[Question #3300] Accuracy of HIV test in question

39 months ago
Hello Doctor.  Early December I had a bad encounter which included a night at an asian  massage parlor with Bachelor party.  The girl gave me unprotected oral for awhile.  no sex was involved.  At the end of the session she put her finger in and out of my butt for what seemed like 5 minutes or more. She used some oil but no latex or cover.  After about a week after I started having symptoms of nausea.  At week 4 i had a small rash that lasted for less than a day.  I went and tested with a private testing place(requestatest.com) which used labcorp to perform my tests.  I read a lot about hiv and have had a 4 and 7 week duo and Aptima assay which both returned negative. I discovered that Labcorp uses the Centaur CHIV and below is a review of the test and wanted your thoughts.

https://www.sciencedirect.com/science/article/pii/S1386653217301312

-My symptoms still are happening with under arms feeling swollen as well as groin.  I thought things were conclusive but reading that it may not pick up acute hiv as me worried beyond belief.  
1)With my symptoms still persisting should I go and have a Quest test done which uses the Abbott Architect to completely rule it out because of maybe less sensitivity of the Centaur?
2)Is there a reason I should test longer than 7 weeks due to possible false negative?
3)In the recent link you have posted regarding time to positive, was that a study involving a large number of people?
4)Do you think that you can have a 4 and 7 week duo  of any kind with the Aptima,  absence of RNA and still have HIV?
5)How far do you really have to test out to?  Do you have to go 90 days or longer?
6)Is it possible that a strain of HIV-1 or let alone HIV-2 could be missed?  Do you have to test LONGER than 6 weeks with duo for HIV-2?
7) Despite ANY symptoms, can I disregard HIV of any type or still test you think?  Better test? Wait longer?
8)Do you feel that I could still be a risk to my wife?  I have not told her about the incident or the testing I have done.
Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
Welcome to our Forum.  As luck would have it, I was on the site at the time your question appeared and so you are getting a response far more rapidly than is the norm.  Follow-ups, should you request them will likely be less timely as well.

The performance of currently approved tests for HIV are amongst the best ever seen for any microbiological test.  While  they may vary slightly from test to test, they are all held to the same performance benchmarks for approval,  the analytic differences noted in this paper are no clinically significant and any difference in performance is eliminated in your specific case by the timing of your testing and the fact that yin addition to the two combination HIV antigen/antibody tests that you mention, you also have a negative Aptima nucleic acid amplification test for HIV RNA.  There is no doubt that you did not get HIV from the virtually no risk exposure that you describe above.  Further answers to your specific questions below in the order you asked them:

1.  Undoubtedly, the symptoms you report are due to something other than HIV.  Your exposures were no risk- there has NEVER been a case of HIV acquired from receipt of oral sex and you do not even know that your partner had HIV.  it is unlikely that she did.  There is no medical need for further testing.
2.  No, even conservative sources such as  the U.S. CDC agree that at 42-45 days HIV test results with combination tests such as you were tested with are completely conclusive.
3.  Yes, our recommendations and endorsements of the CDC recommendations reflect not one but a number of studies involving thousands of persons.
4.  No, I am confident that you do not have HIV.  Please see paragraph 2 above.
5.  As above, no testing is needed beyond day 45 unless you have taken anti-retroviral therapy (PEP or PrEP)
6.  No
7.  Repetitive question. the answer remains the same.  no medical need for additional testing,  Your results are conclusive
8.  No, there is no risk of HIV form your wife from the incident that you describe above.

I hope that these comments are helpful. you can be confident you did not acquire HIV. There is no medical need for further testing.  EWH
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39 months ago
Thank you so much. Yes very quick reply!
So i wanted to clarify that what I am mainly concerned with after reading all you have written, is not the oral, but the insertive penetration by her finger. I understand it was not a penis, and only a finger, but IF she had a potential cut, blood on her finger, fresh small cut, that I didn't see, that could have been a risk. I understand both of you have never had an instance here where someone turned positive, but at some point i am sure it will happen and I  dont want to be the first.  I hope you would be frank with me without any hesitancy on risks/further advice.
1) as far as 4th generation tests go, do they test for IGG/IGM for both HIV-1 and HIV-2?
2)I have in the past had a low titer ANA(unknown cause).  Does that change your opinion or possibility it could take me longer to show positive?
3)If HIV-2 was a potential(although I know remote), would it not take the 90 days for conclusive since the HIV-2 part in only finding antibodies?  It seems to me that CDC would think HIV-2 only test for Antibody.
4)With a 4 week and 7 week DUO and RNA, HIV-1 of any type would be eliminated as a consideration?
5)Can symptoms of HIV of some acute nature, last 7-8 weeks? Would the antibody for either HIV-1 or HIV-2 have shown up on tests?
6)With ANY symptoms, Can I disregard ANY SORT OF HIV with TOTAL confidence?
Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
Sorry I did not comment more on the insertion of her finger into your rectum.  This is a form of masturbation and it is not associated with any known risk for HIV or other STIs.   This is true whether or not she had cuts or scrapes on her fingers and whether or not you have hemorrhoids or other rectal problems.  Still no risk, in the unlikely circumstance that she had HIV. 

1.  The antibodies detected do include IgM
2.  No, your prior positive ANA in now way changes my assessment or advice.
3.  The results of currently available tests are conclusive for HIV-2 as well as HIV-1 at 6 weeks (42-45 days)
4.  Repetitive question.  No change in my answer, you did not get HIV from the events you described.   
5.  No, the symptoms of the ARS do not last more than 2-3 weeks.  Persons who are symptomatic typically have positive tests.
6.  See 4 above.

EWH
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38 months ago
I appreciate your reply.  For some reason the fact she may have had a bleeding cut/finger in my rectum though and if she had hiv, it could have transferred.  I am physically ill with groin swelling, muscle aches, muscle twitch.  I have read CDC, and they say antibody test only conclusive at 90 days. Went and had Abbott architect done this week(10 weeks now) and was negative. So my tests are:(all negative)
4 week centaur duo/Roche taqman(QUANT)RNA-hiv-1
7 week centaur dup/Aptima (QUAL) RNA HIV-1
10 wk Abbott Architect duo
1)No matter how what symptoms or how high or low the risk was, these tests will not lie and are conclusive no doubt?
2)Revisiting hiv-2(no antigen for 2), only antibody portion of duo valid, need to wait 90 days to be certain?
3)If only doing antibody tests(3rd gen), when always do people test positive to antibody?(90 days way too long?)cdc?
4)With symptoms still, do i need to repeat duo AND RNA(qual or quant??), at one testing visit say at 90 days, or more, or all tests in aggregate proof?
5)Is there any way that all those tests could be wrong and missing some sort of HIV of ANY TYPE?
6)Is there ANYTHING, left to do with testing to make 1000% sure I am not missing anything or is the science solid?
7)Is there ANY instance besides PEP, where you would not believe the tests?
I appreciate it.  I know this is my last reply, if you need any other clarification of my tests/symptoms, i will reply as asked
I just want to MAKE SURE I am not ANY THREAT to the well being and health of me or my wife.  If conclusive I will look elsewhere for the cause of my problems.
Thank you
38 months ago
Sorry, i miss typed:
Before #1 was supposed to be this question:
1A)--Is it ALWAYS no longer than 6 weeks for a CONCLUSIVE result NO MATTER WHAT??
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
Your follow-up questions are entirely repetitive and serve no purpose.  Repeating your questions will not change my answers.  Brief answers and then, since this is my 3rd reply, this thread will be closed without further replies in a few hours:

1.  Your risk (which was low) does not change the test performance.  Your multiple results are negative and conclusive.
2.  No, these results are conclusive for HIV-2 as well.
3.  currently available antibody tests are conclusive 8 weeks after exposure
4.  What part of "you results are conclusive" is unclear? No need for further testing of any sort.
5.  No!!!
6.  No!!!
7.  No!!!

Your problem is not your exposure or tests, it is your guilt and anxiety over your dalliance.  you need to move on.  Further thesting is a waste of time and resources.

This thread is now over. EWH
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