[Question #326] 6 week HIV test came back Negative? Is this Conclusive?

35 months ago

I am requesting that Dr. Handsfield answer this question since I am referring to replies he has made in previous forums. Thank you.

Hello Dr. Handsfield,

About 2 months ago, I had protected vaginal sex and gave oral sex to a prostitute in Mexico. I ended up seeing an Infectious Disease Doctor a few days after as I was very concerned that I may have contracted a STD. He initially tested me for every STD and everything came back negative. He again tested me at the 6 week mark and everything, including the HIV test, came back negative. He however said that in terms of the HIV, he wanted to wait until a negative test came back at the 3 month mark until he would conclusively say that I did not contract HIV from this incident and could start having unprotected sex again with my wife. I have not had sex with my wife since this incident occurred. My doctor did say that the chances were very low at this point and that neither he nor any of the doctors in his practice have had someone have a negative test at the 6 week mark and then a positive test at the 3 month mark. (I do not know the name of the HIV test that he used but I can tell you that I took the test at Cedars-Sinai in Los Angeles. If you need me to, I can get the exact name of the HIV test that he used).

I was reviewing answers you gave on this topic in the past and two of them stood out. In the first topic, a married man gave oral sex to a woman and was concerned that he may have contracted HIV. You stated (and I am paraphrasing) that if you were him, you would not have stopped having unprotected sex with his wife and that he needed no further HIV testing. In the second topic, a man had unprotected vaginal sex with a prostitute and then had a negative HIV test at the 28 day mark. You stated (and I am paraphrasing) that he could interpret that 28 day negative test as conclusive and that he did not need any further HIV testing.

Your replies are very encouraging but the fact that my doctor (who has stated that he is on the conservative side) wants to wait until I have a negative test at the 3 month mark before he will conclusively state that I did not contract HIV from this incident is concerning me greatly. The fact that he still believes that this is “possible” is killing me. You should also know that I suffer from major general anxiety disorder which has obviously made this situation a lot tougher and torturous for me.

What are your thoughts on my situation? In your medical opinion, do you believe conclusively that I definitely did not contract HIV from this incident?

Thank you very much for your time and assistance. 

Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago

Welcome to the Forum.  Dr. Handsfield and I answer questions interchangeably depending on availability and your question happened to reach me so I will be answering it.  FYI, as each of us has said on our Forums more times than I can remember over the years, while our verbiage may vary, the facts and substance of our answers do not.  I am confident in addressing your concerns, Dr. Handsfield would share my assessment and advice.

The results of HIV antibody tests vary depending on what sort of test is being used. A test which tests only for HIV antibodies would be positive in all untreated, infected persons in 8 weeks and a negative test beyond that time should be considered definitive.  By 6 weeks over 95% of infected persons would have positive tests.  In addition however there are also so-called 4th generation tests which test for both HIV antibodies and the HIV virus  in the form of the HIV p24 antigen- these 4th generation tests provide definitive results at any time more than 4 weeks after an exposure.  These are the scientifically proven performance tests on currently available tests and I am sure that both HIV antibody only and 4th generation tests are available as Cedars- it is a quality institution. 

Your doctor is following the CDC guidelines for testing.  The CDC continues to state that results with all tests are not definitive until 12 weeks have passed since ones last exposure of concern. These recommendations however are sadly out of date, overly conservative, and do not consider the anguish that they cause in persons such as yourself because of their conservatism.  Few if any experts outside of the CDC feel that results are not definitive until 12 weeks (I know of NONE) and agree that the CDC has been overly conservative in its approach and efforts to not risk being wrong. 

Test results also need to be considered in the context of the risk for infection and the details of your exposure suggest close to no risk for HIV.  Most commercial sex workers, even in Mexico, do not have HIV and even if your partner did have infection, your risk for infection is infinitesimal.  Condom protected sex is safe sex and I know of no instances in which HIV has been acquired through a male performing oral sex on an infected woman- neither in the medical literature, reports from medical meetings nor in my own experience.  Thus, even before testing your risk for infection was incredibly low if there was any risk at all.  with a negative test at 6 weeks, no matter what sort of test, I would have complete confidence that I had not been infected and would have no concerns about having unprotected sex with an infected partner.

My advice is to be confident that you did not get HIV from the exposure you describe.  I would not be concerned in the least of I were you.  I hope my comments will help you to move forward.  EWH

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35 months ago

Thank you Dr. Hook for your response.

There was something that I forgot to mention in my original post and wanted to see if that would change your opinion/analysis above. I saw my doctor 4 days after this incident. Seeing how worried I was, for my peace of mind, he told me that I had the option of taking Truvada. He told me that it’s supposed to be taken within 72 hours of a possible exposure and even though I was past the 96 hour mark, he still wanted to offer it to me for my peace of mind. So I took it. I was reading online that taking Truvada may cause a false negative if a test is taken early on. Is it at all possible that the 28 day supply of Truvada I took could have caused a false negative in my 6 week test? When I took my 6 week test, I had been off the Truvada for 2 weeks.

Also, I found out from my doctor that the test I took at the 6 week mark was both the antibody only test and the p24 antigen test (combo duo).

What do you think doctor? Does your opinion above change at all based on the fact that I was on Truvada as I described above?

Thank you. 

35 months ago
Addition to my last question please. If a false negative was possible by being on Truvada, would it only affect the Antibody Test and not the p24 Antigen Test? Thank you very much for your time and assistance.
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Thanks for the additional information.  Most research tells us that taking Truvada more than 72 hours after an exposure is both a waste of money and useless for prevention of HIV.  Even worse, it can delay tests becoming positive so, from a theoretical perspective, your Truvada could have delayed a positive test result and the recommendation would be to wait until at least 4 weeks after completion of Truvada to expect accurate test results.  On the other hand, for the reasons included in my original answer, I have no concern about you having acquired HIV from the exposure you describe, as long as you have given me accurate and complete information.  EWH 
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35 months ago

Thank you Dr. Hook for your response.

I did give you complete and accurate information. However, I was hoping for some clarification. You stated in the last reply that “for reasons included in my original answer, I have no concern about you having acquired HIV from the exposure you describe.” In your original answer, you state that “with a negative test at 6 weeks, no matter what sort of test, I would have complete confidence that I had not been infected and would have no concerns about having unprotected sex with an infected partner.” However, I believe that statement was based on the fact that you did not know I was on Truvada a couple weeks before I took the 6 week test. In your last response, you state that the recommendation would be to wait until 4 weeks after completion of the Truvada to expect accurate test results. I only waited 2 weeks. Do you think I should get tested now, now that it’s been more than 4 weeks since I’ve completed the Truvada? I am not sure what else you are referring to in your original answer that your opinion hasn’t changed, if the 6 week test was potentially not 100% accurate. Is that a correct statement that the 6 week test I took was potentially not 100% accurate because of the Truvada I took? If you can please advise and elaborate, I would greatly appreciate it. As I stated, I suffer from a major generalized anxiety disorder (which I am receiving treatment for) that is making this whole situation much more difficult.

Thank you very much for your time and assistance. 

35 months ago
One more question please Doctor Hook. Can the delayed Truvada delay positive tests in both the Antibody test and the p24 Antigen test, or just the Antibody test? Thank you. 
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Delay in both tests is possible.  EWH
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35 months ago

Thank you Dr. Hook for your response but I had a previous question that wasn't responded to which I am re-posting here:

I did give you complete and accurate information. However, I was hoping for some clarification. You stated in the last reply that “for reasons included in my original answer, I have no concern about you having acquired HIV from the exposure you describe.” In your original answer, you state that “with a negative test at 6 weeks, no matter what sort of test, I would have complete confidence that I had not been infected and would have no concerns about having unprotected sex with an infected partner.” However, I believe that statement was based on the fact that you did not know I was on Truvada a couple weeks before I took the 6 week test. In your last response, you state that the recommendation would be to wait until 4 weeks after completion of the Truvada to expect accurate test results. I only waited 2 weeks. Do you think I should get tested now, now that it’s been more than 4 weeks since I’ve completed the Truvada? I am not sure what else you are referring to in your original answer that your opinion hasn’t changed, if the 6 week test was potentially not 100% accurate. Is that a correct statement that the 6 week test I took was potentially not 100% accurate because of the Truvada I took? If you can please advise and elaborate, I would greatly appreciate it. As I stated, I suffer from a major generalized anxiety disorder (which I am receiving treatment for) that is making this whole situation much more difficult.

Thank you very much for your time and assistance. 

35 months ago
Hello Dr. Hook, it has been 48 hours since I posted my last question with no response so I am re-posting it below for your review in case you missed it. Thank you for your time and assistance.

"Thank you Dr. Hook for your response but I had a previous question that wasn't responded to which I am re-posting here:

I did give you complete and accurate information. However, I was hoping for some clarification. You stated in the last reply that “for reasons included in my original answer, I have no concern about you having acquired HIV from the exposure you describe.” In your original answer, you state that “with a negative test at 6 weeks, no matter what sort of test, I would have complete confidence that I had not been infected and would have no concerns about having unprotected sex with an infected partner.” However, I believe that statement was based on the fact that you did not know I was on Truvada a couple weeks before I took the 6 week test. In your last response, you state that the recommendation would be to wait until 4 weeks after completion of the Truvada to expect accurate test results. I only waited 2 weeks. Do you think I should get tested now, now that it’s been more than 4 weeks since I’ve completed the Truvada? I am not sure what else you are referring to in your original answer that your opinion hasn’t changed, if the 6 week test was potentially not 100% accurate. Is that a correct statement that the 6 week test I took was potentially not 100% accurate because of the Truvada I took? If you can please advise and elaborate, I would greatly appreciate it. As I stated, I suffer from a major generalized anxiety disorder (which I am receiving treatment for) that is making this whole situation much more difficult.

Thank you very much for your time and assistance." 

Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago

Your anxiety is getting the better of you.  I will respond one more time which, I would add, is beyond the 3 response limit we use on this site. 
After that, if you cannot control your anxiety, you will need to post a new question.  If you feel the need to re-post, please understand that you are asking a question that has already been answered and you are asking to hear the same reply again.

In my original post I said "the details of your exposure suggest close to no risk for HIV.  Most commercial sex workers, even in Mexico, do not have HIV and even if your partner did have infection, your risk for infection is infinitesimal.  Condom protected sex is safe sex and I know of no instances in which HIV has been acquired through a male performing oral sex on an infected woman- neither in the medical literature, reports from medical meetings nor in my own experience."  that seems pretty clear to me and, as I said, If you had asked me if you needed to be worried, to be tested at all, or to take Truvada, my answer to each of these questions would have been emphatically no.  Thus for you to ask if you need to be tested again at this time seems rather silly, since I did not recommend testing to start with.

I hope this is clear.  In my opinion you do not need further testing at all.  If you choose to waste your time and money on further testing, now is as good a time as ever to do so.  This thread is now over.  EWH

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