's say I had one test at 6 months post exposure....

Q3) Would that result be sufficient? 

Q4)Would you personally have any concerns or thoughts at this point about having HIV if you were in my position and having all of these issues? 

Q5)Any final thoughts for a worried lady who can't seem to shake this?  Is it safe to tell me to move on and say HIV is not my problem? 




Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
Glad my comments helped. Straight to your questions:

Q1)So if I had a negative test at 37 days and again in 6 months, can I safely leave this forum and never visit again? Nothing personal
 of course! 
Nothing personal taken.  Yes, your results are reliable, no more testing is needed.  Believe them

Q2)With all of my lymph node problems as explained in the previous message, do I need to inform my ENT to order another HIV test or can I keep all of this confidential? 
Your ENT has no reason to know about your sex life, nor your testing.

I suppose I can't 100% count on that 37 day result because it was technically inside of 6 weeks....So, having all of my lymph symptoms and for, forum sake purposes, let's say I had one test at 6 months post exposure....

Q3) Would that result be sufficient? 
In my opinion, additional testing is unneeded.  If it makes you feel better, you can get it.  I would be flabbergasted if it were positive. 

Q4)Would you personally have any concerns or thoughts at this point about having HIV if you were in my position and having all of these issues? 
No, I would have no concerns whatsoever.  If it were me or if it were a family member

Q5)Any final thoughts for a worried lady who can't seem to shake this?  Is it safe to tell me to move on and say HIV is not my problem? 
I wish I had the answer to that question.  You would not be the only person who would benefit from it.  You have other things to attend to. you have done the right things in terms of your sexual health.  Time to move forward.

Take care.  EWH 
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46 months ago
Thanks - realizing this is my last question and then you can close this up...

Question 3 above was asking: 
If I only had 1 test one at 6 months.  Let's say for question purposes my 37 day never  happened. Would one test alone at 6 months be reliable even if I'm going through lymph node issues? 
In my head, I'm not counting my 37 day test because (technically) it doesn't count as I'm not at 6 weeks. 




Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
Were I you and had only tested at six months, I would have considered the result definitive and not worried.  Our perspectives and backgrounds are different however and if this continues to trouble you, then I would suggest you test once more but only after you convince yourself that the result will be accurate.  I am confident that if you choose to test again, the result will be negative.

As you know, this thread will be closed later today  EWH
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