[Question #3517] Exposures yrs back/recent/symptoms,confidence tests/window period despite it all

35 months ago
Hello Dr.  I would like to ask about old/recent exposures.  Over the past 5-6 years I had some risky behavior and tested every 6 months for HIV, always negative.  My last exposure was 11/2017.  Since that time I have symptoms but ALL neg tests.  I've had a 3,4,5,7,10,13 week HIV duo/4&16 week HIV-1 RNA/viral load/5&7 week Aptima/16 week HIV-1 proviral DNA/7 week proviral DNA HIV-2 PCR.  My exposure was a lady of foreign descent and I am REALLY WORRIED about HIV-2.  I understand HIV-2 is less viremic, so possibly it takes longer for tests to become positive and generally viral load is much lower so PCR could have missed.  I will try to be brief.
1)IF I was infected years back with HIV 1 or 2, would most if not all the test be positive, or could one be at a more advanced stage of disease and not show at all?
2)With ALL my HIV-1 tests(most recent 13 week 4th/16 week RNA quant/DNA qual), can I be CERTAIN without any doubt that I do not have ANY type of HIV-1?3)Any way that most recent tests or prior miss HIV-1 at all?
4)With HIV-2 being less aggressive, could it take longer for the immune response to show positive on the duo test?  I understand that 13 weeks is considered conclusive for antibody tests, and with the HIV-2 portion of the duo test being just antibody, could it be false negative, especially with symptoms that are many?5)Some sites say you may need to test to 6 months for HIV-2, what are your thoughts on that and do you need to use a specific EIA just for HIV-2 to be more sensitive because the hiv-2 portion not as sensitive for it?
6)When would you advise someone with symptoms but tested negative at 6 weeks let alone 90 days, and without prep/pep, to keep testing for HIV of ANY TYPE?7)HIV-2 is my BIGGEST worry even though it is rare, because of my exposure with the girl of foreign land.  WHAT can I do to make ABSOLUTELY SURE,  that I don't have or missing it(all my duos, 7 week pcr, 7 week HIV-2 specific EIA.
8)Is there ANYTHING left to do to be SURE??
Thank you
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Your second and most recent thread ended with a statement from Dr. Hook that "no further questions will be accepted and further posits will be deleted without comment and without reimbursement of your fee." And your current questions all repeat ones answered in your other threads, either directly or by implication from the general information Dr. Hook provided you. Hence succinct replies and no opporunity for follow-up comments.

1) "IF I was infected years back with HIV 1 or 2, would most if not all the test be positive" YES 

2) Can you be certain you don't have HIV based on all those test results? YES

3) Could tests have missed HIV1? NO

4,5,7) No, the frequently less aggressive clinical disease with HIV2 does not imply longer times to conclusive testing. We have never heard of patients taking 6 months to test positive for HIV2 and have no advice for further testing.

6) I would advise such a person to trust the tests, and work with his or her doctor about causes of the symptoms other than HIV.

8) NOPE.

To repeat and expand on Dr. Hook's previous warning:  Please note the forum does not permit repeated questions on the same topic or exposure. This will have to be your last one; future new questions about this exposure, testing, and your fears about HIV will receive no reply and the posting fee will not be refunded. 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. Thank for your understanding.