[Question #244] Does (co) infection with TB prolongs the window period?

96 months ago
Dear Doctor,

     I am a 25 male in China. 65 Days ago (in September) I went for a combo HIV test because I had a protected intercourse with a csw 3 months prior(in June, which was the only intercourse I have this year). But after the blood drawing I recalled that the nurse put the needle in the table for several seconds since she could not locate the vein in my arm so she switched to the back of my hand. The clinic was the most busy HIV clinic in China, with at least 30 positive people get blood drawing daily, and blood drawing in China is unlike in US, we get blood drawn one by one closely. That combo test turned to be negative.

     After 10 days of the blood drawing, I suffered from a sudden chest pain, and 11 days later I did a chest X-ray, the result was normal. I also did hiv, hepatitis A,B,C, syphilis tests which were all negative, except positive hepatitis B antibody. The chest pain lasted for about 3 weeks and then released. 

     However, I got a cold two weeks ago and was recovered ten days later on last Tuesday. But on Tuesday and Wednesday I found there is blood streak in my sputum, especially in the morning's sputum(though I do not have much sputum). I went to see a doctor and is suspected to have pulmonary TB. I scheduled to have skin test and CT scan next week. Please note that weirdly I do not cough and I didn't feel feverish since the blood drawing.Also I did four combo hiv tests, 21 days, 28 days, 42 days, and 60 days after the blood drawing and all were negative. 

     I have two questions:

     1. Does co-infection with TB extend the hiv window period?I consulted some doctors and most of them think no, because the immune responses to the two are different, and TB is caused by bacteria, whereas hiv is a virus. But two of them think it may have effect on the window period since TB is a serious disease and may make the immune system compromised. 

    2. Is p-24 antigen detectable in all newly infected hiv-1? And if so must it present within 4 weeks of infection? 

    Thanks a lot for your help.

Edward W. Hook M.D.
96 months ago

Welcome to the Forum.  I will be please to comment.  Acquisition of HIV from a needle which was contaminated by contact with a surface where HIV infected blood had been is essentially unheard of and should not worry you.  Further, each of your three combo HIV blood tests 28 or more days after the exposure is completely reliable and proves that you did not acquire HIV.   there are no data to suggest that TB would prolong the window time for HIV tests to become positive. 

Your blood tests were reliable,. After 28 days, either the p24 antigen or antibodies to HIV are present in all infected persons.

I hope this answer is helpful to you.  Good luck in dealing with your pulmonary infection.  EWH

96 months ago
Dear Dr. Hook, thank you very much for the response, it's very reassuring. 

And I also want to figure out something:

1. Since the combo test detects both antigen and antibody, is it theoretically conclusive for everyone after 4 weeks? E.g.  for people with compromised immune system, taking pep, suffering from cancer, etc. since the p24 antigen is produced by the virus and is not related with the immune system's condition?

2. Can hiv phobia lead to hypoimmunity? Because I can't realize how I was infected with TB. Is it possible that I had latent TB but was activated due to extreme fear of hiv?

3. Do you think a test at 12 week or more is necessary´╝čOr is my 60 day duo test conclusive even if I have any symptom?  Thank you!

Edward W. Hook M.D.
96 months ago

1.  It is not theoretical that the combo tests is conclusive at 4 weeks.  this has been shown in multiple carefully performed scientific studies.  Believe it!.  This includes most persons with compromised immune systems.

2.  No, phobias do not compromise immunity.  If you have TB, it is unrelated. Most people with TB do not have HIV.

3.  I have already told you that your 60 day combo test was conclusive, as were your 28 and 42 day tests.  Repeating the question will not change the answer.  EWH

96 months ago
Dear Dr. Hook,

Thanks for your comment. I try to make my last question as short as possible.

My last exposure before this year's was 2.5 year ago(unprotected w/ unknown female). I have developed multiple dermatological symptoms(seborrheic dermatitis in my scalp and eyebrows, scrotum eczema, urticaria papulosa on my feet) in the recent one year. And I noticed that there are some seronegative people. 

So may I ask:

1. If someone is infected and doesn't produce hiv antibody all the time, is he very likely dead in 2 years?

2. Is the p-24 antigen part of the combo test sensitive enough? Since I found a paper reported a case in 2010 that an Indian patient had non-reactive combo test but positive p-24 antigen assay (http://www.omicsonline.org/seronegative-hiv-1-infection-a-difficult-clinical-entity-a-case-report-2155-6113.1000106.pdf).

Your comments are high appreciated!
Edward W. Hook M.D.
96 months ago

You should not be worried.  Most people with seborrhic dermatitis do not have HIV.

In answer to your questions:

1.  All persons with HIV produce antibodies.  If they do not produce antibodies they would be sick from other, non-HIV infections very quickly. Further, even if you did not produce antibodies your combo test would have been positive as it would detect the virus (p24 antigen)

2. The p24 antigen in the combo test is sufficiently sensitive that it would have detected your infection if you did not produce antibodies.

Our Forum guidelines permit up to three interchanges with clients. this is my third response. this thread will be closed.  You should move forward with confidence that you do not have HIVB. EWH