[Question #3382] Dr.HHH - HIV Testing question

38 months ago
Sir,

High risk exposure with a very high risk individual (I’m male exposure unprotected anal vaginal with female CSW). Just a big mistake I made while I was drinking heavy that night. Sex happened twice that night. 

10 days later started developing symptoms, rash, flu and swelling under arms and behind knee. Now the reason why I’m here and need your sold guidance and reassurance. 

10 day PCR RNA - Not detected, 30 day duo CMIA- Non reactive, 65 day Duo CMIA- non reactive, on the 82 day I requested the lab to do a PCR RNA and another duo CMIA from the same blood test and they both were negative.  

Can an elite controller or non progessor or any other case have no antigen or no antibody and also a negative PCR RNA also.  Is that possible given that these are the 3 markers for detection. While other symptoms have gone I have a swollen bump under my left arm still almost 100 days post exposure. Please need some guidance and help !!!

38 months ago
Sorry forgot to mention I have done other STD tests at 30days and 65 days again which included Syph/chal/gon/hepc/hsv1 and 2 igg and igm. 

And sorry for the typo error I meant solid and not sold guidance and reassurance. The above STD tests were done as a panel along with the duo. And all results were negative both times at 30 and 65 days both. 
38 months ago
I don’t know if this makes a difference but all the tests that I mentioned are done in a laboratory with blood taken from a vein and are not finger prick or at home tests. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Welcome to the forum. Thanks for your question.

I'm glad you understand the potential risks involved with this exposure, and that it's the sort of thing that isn't likely to happen again. Still, you were over tested -- but the results are good. For sure you did not catch HIV or other STD.

The most important thing here is that the HIV blood tests are among the most accurate diagnostic tests ever developed, for any medical condition. Your 35 day duo test was 100% conclusive, and the other negative results also confirm you did not catch HIV. It is not possible to have HIV and have the negative results you report. And when HIV testing is done sufficiently long after exposure, as these were, they overrule alll other considerations. Your exposure was less risky than you have assumed, but even if it were very high risk (e.g. if your partner were known to have HIV), that no longer matters:  the test results show you didn't catch it. Same for symptoms:  some aspects of them are consistent with a new HIV infection, but the test results rule.  Elite controllers or other non progressors have no differences in blood test results and timing.

Your other STD tests also are completely reliable. The combination of your test results plus lack of symptoms is 100% proof you did not acquire any of the infections for which you were tested. Don't have any more tests of any kind. But do see your doctor if you continue to have symptoms that concern you.

So all is well. I hope the information is helpful. Keep those condoms handy in the future!

HHH, MD




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38 months ago
Sir,

Thank you so much for your reply. I was anxiously waiting to hear from you, of course I understand that replies won’t be real time and may take a while. I have read a lot about you and your replies on Med Help, health tap and here as well. Except the change from 4 to 6 weeks regarding the duo all your replies have been consistent and honestly I was expecting a very encouraging and reassuring reply which I got and THANK YOU for that. 

Assuming even if I was that rare case of not enough detectable antibody the 30 day should have detected the p24 antigen and the 10 day PCR should have detected the virus, else the 82 day PCR should detect it. From my understanding I have tried my best to test at suitable timing - 10 day PCR and 30 day duo and then ofcourse the 65 and 82 day tests. For HIV 2 should I try the HIV2 pcr test to be sure. Also I read blood from vein tests are more accurate than at home kits or finger prick tests. 
I just want to be sure about HIV2. 

With my tests am I missing any chance of detecting the infection ?  I don’t understand why all those symptoms and the timing ??

I know this is follow up 1 question. 





H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Thanks for the thanks about our services.

The gold standard for "consistency" is scientific data. The data for time to conclusive testing changed. Would you prefer we stayed with 4 weeks when it became clear 6 weeks is better? Would you prefer consistency in our advice or maximum accuracy?

Yes, the later tests would have detected your infection if somehow the 30 day test did not. The antibody components of the duo tests are sufficient to detect all HIV2 infections. Don't waste money on an HIV2 PCR test.

As for your symptoms, re-read my reply above. Anyway, there is no possibility that HIV would be responsible for a single "swollen bump" under one arm. As I said, see a doctor about it if you remain concerned.

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38 months ago
Sir,

Thank you for your reply. Ofcourse any day accuracy in place of consistency and I understand new scientific data became available and hence the advice.

Since this is my second follow up I shall break down my concerns in point wise questions, please pardon me if some are repetitive or anxiety driven as i am undoubtedly going through a tough time dealing with this situation.

1.) can I be 100% sure given my test that I didn’t catch HIV?
2.) yes I have a swollen bump under my left arm but there is slight pain and discomfort under both arms. It’s like the pain comes and goes. Can this be related to the exposure ?
3.) There is a slight pain in the abdomen area.
4.)Do I need anymore testing at all for HIV in particular?
5.) HSV testing twice at 30 and 65 Days post exposure is sufficient IGG and IGM testing. 
6.) I’ve had a pimple with a white head once on my nose and now near my lip post exposure. Do I need to be worried about this? Can this be a sign of anything? 
7.) can I resume unprotected sex with my partner?

I’m just trying to be certain so that I don’t end up infecting my partner. I know post answering this my thread will be closed so Thank you Sir for your help and this incredible service. 

By the way I’m luck to have marked a question to you and also get you to answer them as I know we don’t have the right to choose who answers our questions. Take care and best of luck!!! 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
These questions also have already been addressed directly, or the replies are obvious from my previous comments. Hence very succinct replies.

1) Yes
2) No
3) Abdominal pain doesn't suggest HIV or any other STD.
4) No
5) IgM testing for HSV is useless -- highly inaccurate and high risk of false positive result (which fortunately you didn't have). It take up to 4 months for IgG to become positive, so you'll need to wait until then for a truly conclusive test. However, 90% would be positive by 65 days, and almost certainly you didn't catch herpes.
6) Neither HIV nor any STDs cause pimples. It's acne, for goodness' sake! You can't go through life attributing every zit or other minor symptom to this sexual exposure!
7) Yes

That concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe.
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