[Question #3278] HIV-2 eliminated?

37 months ago
Hello Doctors, and in all fairness I will try and make it brief.  I think I mistakenly gave you wrong information when I was even reviewing my post and misspoke and omitted information that could change your opinion one way or the other.  I couldn't change my post though to correct myself.  Nonetheless, I had my exposure  about nine weeks ago as you can see from my earlier posts.  What I am really trying to find out is the window for HIV-2.  I needed some clarification on jumbled questions I had.  It looks like I have ruled out HIV-1 with the following but have issues/doubts:
3 weeks- HIV duo test NEG
4 weeks-HIV duo test  and PCR HIV-1 Quantitative all NEG
5 weeks-HIV duo test  and PCR APTIMA HIV-1 Qualitative NEG
7 weeks-HIV duo test, PCR APTIMA HIV-1 Qualitative, EIA for HIV 2, HIV 1/2 differentiation, as well AS the HIV-2 Proviral DNA test.--All NEG 
1)Can I absolutely rule out HIV-1 of any type/subtypes in your opinion?(CRF, other?)--Mainly due to Asian nature of exposure?---Is there any Value to having an Abbott Real-time which can pick up most subtypes of HIV-1/CRF?
2)When I said HIV duo tests mainly focus on HIV-1 I meant because of Antigen.  So how reliable is the HIV-2 part of the duo test at seven weeks since it is only really looking for antibodies and no viral material?
3)Is the window for HIV-2 longer and more difficult to detect due to lower viral replication?
4)If had symptoms say starting around 7-10 days after exposure, and test at 7 weeks after exposure, would a I definitely show antibodies for either type on the duo or even stand alone antibody test(even ones designed for HIV-2?
5)Is there any way that at 7 weeks after exposure, my testing missed infection for either type?
6I have read that possibly p26 cross reacts with the p24 part of duo test for hiv-2, is there any merit to that?
7)Do I need to continue to test and if so approximately which test and what  timeframe to be ABSOLUTELY sure I have ruled either type out for SURE?!
Thank you
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
From my last reply in your previous thread:  "The tests you had cover HIV2 as well as HIV1." This is especially true since you now report being tested 9 weeks after the exposure on your mind, instead of 32 days as described in your other thread. I did not misunderstand any of the details of your question last time.

1) Yes, you can absolutely rule out any and all HIV1 subtypes. You don't need the Abbot or any other test.
2) The antibody component of the duo test detects 100% of HIV2 infections any time more than 6 weeks after exposure.
3) No, the HIV2 window period for antibody is the same as for HIV1.
4) When symptoms are caused by HIV and have been present more than 7-10 days, the antibody tests are always positive.
5) There is no way these tests missed any HIV infection.
6) Interpreting a positive test could be affected if p26 and p24 cross react. With a negative test result, this is irrelevant.
7) No, you do not need to continue to test. There are no tests that can give you more than 100% assurance, which you already have.

Please do not ask anything again that has already been answered, or whose answer is obvious from the previous replies on this thread or the previous one.

37 months ago
Thank you.  BUT, I have ONLY tested out to SEVEN weeks and I fear that somehow HIV-2 may not have been detected or somehow all of my tests are showing falsely negative even in setting of symptoms.
1)If i went to see an ID doctor, what more would they do at this point?(9 wks post exposure) continue to test?
2)I know you have discounted HIV-2 as remote, but what is the CDC advise on testing for HIV-2?  I am assuming the 4th generation 6 week number is ONLY valid for HIV-1?  Do you in fact HAVE to wait for 90 days or longer, or what TRULY is the answer?
3)You mentioned HIV tests are always positive with symptoms or shortly after, but would it be more conceivable that the antibody would be more detectable  after you have gotten better because there are more antibodies to right off pathogen? Mine have subsided somewhat at the nine week mark now(been having since day 10)
4)Do you agree in every case that symptoms dont matter and test results rule every time( regarding my timeframe)?
5)I feel guilt not telling my wife I have concerns, but I dont want to open Pandoras box if not needed.  Do you feel its safe to have sex, is there a reason from me to have her tested to be sure? (She has vague symptoms of fever, night sweat, and I want to make sure(from me) she is not as risk since we did have sex 6 weeks ago)
6)Is HIV of any type typically easy to diagnose if you are looking for and having/had recent symptoms/tests?
7) How likely is the duo test i had out to SEVEN weeks likely to change for HIV-1 or HIV-2?
8)I am mainly concerned about HIV-2 mainly because HIV-1 has been pretty much ruled out from what I am told.  I just want to be totally confident that I am HIV free of type 1 or2.  I have had HIV-2 PCR but there is no good clinical data on it that I have come across.
9) how can i be totally sure I am not infected with HIV of ANY TYPE 1 or 2, am not a risk to my wife, or do not need to continue to test in the event I am in a window period of some sort still for it.
I know you haven't had anyone here test positive, but IF you have ANY reservations or otherwise AND please be blunt,  or advise more tests, I will take your recommendations. Especially for HIV-2.
I know this sounds unrealistic, but I cannot shake the fact that possible for HIV-2, I am in that GREY area of testing, and may need to test longer.  Whatever I need to do I will do to make sure I have exhausted all means of testing to confirm or deny the presence of this disease.
Thank you

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
You're way overthinking all this. The answer to all your questions is covered in question 9:  You already can be "totally sure" you are not infected with HIV of any type or subtype. 

In the 14 years I have been answering questions like this in online forums, with thousands of questions in total, not one person who was concerned about an exposure turned out to have caught HIV. Not one. You will not be the first. If and when that happens, I expect it to be someone with a real high risk exposure, such as unprotected anal sex between two men, and not a zero risk situation like yours.

You came here for reassurance and I have tried my best to give it to you, but you are questioning my replies at ever turn. Suck it up, accept the reasoned, science based evidence you have heard, accept it and move on.
37 months ago
With all due respect Doctor, I spent a great deal of time trying to ask questions I think are important ones in my case and possibly others.  I have gone from 180lbs to 165 in two months without other explanation.  I want to make sure that in NO WAY, I have HIV of any kind.  If you would warmheartedly consider answering the questions presented previously It would mean a great deal.  i really appreciate it
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
Sigh. If you would just read all the comments in replies to all your specific questions, in this thread and the previosu one, you would understand that the answers to the ones above already exist or are obvious. They includes several reasons that "in NO WAY, [you] have HIV of any kind". Believe it and move on with your wife.

Please note the forum does not permit repeated questions on the same topic or exposure. This being your second, and with very detailed and largely repeated replies, it will have to be your last one; future new questions about this exposure, testing, and your fears about HIV or other STDs will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand. I do hope the discussions have been helpful.