[Question #3570] HIV-1 subtype/strain of HIV-2 missed? Tested@ 129 days. Believe or test more?

34 months ago

Dear Doctors, I hope you can give me knowledge to direct me.  I had an exposure early December of last year.  I was involved with a woman from Beijing(she was native) when I was on business.  We briefly had intercourse that was briefly unprotected.  Also, at the same time, she masturbated me by sticking her finger in my rectum during the act of sex when it was protected.  We did this off and on for around ten minutes.  When I returned to the states a week later, I started feeling very ill with nausea and stomach cramping. I have also developed many muscle twitches, sensations.  To this day I still have all the above.  This has now been 19 weeks since exposure abouts.  I went and tested at Laborp(L) and Quest(Q)through requestatest.  I tested at the following weeks.  4L,6L,10Q,13Q,18L. All these tests were negative. I know that it should rule it out, but with symptoms, scares me!

1)Would for sure ANY HIV-1 subtype or strain be picked up by now?

2)Do I need to test longer for HIV-1 to make sure, in case she had it? Longer than my 4 months?

3)IF it was HIV-2 and since there is no Antigen to that test, how long AT MAX, do I need to test out even in the setting of my symptoms that started right after?

4)Not much is know about HIV-2, but can I be certain, that at 4 months the antibody portion would have picked it up if there was infection?

5)I see where you say symptoms do not matter with test results, but are there qualifying exceptions to that?

6)Can I be ABSOLUTELY certain that my tests are true for HIV-1 AND HIV-2 in the setting of my current symptoms, or are more tests necessary at a later date, and if so when to be totally sure?


I just want to make CERTAIN, that I do not have any type.  I will test again if necessary to be absolutely sure at whatever time frame you think.  I appreciate your input.

Thank you

Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Welcome to our Forum.  We are frequently asked about the ability of current HIV tests to detect HIV-2, often because clients have picked up mis-information from the internet where incorrect and out of date statements are very, very common.   You can see other responses regarding questions similar to yours by reviewing a handful of other posts on our site.  The short answer is that based on the testing history you provide, you can be entirely confident that you did not acquire HIV-1 or HIV-2 from the encounter you have described.  All  currently available HIV tests reliably detect infection, including HIV-2 when performed more than 6 weeks after exposure.  Further, the exposure you have describe was quite low risk- most people, even most commercial sex workers do not have HIV and even in the unlikely circumstance that your partner had HIV, HIV is transmitted only at a rate of one infection per 1000-2000 sexual encounters.  Thus, even before testing the odds were strongly in your favor that you were not infected and now your testing has proved that you were not.  As for your specific questions:

1)Would for sure ANY HIV-1 subtype or strain be picked up by now?

Yes.


2)Do I need to test longer for HIV-1 to make sure, in case she had it? Longer than my 4 months?

No, testing is absolutely conclusive at all times more than 6 weeks after exposure.


3)IF it was HIV-2 and since there is no Antigen to that test, how long AT MAX, do I need to test out even in the setting of my symptoms that started right after?

See above, still six weeks.  Further, if your symptoms had been due to HIV, any and all tests performed after the onset of of symptoms proved that your symptoms were not due to HIV.


4)Not much is know about HIV-2, but can I be certain, that at 4 months the antibody portion would have picked it up if there was infection?

Yes, again.


5)I see where you say symptoms do not matter with test results, but are there qualifying exceptions to that?

Nope.


6)Can I be ABSOLUTELY certain that my tests are true for HIV-1 AND HIV-2 in the setting of my current symptoms, or are more tests necessary at a later date, and if so when to be totally sure? . 

For the 3rd or 4th time, believe your tests, they are conclusive and have been on more than one occasion.  EWH



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34 months ago

Thank you for the reply, I SO VERY MUCH hope that in ANY WAY that my tests are NOT WRONG.

1)So as I told you my last test was 4/06/17(LAbcorp).  In the last few days I have felt MUCH better without the GI stuff II have been experiencing over 4 Months!! Is it possible that my last test from Labcorp(Advia Centaur) could have JUST missed the infection because immune system was just kicking in and it is taking longer to produce antibodies and if test further out, it could show positive for either HIV-1 or HIV-2?

2)Possible.that her sticking her finger in my butt with possible cut/bleed, there my have not been as much virus inserted and therefore it takes longer to produce antibody or at a slower rate?  Is this true?

3)If i have HIV-1 or HIV-2, and with ALL my symptoms over 4 MONTHS, one of my tests at least at 6,10,13,18 weeks would have been positive for sure?

4)I have done a search on your site but hard to do.  With these tests they mainly are based on group M/subtype B.  If it was another group(N,O,P) or other subtype, would these tests have by now shown reactive in the setting of symptoms, or possible not able to detect?

5)The CDC still says in some cases you have to test out to 6 Months.  In what cases?  I am worried that this could be me with all my symptoms, occurring after exposure with still some persistent.

6)We think I could be dealing with a fungal infection of GI tract/sinus.  If that being the case, does that change your opinion or are the tests still conclusive no matter the symptoms?

7)If I was infected with a different strain or other, could the tests ALWAYS show negative no matter how long you wait to test?

8)If we step back and regard 90 days as conclusive(not your advice), would the antibody portion of the test for HIV-1 or HIV-2 be positive or could you have symptoms for this long and STILL test negative?

9)Do you feel there is NO danger to me having sex with my wife, no matter what symptoms I am having regarding my HIV tests and potential late seroconversion?

10) Can I be, without question, confident that I don't have HIV of any kind, or would another type of test(CD4, another duo test/other) be advised?

11)Is there ANY reason to worry any longer, and with my tests, no matter what I am experiencing?

I just want to make sure I am not missing something that could have disasterous consequences if not diagnosed and found/treated.

Thank you

34 months ago
In number one, I meant 04/06/2018.  sorry
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Your questions are a bit repetitive.  Repeating the questions will not change my assessment.  For this reason my responses will be brief:

1.  No, your test would not have missed HIV-1 or HIV-2.
2.  This is untrue.  Your results are reliable.
3.  Correct.
4.  Less common HIV strains would have been detected.  The idea that they do not is an internet fueled myth.
5.  The CDC is overly conservative.  You would need to test out longer if you had taken preventative anti-HIV therapy before (PrEP) or after (PEP) your exposure.
6.  No change in my opinion. If you have a fungal sinus infection it is unrelated and does not suggest you have HIV.
7.  Repetitive (again) - see 4 above
8.  Repetitive- see above
9.  Correct- no danger
10.  Believe your results.  No further testing is needed. 
11.  There is no further reason to worry.

EWH
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34 months ago

I appreciate the information.  What does worry me is the fact that it seriously may be a body fungal infection.  I have all the Gastrointestinal stuff, sinus odor, and transparent worms in vision that look like textbook hyphae.  I am also getting muscle twitch and light night sweats, AS IS MY WIFE. I am also worried of the fact that she stuck her finger in my rectum and there may have been infectious blood from a cut/nick as the unprotected sex was very brief.  Also it is the fact that I am American and she Chinese and therefore there could be testing limitations due to different strains/different part of world as tests here in US not going after necessarily strains found overseas. I get this will be last reply.

1)Being the fact she was Chinese, does that alter testing strategy/reliability of tests or do you need to do different?

2)With her inserting her finger in me, how much risk does that pose?

3)As said, tested with Abbott@13 wks, Centaur@18 weeks, how would you classify the reliability of those tests and timeframe, and whats the chance that those tests(there were also earlier ones), could be wrong and giving false negative in the setting of these bad symptoms?

4)There are prominent researchers with papers like Plantier, that say you can continue to test falsely negative because of O or other “different” strain.  With symptoms should I still be concerned and if thats the case, what does one need to do to identify these to rule out?

5)With a few exposures years ago and even considering latest exposure, is it possible that one could show falsely negative on all the tests I have taken out to 18 weeks and still be HIV positive for ANY type. 

6)If you had “classic” symptoms, do my test results trump them, and am I conclusively negative for HIV of any type (1 or 2)?

7)I understand you get a lot of people like myself and over the years have not had anyone be positive.  If in fact though, you did have skepticism, would you relay that without regards to just the numbers/odds?

8)With symptoms JUST now going away in the GI tract(started 4 months ago), if it was HIV, would AT LEAST my tests(including last one) been indeterminate, or how soon would have they shown positive?

9)What is the LONGEST in terms of tests ag/ab or just antibody(HIV 1 or 2)you have to test to make the result CONCLUSIVE without question—CDC says 90days.  Does one ever have to go longer other than PEP or Prep?

10)Are there any better tests to do to make ABSOLUTELY SURE without any question that my status is ROCK SOLID no matter what symptoms I may be experiencing and not potentially putting others in harms way?

11)No matter what I or my wife is experiencing, when/is there reason to continue to test or be suspicious of a possible type that is evading detection at 18 weeks?


All I want is to be sure that I have not screwed my life or my family’s life up.  I understand that 97% or more(what is true figure?) will test by 90 days and I have had two tests at that point that are negative.  I want to believe and move on but my pure physical symptoms are real and just not “mental”.  I want to find out what is going on with my body, and as long as HIV is not part of it, then I will be OK. 


Thank you

34 months ago
Sorry, I missed something in last:

I appreciate the information.  What does worry me is the fact that it seriously may be a body fungal infection.  I have all the Gastrointestinal stuff, sinus odor, and transparent worms in vision that look like textbook hyphae.  I am also getting muscle twitch and light night sweats, AS IS MY WIFE. I am also worried of the fact that she stuck her finger in my rectum and there may have been infectious blood from a cut/nick as the unprotected sex was very brief.  Also it is the fact that I am American and she Chinese and therefore there could be testing limitations due to different strains/different part of world as tests here in US not going after necessarily strains found overseas. I get this will be last reply.

1)Being the fact she was Chinese, does that alter testing strategy/reliability of tests or do you need to do different?

2)With her inserting her finger in me, how much risk does that pose?

3)As said, tested with Abbott@13 wks, Centaur@18 weeks, how would you classify the reliability of those tests and timeframe, and whats the chance that those tests(there were also earlier ones), could be wrong and giving false negative in the setting of these bad symptoms?

4)There are prominent researchers with papers like Plantier, that say you can continue to test falsely negative because of O or other “different” strain.  With symptoms should I still be concerned and if thats the case, what does one need to do to identify these to rule out?

5)With a few exposures years ago and even considering latest exposure, is it possible that one could show falsely negative on all the tests I have taken out to 18 weeks and still be HIV positive for ANY type. 

6)If you had “classic” symptoms, do my test results trump them, and am I conclusively negative for HIV of any type (1 or 2)?

7)I understand you get a lot of people like myself and over the years have not had anyone be positive.  If in fact though, you did have skepticism, would you relay that without regards to just the numbers/odds?

8)With symptoms JUST now going away in the GI tract(started 4 months ago), if it was HIV, would AT LEAST my tests(including last one) been indeterminate, or how soon would have they shown positive?

9)What is the LONGEST in terms of tests ag/ab or just antibody(HIV 1 or 2)you have to test to make the result CONCLUSIVE without question—CDC says 90days.  Does one ever have to go longer other than PEP or Prep?

10)Are there any better tests to do to make ABSOLUTELY SURE without any question that my status is ROCK SOLID no matter what symptoms I may be experiencing and not potentially putting others in harms way?

11)No matter what I or my wife is experiencing, when/is there reason to continue to test or be suspicious of a possible type that is evading detection at 18 weeks?

12)Besides "moral", is there a reason I should have my wife undergo testing as well, or suggest?  I don't want to bring up unless absolutely needed.


All I want is to be sure that I have not screwed my life or my family’s life up.  I understand that 97% or more(what is true figure?) will test by 90 days and I have had two tests at that point that are negative.  I want to believe and move on but my pure physical symptoms are real and just not “mental”.  I want to find out what is going on with my body, and as long as HIV is not part of it, then I will be OK. 


Thank you

Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
These questions, are once again, largely repetitive.  Asking the same question repeatedly or using slightly different wording will not change my replies.  These final answers will this be brief.  As far as the "transparent worms" that you describe visually, these are floaters which may be normal or may indicate a problem.  They are not related to HIV. the proper way to evaluate this is by seeing your ophthalmologist, not testing (again) for HIV. The other symptoms you describe are likewise non-specific.  Since your have COMPLETELY RULED OUT HIV, my advice would be to see your regular physician and have your symptoms checked out.  As far as your specific questions, see below:

1)Being the fact she was Chinese, does that alter testing strategy/reliability of tests or do you need to do different?

No change is assessment, advice or tests needed. 

2)With her inserting her finger in me, how much risk does that pose?

Zero.  STDs including HIV are not transmitted through transfer of secretions on a person's hands

3)As said, tested with Abbott@13 wks, Centaur@18 weeks, how would you classify the reliability of those tests and timeframe, and whats the chance that those tests(there were also earlier ones), could be wrong and giving false negative in the setting of these bad symptoms?

Completely reliable.  Believe your results.  When symptoms and test results disagree the test results are invariably correct.

4)There are prominent researchers with papers like Plantier, that say you can continue to test falsely negative because of O or other “different” strain.  With symptoms should I still be concerned and if thats the case, what does one need to do to identify these to rule out?

See earlier answers.  Internet based concerns about type O do not warrant repeat or different testing.

5)With a few exposures years ago and even considering latest exposure, is it possible that one could show falsely negative on all the tests I have taken out to 18 weeks and still be HIV positive for ANY type. 

NO!!!

6)If you had “classic” symptoms, do my test results trump them, and am I conclusively negative for HIV of any type (1 or 2)?

See comment above.  Symptoms are non-specific, tests help to sort them out.

7)I understand you get a lot of people like myself and over the years have not had anyone be positive.  If in fact though, you did have skepticism, would you relay that without regards to just the numbers/odds?

If I were skeptical I would say so.

8)With symptoms JUST now going away in the GI tract(started 4 months ago), if it was HIV, would AT LEAST my tests(including last one) been indeterminate, or how soon would have they shown positive?

Correct.  People do not understand that the way problems with prior tests were detected were because test results were repeatedly indeterminate.  IN determinant test results warrant further evaluation.  Repeatedly negative tests do not.

9)What is the LONGEST in terms of tests ag/ab or just antibody(HIV 1 or 2)you have to test to make the result CONCLUSIVE without question—CDC says 90days.  Does one ever have to go longer other than PEP or Prep?

CDC is overly conservative.  After 6-7 weeks testing with currently available combination HIV antigen/antibody tests are definitive.

10)Are there any better tests to do to make ABSOLUTELY SURE without any question that my status is ROCK SOLID no matter what symptoms I may be experiencing and not potentially putting others in harms way?

You've had them. No need for further testing.

11)No matter what I or my wife is experiencing, when/is there reason to continue to test or be suspicious of a possible type that is evading detection at 18 weeks?

There is not.  You and perhaps your wife should have your symptoms evaluated for other causes by your doctor(s)

12)Besides "moral", is there a reason I should have my wife undergo testing as well, or suggest?  I don't want to bring up unless absolutely needed

No.


This completes this thread.  There will be no further responses.  Further, I should warn you that should you return to the site with further repetitive anxiety-driven questions regarding the exposure you have described, the questions may be deleted without a response and without return of your posting fee.  I hope my responses have been helpful. I urge you to put aside your now unwarranted concerns about HIV of any sort and to look for other reasons for the symptoms that are troubling you.  EWH

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34 months ago
Ok. Thank you very much and if You could just answer this?
1) can/could the symptoms of early hiv last the four months I had them?
Thank you and have a good weekend. 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
NO!!!!!   EWH
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