[Question #3422] Despite ANY symptoms--Tests rule?

37 months ago
Hello Dr. Hook or Dr. Handsfield.  To make it simple I will be as brief as possible.  Recap-  Exposure 12/2017 and since that time multiple symptoms.  I have tested many times as well with:-4 week HIV duo/ HIV-1 Quantitative-5 week HIV du0/ HIV-1 Qualitative -7 week HIV du0/HIV-1 Qualitative - 10 week duo--NOW I have tested out to (13 weeks) 91 days with the Abbott architect duo which was negative.What scares the hell out of me is that somehow these tests have failed to detect the virus or the replication is so slow that it will take longer to show an accurate result.I have read the references that you cite, and I truly want them to be accurate in my case.  As of the last few days, it seems like I may be having some groin lymph nodes that are becoming sore and swollen, nothing definitive yet, but the groin is sore one side more than the other.  Also i have had one side of the neck that was sore but no node seen.  I know both of you always say, that symptoms dont matter with HIV at this time period, but in your experience are there exceptions?  I know there always a lot of worried wells here, but if there would be ANY DOUBT, I hope you would please share them.
1)With my last RNA at 7 weeks, and latest duo at 13 weeks,can I be ABSOLUTELY CERTAIN that results are reliable and certain and there is no need for anymore testing no matter what symptoms or ailments I may experience?
2)Is there any reason that I should be cautious with sexual relations with my wife?
3)With all the above tests, is there a chance that somewhere between the RNA tests and others(say 7-13 weeks) that there was a small window where the antigen or virus was not detected or could not for that matter?
4)Can it take longer for tests to show, and should I be worried any longer for the sake of my family and myself?
5)Safe to say that if the tests have not shown anything by now, they are never going to?(Possible limitation of the test to virus)?
6)Is there anything more to do now or later to be FINAL?
Thank You
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
 Welcome back to the forum. I must say however I am sorry to see that you are back asking exactly the same questions that you asked about a month ago. Repeating the questions will not change the answer or my assessment of your situation. Your tests have proven that you do not have HIV, no if's, and's,or butts about it. You need to accept this answer.  If you have swollen lymph node's based on an experienced physician's examination,  then you need to look for reasons other than HIV is their cause.  Straight to your specific questions.

1.  Yes
2.  No
3.  No
4. No
5. Yes
6.  No

EWH
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37 months ago
Hello and thank you.  Yes I do see where there was repetition.  What concerns me now is that I have had my upset stomach/nausea since the episode but has died down  since this past Sunday which had been 14 weeks since the exposure.  My symptoms started 1 week after exposure and continued to this past weekend.  NOW, though, I have the under the arm swelling/muscle pain as well as groin paint and pain in the rear inner hamstrings.  I know muscle pain can be indicative of disease.  I also was concerned because some experts(not yourselves) say that if you think you may have had interaction with HIV person, you  MUST verify @ six months.  These seemed like experts/papers that had good credentials.  So I just need to be clear so that I can put this to rest.
1)Could i have the symptoms starting a week after exposure and last 13 weeks, and then now develop groin swelling(possibly nodes) but have all the negative tests within that time period, and now out to 14 weeks?--therefore somehow/some way be HIV positive?
2)Is it true or not true, that if you had a high risk exposure(confirmed risk with HIV positive) that you should test out to 6 months even after a 90 day negative test?
3)Are there any limitations to the test modalities I had(RNA/DUO) that at their timeframes i took them, ANY type of HIV could be missed or beyond the lower limit of detection?
4)Would these tests even pick up the "odd variant"?  I have read that even though not indicated sometimes, the tests will pick up more than they are "approved for".
5)With regards to my wife/family.  Yes there is guilt in me testing without her knowledge, but is there any reason to mention testing to her based on "risk"to her? I dont want to if I don't need to because it would tear us apart for sure.
6)When I took the RNA at 4,5,7 weeks, if I had any type of HIV-1, would have the RNA been positive for sure?--elite controller at all?
7)Is there any other type of test or combo to do to make certain beyond 90 days?(DNA, repeat RNA viral load, repeat duo. etc)
All I want to do is return to normal family life and learn from this bad decision.  If there are things you would advise as it relates to further testing or consultation with ID specialist, I would greatly take the advice.  I will try not to return to this forum hopefully ever again based on my actions.  
Thank you

Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
Your insistence on having HIV is mystifying and suggest to me that you really need to talk this through with a counselor.  No matter what the symptom, your multiple negative HIV tests PROVE that you did not acquire HIV.  Thus whether your stomach hurts, have muscle pains, have swollen glands (I ask again, were these diagnosed by a physician or is this what you think is there- most people have palpable lymph nodes and a physician should both assess any swollen lymph nodes that you have and determine how to evaluate them), or any other symptom, the negative HIV tests trump those symptoms.  Period.

Whatever expert you are referring to is being overly conservative.

1.  No - see above.  When symptoms are present, within a few days of their onset, HIV tests are always positive.
2. Not true.  With current combination HIV antigen/antibody tests the results at 6 weeks are conclusive.  With a negative PCR test, results are conclusive even sooner.
3.  No
4.  Yes- you need to stay off the internet which I suspect is the source of your mis-information.
5.  No
6.  Yes, including elite controller
7.  No

You do not need to see another doctor regarding HIV.  I sincerely believe you do need to see a counselor.  I say this out of concern for you, nothing more.  EWH

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37 months ago
If just all the symptoms hadn't started shortly after encounter, it would make it easier. I REALLY want to believe results. I just want to do ALL I can to solidify the negative result. 
1)I know no results can be "guaranteed" to be absolute, but how close is this with all the tests and at their times?
2)if it was a non-b subtype or other would that still be absolute or change your mind?
3)are there situations other than pep where it can take 90 days or longer?
4)are there instances where one can be seronegative on all the tests and still have hiv?
5)so I tested at 13 weeks(91 days exact), does it make sense or even justified to test say in another month(are the results any more reliable the longer you test out)?

As said, I really do want to be over it all but the prospect of missing the diagnosis and subsequently endangering my wife frightens me. If In your experience as well as the science of hiv testing, these results PROVE that I am hiv negative and without subsequent exposures, the tests will not change or show otherwise, the so be it. 
I thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
Coincidences occur.  Our responses (past and present) to your guilt ridden, repetitive posts are clearly not helping.  You really need to seek counseling.  Final responses:
1.  one in tens, if not hundreds of millions. 
2.  Your results are absolute for non-B or other subtypes.
3.  No
4.  No
5.  No further testing is warranted

Yes, your results PROVE you are not infected.

This is your third and final response to this series of questions.  I must warn you that if you return to our forum with similar or related questions related to this exposure and your test results, the question will be closed without a response and without a refund of your money. This decision is being made out of concern for you and your mental health, nothing more.  You really need to move on and we do not wish to enable your continuing, inappropriate anxiety.  I wish you the best.  EWH
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37 months ago
I meant to ask this prior and if you would be so kind even though past the limit. 
I know that in the past sometimes you had to test out to six months.  I see now even that if you have an occupation exposure, they consider it conclusive at 90 days. (True?)
1) would you say that even AT MOST, that 90 days (much longer than six weeks)is going to catch all truly infected individuals with any sort of hiv infection without a false negative?
Sorry, was meant to be included in earlier post. 
Thank you
37 months ago
I meant to ask this prior and if you would be so kind even though past the limit. 
I know that in the past sometimes you had to test out to six months.  I see now even that if you have an occupation exposure, they consider it conclusive at 90 days. (True?)
1) would you say that even AT MOST, that 90 days (much longer than six weeks)is going to catch all truly infected individuals with any sort of hiv infection without a false negative?
2)FINALLY, yes repeat but HAVE TO BE CERAIN, no worries about sex with wife whatsoever?
Sorry, was meant to be included in earlier post. 
Thank you, and hope to NEVER be back here. Take care
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
1.  Yes, true
2.  No risk to your wife.

Further new questions on this forum will be deleted without comment and without payment of your fees.  EWH
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