[Question #30] accuracy of rapid tests

113 months ago

Hi Dr. Hansfield

I am great admirer of your work and knowledge. I have been benefited from your knowledge in past when you were on medhelp. I am glad I found you here. Please allow me to ask few questions.

I am bisexual and was sexually active from 2003 to 2009 with MSM and some straight encounters. I did involve in risky behavior with different guys I met online.

I am writing all these because I trust your advice and truly my own doctor had not answers to many of my questions.

LAST RISKY ENCOUNTER WAS JULY 2009

SYMPTOMS:

1- Got sick in late 2009 with fever, fatigue. Usually I used to feel ok in morning but till evening I felt tired and fatigued. Seen by doctor and given injection and started feeling good right away. Fever and fatigue went away same day after injection.

2- Flu and sinus issues which come and go with medicines till start of 2013. Then I started to get flu shots every year and never got sick afterwords with flu.

3- Pneumonia after travelling internationally to a THIRD WORLD COUNTRY in late 2011. It took at least 10 days to cure and antibiotics were not working till doctor gave me drip and Started feeling ok and Next day I even went work.

4- Flu in start of 2013 was difficult to treat and doctor referred me ER from urgent care . However before leaving for ER I asked doctor if it is related with HIV and told her I had been tested with rapid blood with negative and She said that NO ITS NOT HIV and believe me until I got to ER I was ok without even getting treated at ER and in next day I was feeling ok and I DID NOT get treated at ER.

5- In 2014 I was diagnosed by MARSA. MRSA came after extreme depression.

6- Currently MRSA came back after 1 year again I am experiencing extreme depression and anxiety from one of none risky behavior (fingering)

7- I have gastro and stomach issue from long time (digestion). I just had to take anti acid after a day or two

8- On my left leg I had brown spots there are not raised up from skin I recall noticing them from atleast 4 years now. I was seen by dermatologist and said not to worry about them and gave me a spot fading cream for them. They are not spreading. Can it be Kaposi scorma?

9- recently had pink eye disease

However, I never been hospitalized and last year after taking advice from you and testing with Rapid tests. My symptoms start going away and even my gastric issues were pretty much resolved without medications.

TESTING

1- I was first tested with clearview finger prick test in OCT 2012 with negative results at AHF

2- In 2014, I was tested with MULTIPLE times with clearview rapid test and oraquick at AHF and carefound along with several oraquick home tests. All of them were negative (5 clearview blood and 9 oraquick)

3- In 2015, I was again tested with Oraquick (oral), Clearview (blood)and once with Trinity biotech unigold (blood). All of them were negative.

QUESTIONS:

1- Based on my symptoms above, do you think that I have passed through all HIV stages and on late last stage of aids. That’s why I am testing negative.

2- Is it possible to be on last stage of aids from 3 years and still work normally, go to GYM and FAST.(avoiding food and water for some time)

3- Do you think as I had above symptoms my immune system is not producing enough antibodies that are not detectable on rapid tests?

4- I am also concerned about the accuracy of rapid tests. I read your post on medhelp from 2010 that states rapid test are 85% accurate. However other experts say almost 100% after 3 months. What is truth? Do you think I need lab based tests?

5- I also wonders why studies have different stats then FDA. e.g on FDA site unigold is 100% sensitive.

6- From symptom 8 . Can it be Kaposi scorma? I am attaching image . they are of different size, some are more darker then others

7- If my body is not producing detectable HIV antibodies from last 6 year for rapid test. should not i be hospitalzed yet

Thanks in advance.

Attachment: imageLeg.jpg

H. Hunter Handsfield, MD

113 months ago

Welcome to ASHA's Ask the Expert forum. Thanks for you kind opening comments.

Having followed me on MedHelp, I'm guessing you won't be surprised by my comments and advice. The news is good; you can be sure you don't have HIV. One of the unvarying themes on the MedHelp STD and HIV forums, which will also hold true on ATE, is that the HIV test results are far more reliable than either exposure history or symptoms in judging whether or not someone has HIV. Stated another way, test results always overrule exposure history and symptoms, no matter how high risk the exposure at the time, and no matter how typical symptoms seem to be for an HIV infection. To your specific questions:

1) You have a misconception. All HIV tests are positive for life. There is no such thing as tests becoming negative in advanced or late HIV infection. It's an urban myth.

2 and 7) These are variations on the same question. If you had late/advanced HIV infection, you would be obviously very ill with multiple medical problems that would have brought HIV/AIDS to light.

3) Another urban myth. There is no such thing as negative HIV tests in this circumstance, or in having a "weak" immune system that therefore doesn't produce antibodies to HIV.

4) The rapid tests were relatively new back in 2010 and experience was rising. The only 85% figure that comes to mind or memory is that one study suggested such results with the rapid oral fluids test, but those data have been overridden by clinical experience. The 100% figure is closer to the truth. But you can always have a laboratory based blood test if you remain uncertain or want still more reassurance.

5) It's a very complex story why different tests have differing official accuracy figures. The bottom line is that all of the newer tests (3rd generation antibody, or 4th gen antibody/antigen) pick up 100% of infections by 6-8 weeks (4 weeks for 4th gen).

6) Kaposi sarcoma can occur in people without HIV. It's extremely rare and almost entirely limited to the elderly, especially of Mediterranean (mostly Jewish) heritage. Your test results prove you don't have HIV, and your dermatologist's reassurance is additional strong evidence against KS.

So all is well. You don't have HIV and needn't worry about it further. That said, these questions have all the earmarks of somone obsessed with worry despite all logical analysis. That suggests that counseling might help. I would definitely recommend that if you find yourself still worrying about it after reading these comments. As I said often on MedHelp, I suggest it from compassion, not criticism.

Best wishes-- HHH, MD

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113 months ago

Hi Dr. HHH

Thanks for your responses. I am very much clamed after hearing from you. I tried to do lab test before but anxiety took me so hard that I had to cancel them before result came in. However I had about 15 - 20 rapid test over three years. please bear my anxiety related questions below.

1- How can be I sure that my scars are not KS as I did not ask dermatologist directly if it is KS. Can KS be noticed easily by dermatolgist? (I live in Florida). Should not I have more symptoms along scars that will point to aids if that is aids related KS? Did you look at my image? I am just trying to address those thoughts which I build during searching the symptoms before I found you online.

2- Does Viral load stay high in HIV people who does not have symptoms?

I appreciate your advice for therapy. I know I may need it.

Again Thanks Dr. HHH

H. Hunter Handsfield, MD

113 months ago

Just suck it up and have a lab based test. Not testing for fear of the result is irrational nonsense and you know it. It will be negative. Until and unless you do that, I am not inclined to reinforce your anxieties by answering silly questions like these. So quick replies only and that will be the end of this discussion. 1) The dermatologist would have recognized KS. (I don't examine posted photos -- too close to practicing medicine from a distance, which neither ASHA nor its experts is permitted to do.) 2) Viral load can be high or low regardless of symptoms.

Get a lab based test. And read my closing comment yesterday.

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113 months ago

Hi Dr. HHH

I do not mean to upset you. I apologize. In past months I went through so many online resources which had build so many irrational thoughts in me. I am here to get HELP but not to upset you. As I mentioned in my first post, My doctor did not have answer to many of my questions.

I have two options either spend money on tests or go for counseling on my fears and that's why I am talking to you to make right decision.

I apologize again.

113 months ago

Dr. HHH.

Please RESPOND to this and CLOSE this thread

If you think testing with rapid test multiple time over three years totally exclude chance of HIV virus. I will go with rapid tests then.

(I work in high paced environment. I am afraid if I go with lab based and encounter with false positive. I will have additional two to three weeks of anxiety and that might cost me in terms of my job. I was not aware of false positive / negative until recently.)

Thanks

H. Hunter Handsfield, MD

113 months ago

It's not anger or being upset. It's frustration that such a scientifically obvious situation, clearly explained, doesn't seem to have much impact.

There is zero chance of a false positive lab based test. That's old news, leftover from HIV test technologies no longer used. And with all those negative rapid tests, for sure it won't happen. Unlike the lab based tests, rapid ones ARE susceptible to occasional false pos results -- which you've never had.

But as already noted, your negative rapid tests are, collectively, 100% conclusive. You don't need more tests. I raised the lab test possibility because you seem to have trouble accepting the truth of all you've been told so far. If you're definitely going to be able to get beyond any worries about this, don't have any more tests. It's up to you.

Whatever you do about testing and counseling, stay safe and best wishes.

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