[Question #2724] Entecavir and HIV test window period

41 months ago
About 6 weeks ago (exactly on Aug 04, 2017), I went to a massage spa and did genital rubbing/frottage with the lady there. But we were both wearing the underwear with no ejaculation during the frottage, and also no intercourse or penetration or no oral sex either. However, I was rubbing or grinding vigorously like in the motion of sex. After frottage, I see a small moisture spot on front-side of my underwear, not sure if it is from my pre-cum or vaginal fluid through her underwear. By the way, I am not circumcised. After this incident, I called New York PEP hotline for taking PEP but they said it is not risk enough for taking PEP.

2 days later I was sick briefly for two days and at 21 days after exposure, I got sick with stomach flu symptoms like no appetite, diarrhea and fatigue for 10 days. So far, I did the following HIV tests including all STDs. 

* 2 days after exposure - 5th generation HIV test negative  (BioPlex 2200 lab-based) 
* 22 days after exposure - 5th generation HIV test negative (BioPlex 2200 lab-based) 
* 24 days after exposure - OraQuick home test negative
25 days after exposure - 4th generation HIV test negative (lab-based)
* 32 days after exposure - 5th generation HIV test negative (BioPlex 2200 lab-based) 

Some expert doctors online say 4th generation test is conclusive or close to it after 4 weeks. But then now I am worried about possible window period delay to my HIV test. Because I am chronic Hepatitis B carrier and I am on medication for 1 mg of Baraclude (entecavir). So I wonder if my medication Baraclude (entecavir) will affect the accuracy of my 4th/5th generation HIV test? 

Do I need to another test at 6 weeks or 8 weeks or 3 months? 

Thanks in advance!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
Welcome to the forum. THanks for your confidence in our services.

Entecavir has modest activity against HIV, with only a modest reduction in viral load (i.e. the amount of HIV DNA/RNA detectable in the blood). This effect probably is insufficient to have any effect on HIV seroconversion, i.e. time to positive test results, and therefore has no known effect on the window periods of the tests you had. The 4th generation tests still are highly reliable at 4 weeks, although they require 6 weeks for 100% conclusive results. (The new "5th generation" test is really no different than other 4th gen tests. Calling it 5th gen is marketing hype by the manufacturer.)

Having said all that, to my knowledge there has been no actual research on whether entecavir might delay positive HIV tests after any particular exposure. However, I really don't think it matters. You had a zero risk exposure:  nobody has ever been known to catch HIV from genital rubbing, hand-genital contact, etc. Based on this exposure, you really didn't even need HIV testing, let alone PEP.

I recommend you ask this same question of the doctor or clinic treating your hepatitis B; they should be up to speed on any potential effect of entecavir on HIV test window periods. As just noted, I would have recommended against HIV testing at all, but since you have started down that path, I would advise one more 4th (or "fifth") gen test 6 weeks after the exposure you are concerned about. You can expect a continued negative results.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
 
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41 months ago
Thank you very much doctor for detailed explanation and answer. 

Yes I then will do another test this week which is more than 6 weeks after exposure.  By the way, I got flu shot yesterday, will it affect the 4th generation HIV test in anyway?

And also at 6 weeks after exposure (Sept 15, 2017), I noticed a small bump about the size of one or two rice grains on my neck (right side) and so I went to see the doctors, one said it is enlarged lymph node and another doctor said it is insect bite, not sure which one to believe.  Now about 3 days after, that bump is now almost gone like only a tiny dot. Is it something I need to worry in regard to HIV acute infection symptom? Or any of my earlier sickness with diarrhea has to do with HIV ARS symptoms? If so, with all the tests done so far different times can I rule as not related to HIV?

Thanks again for your help with expert knowledge.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
I should have commented last time that your exposure was zero risk, even if your partner had HIV, which she probably didn't.  You didn't even need testing. I also already explained that your test results so far are nearly conclusive evidence you weren't infected. Flu shots have no effect on HIV test reliability.

Enlarged lymph nodes are under the skin and never so tiny. They are more like a marble under the skin. Despite one doctor's apparent opinion, I can't image the bump was a lymph node. If it was, ARS doesn't cause only a single lymph node to enlarge; onset was too late; and ARS is not a likely cause of diarrhea. Finally, you can't have ARS symptoms without a positive blood test.

Trust me on this:  you don't have HIV. Do your best to stop worrying about it.

Thanks for the thanks about our services.

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41 months ago
Thank you so much, Dr. Handsfield for answering the follow-up questions. I have no more questions. 

While I truly respect your advice, I think I will still go ahead with another test to clear my doubt.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
Thanks for the thanks. I'm glad to have helped.---