[Question #3338] General knowledge/clarification please

38 months ago
Hello Doctors, I won't go into anything personally, but want to find out facts from fiction or otherwise.  Being that HIV is so serious, I want to get honest and serious answers from either of you regarding HIV and window period even though I know its beens discussed scatteredly before.
1)Does it go to say that NO MATTER what symptoms a person is experiencing, the HIV test results typically never lie?  (timeframe)?
2)I see some sites/papers say 3 months is not conclusive (even with 4th generation)and then a follow-up at six and 12 months.  Is this possible and does this need to happen in the absence of any PEP or cancer?
3)You both say 6 weeks is 100% conclusive for 4th generation, do you typically stand by that no matter what?
4)With the current 4th generation tests, are there types of HIV that can evade detection?
5)Regarding HIV-2, do you have to wait the 84-90 days to be completely sure of negative result since the duo antigen is for hiv-1 only and thus only the antibody portion of the duo test for is valid thus possibly prolonging window?
6)If you only did a 3rd generation test CDC says 90 days is the window, but I read from time to time here that 8 weeks is long enough. Can you please clarify?
7)Will you always have either a positive RNA, duo, or both at six weeks or(maybe 8 weeks), if you are truly infected?  False negative?
8)Last, when can one feel 100% certain that they don't have ANY type of HIV, and what combination of tests (duo,RNA, etc)does it take to make without question that the results are valid.
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
Welcome to our Forum.  I'll be addressing yoru questions however I should point out that the value of our Forum is to provide context specific advice. 

1)Does it go to say that NO MATTER what symptoms a person is experiencing, the HIV test results typically never lie?  (timeframe)?
Correct, as long as the test is performed at an appropriate time and the person being tested has not taken anti-HIV medications, HIV test results perfromed by a liscensed lab should be believed. they are among some of the most reliable testis in all of medicine.

2)I see some sites/papers say 3 months is not conclusive (even with 4th generation)and then a follow-up at six and 12 months.  Is this possible and does this need to happen in the absence of any PEP or cancer?
Those sites are out of date or wrong, perhaps with the idea that being overly cautious is a good thing.  it is not.

3)You both say 6 weeks is 100% conclusive for 4th generation, do you typically stand by that no matter what?
Yes, in the absence of anti-HIV therapy.

4)With the current 4th generation tests, are there types of HIV that can evade detection?
No

5)Regarding HIV-2, do you have to wait the 84-90 days to be completely sure of negative result since the duo antigen is for hiv-1 only and thus only the antibody portion of the duo test for is valid thus possibly prolonging window?
No, results are accurate at 6 weeks.   In the US between 1987 and 2009 there were only 66  cases of HIV-2 in the U.S. while there were over a million new infections. 

6)If you only did a 3rd generation test CDC says 90 days is the window, but I read from time to time here that 8 weeks is long enough. Can you please clarify?
90 days is what is described on the test instructions, a document that is approved by the FDA based on the design of the study used to get approval for the test.  The fact however is that current antibody detection tests are reliable at 8 weeks but this is not captured by the design of the licensing studies. 

7)Will you always have either a positive RNA, duo, or both at six weeks or(maybe 8 weeks), if you are truly infected?  False negative?
Yes, once infected and positive, the tests remain positive.

8)Last, when can one feel 100% certain that they don't have ANY type of HIV, and what combination of tests (duo,RNA, etc)does it take to make without question.  see answers above.  EWH
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38 months ago
Ok, I was trying to get an idea on a general basis as for testing and conclusiveness.  Me personally had an exposure towards the end of last year.  Since that time I have had LOTS of physical things going on with my body that no doctor can explain.  I have NOT mentioned the exposure(Asian girl) to them because I wanted to keep quiet.  I subsequently tested with an online source that uses labcorp and quest. At 5 weeks after exposure I had a duo and early quantitative detection test with labcorp, at 7 weeks a duo and early qualitative test done via Quest, and 10 weeks another duo test.  ALL negative.  In the past I have also had exposures prior to this and always a positive test.
1)Can I without question regard myself as hiv negative no matter what symptoms I experience(oral stuff, swollen groin area but no nodes i see)
2)Dont need to follow up beyond 6 weeks let alone my 10 week test with a 12/13 week test?
3)Is it more reliable to test say at the 3month mark with both the Early test(which is better, quant or qual??) and another duo?  Is is more solid?
4)I know you say HIV-2 is rare, unless you are that 1/66.  My 10 week duo(antibody portion of it)would have picked up/detected for sure?
5)Clarify, if you had HIV-1 with no treatment and tests i have had, would have RNA AND antibody be positive at my 7 week test and RNA stay that way unless treated?
6)As an expert, is there any more testing you would advise your own relative(son/daughter) at this point to absolutely be certain or is it enough?
7)As said, effectively all antibody tests or duo will give certain results at 10 weeks?
8)When do you as a clinician these days stop testing people for HIV knowing you have ruled it out?(Do you still directly take care of patients since professor at UAB?)
As a father and a husband I want to do or know I have done all is possible to effectively eliminate as possibility without any shred of doubt.  
Thank you
38 months ago
sorry,  at end of opening paragraph of reply, all past exposures, NEVER a positive test.--typo
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
Thanks for the additional information.  Quest and LabCorp are both well respected, highly reliable laboratories.  Even before I answer your specific questions, I can assure you that you are not infected and that the tests did not miss an infection.  Based on my personal experience with literally thousand of patients, I can say that when multiple tests agree you can be entirely sure that your symptoms are not due to the infection (in this case HIV) that you were being tested for.  Something may well be going on but it is not HIV.  With that, on to your next series of questions:

1.  Correct.  At this time, with multiple negative tests, you can be confident that you do not have HIV.
2.  No further testing is needed for the exposure you are referring to.
3.  The tests are equally sensitive and in your case, there is no different between qualitative and quantitative tests.  The quantitative tests are useful for determining response to therapy but for diagnosis both tests perform similarly.
4.  Your result is reliable. Your 10 week test would have detected it. 
5.  Correct
6.  this sort of question is a bit irritating, to suggest that I would treat my patients different than my on family.  I would not.
7. Repeating your question will not change the answer. See above.
8.  I consider my test results conclusive at 6 weeks, nearly so (99%) at 4 weeks. 

Believe your results. EWH
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38 months ago
Sorry, no insult intended.  I will ask my other questions in number format instead of long story.  If other questions needed I will follow with fee.
1)Even with HIGH suspicion with SYMPTOMS/no matter how low/HIGH the risk, when can you TOTALLY rule out HIV of ANY sort? Type 1 or 2 for sure?
2)Can one have negative duo/RNA at 7 weeks and another neg duo at 10 weeks and have some sort of HIV that is missed?
3)Is there value to more testing at the 12/13 week point after my other tests, make more solid/reliable/official?
4)Whats the chance that my tests at their timeframe could change past 10 weeks for either TYPE 1 or 2? RNA/duo become positive later?
5)Is there any value in me seeing an ID doctor besides advice? Seems that they would simply repeat the test?
6)Any reason I should mention to my wife or have her tested in regards to me/refrain from sex especially tonight(valentines day)?
7)I now have felt ill for two months without relief. Is is possible my immune system is compromised by an aggressive sort of hiv or i have been infected longer than thought where tests of either sort will not detect?
8)Any value to a CD4 count?
9)IS there any doubt beyond 6 or even 10 weeks for that matter when you get a negative test, that you should not believe it?(seronegative cases)
10)LASTLY, I want to make ROCK SOLID, CERTAIN, AND CONCLUSIVELY, that I have done whatever I can to rule out this as a cause of symptoms.  I remain skeptical of tests because nothing else has revealed itself, and things tend to add up more to immune problem.  Maybe I need to see an Infectious disease doctor so I can have some direction.  Online testing is nice, but gives a lay person no guidance, and thats why we all come here for sound advice.  
Thank you much
As said prior, for your time i will remit additional fee if necessary.
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago

Your questions are repetitive and have been answered earlier.  Our forum does not permit repeated anxiety driven questions by the same users. This will have to be your last one; future questions on this topic area will be deleted without reply and without refund of your posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers; because experience shows that continued answers tends to simply prolong such anxieties, when the real answer normally should be professional counseling; and because such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.


Straight to your questions:

1.  Repetitive.  6 weeks using combination HIV antigen/antibody tests.

2.  No

3. No

4.  Virtually zero

5.  No value as regards HIV.  If there is reason to worry about another process infection, perhaps it would help.

6.  No, not with regard to HIV

7. No, you should look for other reasons for your symptoms

8.  No.

9.  No, not unless you have taken anti-HIV therapy.

10. I have nothing more to say


This thread will be closed later today.  There will be no further responses


EWH


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38 months ago
Thank you for your time and replies