[Question #3572] HIV test confusion

34 months ago
Respected Experts/Doctors

Apologise that I’m back regarding my exposure. Read your posts I understand and know 6 weeks 100%, also read the CDC website which is 45 days for AB/AG tests. I’m also aware that CDC says 90 days for all other tests, I have tested beyond 90 days with a CMIA test. 
Dr. Hook explained very well and assured me that tests today cover all HIV types and subtypes and even the rare strains. 
Reason why I’m back is because things do not add up sir. Swollen glands behind knee, bouts of pain under arms and a swollen  lymph node under one arm that refuses to go, unexplained mouth fungal infection which has never happened to me but refusing to go since the past 45 days and all these things happening to me ONLY and ONLY post exposure. Wouldn’t anyone in my place feel that it is certainly because of that exposure. 
You are the experts in this field with decades of experience, please guide me that suddenly post exposure if I so much is happening to my body, what is it then? What should I get tested for? 

I need your guidance and help doctors, my symptoms are not anxiety and are Very real and hurt. I have done all my tests through one lab, should I try another lab? Do you think very rarely a lab machine may mess up or a particular lab may use an assay which is not up to date? All my test reports have CMIA written on them below HIV1/2 antobody and p24 serum. Is it asking for too much if you check the laboratory Lalpathlabs India for me online and tell me if they are up to the mark. Something is wrong in my body and I know it.
Have you heard directly or through your colleagues ever that someone tested beyond 90 days and the lab assay was not standard? I worry that your information and decades of experience is in America and I live in a third world country where there are no reliable bodies to check standards. One important question - all my tests are CMIA which is the best test for HIV 1 and 2 according to you? The most reliable one? 
34 months ago
I also want to mention Sir, before I found your site I had one interaction on a site called Healthtap regarding this same exposure and a doctor (Dr. Gurmukhi Singh) replied and said to be sure get a NAAt at 6 months post exposure. Isn’t this beyond what CDC recommends ? I checked the RNA PCR test I took from the lab and they have developed their own indigenous method of testing. Now how do I know how reliable is that?  Below from their website - PLEASE PLEASE READ. 

Since in India subtype C is the predominant circulating HIV-1 clade accounting for more than 90% infections, we at Dr. Lal Pathlabs Pvt. Ltd. conceptualised development of a sensitive, specific, reproducible and affordable assay based on Real-time Reverse Transcriptase-Polymerase Chain Reaction technique (RT-PCR) for quantification of plasma HIV-1 RNA levels in patients with HIV infection. The real-time PCR technology measures accumulation of PCR product in real-time providing better quantification of the initial copy numbers with a dynamic range of detection. We designed and developed a two-tube method in which one tube is used for reverse transcription of HIV-RNA extracted from plasma/serum of HIV infected individual and the second tube is used for amplification of the transcribed cDNA. The use of Taqman probe contributes in measuring reporter dye emissions accurately with almost 100% specificity and sensitivity since it has already been reported that a single mismatch can lead to reduced amplification efficiencies resulting in decreased viral load measurements. Our assay is highly specific as all HIV-1 negative healthy donor samples failed to show any positive fluorescent signal. In addition the assay has a very high sensitivity and it can detect 30 g. eq./ml of HIV RNA. The standard curve showed linearity over eight orders of magnitude with high coefficient of correlation indicating its high sensitivity in determining viral loads over a broad range.

Uniqueness of this test resides in

  • It quantitated almost all subtypes of HIV-1 including HIV-1 subtype O, particularly  ● subtype C and subtype B;

34 months ago
I have no reason to get into types and subtypes of HIV1 and HIV2. Neither do I have any reason to get into type of tests and assays because I’m not qualified to understand all this. 

You Sir are experts with immense experience, please show me the right way taking into account the minutest or rarest of circumstances as I’m genuinely struggling. 
34 months ago
Ok. I’ve decided that whatever you reply I’m going to take that as final with regards to HIV and my exposure irrespective of anything else including my symptoms. Forget my city I think my country also does not have experts like you. I know I cant do better than this in terms of expert advice. When replying to me please consider that my exposure was in Thailand and I have been tested in India. 

Strains, types/subtypes found in India/ Thailand/ HIV2 presence in India etc are making me crazy. I’m now going to follow your advice blindly. 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
I'm saddened to see that you are back, unable or unwilling to accept your negative laboratory tests for HIV.  You indicated that the lab you used is one of a large chain or laboratories and that it used the Abbott CMIA assay which is used worldwide for HIV diagnosis.  I would think that would raise your confidence and am skeptical that your negative tests indicate some sort of problem at the laboratory.  Further, you indicate that your negative lab tests have also been confirmed by a laboratory-developed PCR test which confirm the results you received earlier. 

You need to accept that you do not have HIV.  Swollen lymph nodes are a non-specific finding which have many. many non-HIV causes and can be normal findings.  My advice is that rather than wasting your time with further testing to pursue your incorrect assumption that you have HIV, to suggest you see a trained internist and work to find out whether your swollen lymph nodes are abnormal (you may have only just coincidentally noticed them after your encounter of concern) and if they are, to find the non-HIV cause.  Continuing to search the internet will only mislead you.

I also need to point out to you that our Forum does not permit clients to post repetitive, anxiety-driven posts.  Continuing to ask these repetitive questions will not lead to different answers and risks having your post shut down without further responses and without refund of your posting fee.  There is no good medical reason for you to think you have HIV.  EWH
34 months ago
Thank you Dr. Hook. Thank you once again. My swollen lymph node may have been there but it never hurt. Now I have bouts of pain that come and go. 

I have a swollen gland behind my knee which also hurts. Trust me, my symptoms are not anxiety. 

Anyway, like I said this time - forget my city .... I’m confident that my country doesn’t have experts like you and I’m going to follow your advice totally and absolutely. No more follow up questions. I’m going to resume intimate relationships with my partner based on your advice. 

I just hope and pray that I’m not that case which was a missed infection by these tests. 

I am trusting your advice and your confidence on these tests. Yes I confirmed with the lab they use abbott architect 1000. The PCR they use also I mentioned above in my post. Whatever information I could get I mentioned it for you. 

Also, a couple of posts I read where Dr.HH said that in 14 years of answering questions there is not even one person who got HIV from the exposure he/she was concerned about. Praying to god that I’m not the first.

Thank you sir. Have a nice day!! I’ve decided now that I need to trust your advice and I have to stop somewhere with this. 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Once again, I am not denying your swollen nodes or symptoms.  What I am doing is telling you, repeatedly to no avail, that they are NOT HIV.   You need to find out what is going on through interactions with a thoughtful physician who will carefully evaluate you for non-HIV causes of your symptoms.  In the meantime, you might also consider seeking the input of a mental health professional to help you understand why you are having so much trouble believing some of the most reliable tests in all the world and what to do about it.  EWH
34 months ago
Dr. Hook,
No follow up questions as you have now in two posts made yourself very very clear. 
Like I said I’m going to trust your advice blindly as I have given you all the information I possibly could.

Whenever I feel anxious I will re read your replies. 


Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Thanks for your thanks.   I'm pleased that the information I have provided is useful to you. Take care.  EWH---
34 months ago
Hi Dr. Hook,

I didn’t use my second follow up, with your kind permission will use it now and then ofcourse I know you will close this thread. Thank you for all the help and explanation. Please bear with these last set of questions which ofcourse are for my understanding and reassurance that I’m not missing anything. Your help is greatly appreciated. I will be HIGHLY GRATEFUL if you could mention about the Roche cobas ampliprep and abbott architect CMIA tests detecting all types and sub types in detail. 

1.) I called the lab to ask them about the PCR RNA I took and although it was difficult but post a lot of persuasion the lab technician said for the PCR RNA HIV1 they use Roche Cobas Ampliprep. Have you heard of this and is this reliable for all types and sub types of the HIV virus?
2.)Please confirm 100% that HIV tests today Ag/AB tests specially the Abbott Architect CMIA assay covers all types and sub types - I don’t need to worry about different types and subtypes at all under any circumstances whatsoever ?
3.)I have a lot is symptoms like I informed you earlier Sir - headaches, mouth fungal infection, some weird nails infection, swollen and painful nodes under arms, swelling and pain in knees. Are you still 100% sure that all these symptoms together at the same time are not because of HIV, considering negative abbott architect CMIA HIV 1/2 AB/ag tests at 30,65,82 and 140 days? 
4.) Sir, you are an expert and have so many years of experience and will have so many colleagues in this field, has it never happened that someone tested negative with 4 tests upto 140 days and then realised that infection was missed? Co infection, another ailment etc any reason - I have not taken PEP/Prep. 
5.)you said abbott architect CMIA assay is used worldwide for HIV tests. Given severe symptoms now, typical ARS symptoms earlier and a high risk exposure - would you even consider testing by another method? Even minutest possibilities? 
6.) My last test was about four and a half months post exposure . The CDC says 97% people till 3 months and 3% might seroconvert upto 6 months. In your opinion someone with typical symptoms should take a 6 month test? 
7.) is a bakers cyst behind knee related to HIV ? Is it seen with people with HIV infection?
8.)Last question - there may not be a study or data but if oil is used on a condom what are the chances of it failing in terms of %. Is it 50% or less chance of failing? Or it is in the lines of 80% sure the condom will fail? Just guide me on the chances are the big or are they small that it just might break but mostly it won’t . PLEASE THIS ONE IS IMPORTANT TO ME. 

Thanks SIR!!! 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
These will be final answers to your repetitive questions which show that you are unable to accept that your symptoms are NOT due to HIV and that you have already PROVEN that you do not have HIV and that you are unwilling to look for other explanations. 

1.  The Roche Cobas assays are accurate tests which have been approved globally, including by the U.S. FDA.  Their results are reliable.
2.  Repetitive- see earlier answers.  Believe your results.
3.  I am confident your symptoms are not due to HIV based on your test results.  I have recommended you work with a doctor to look for other reasons.  You do not have HIV.
4.  Correct, I have never seen a persons with a story like yours and negative tests who turned out to have HIV.
5.  No, there is no need for further testing
6.  There is no need for further testing
7.  No
8.  Petroleum products weaken condoms but most condoms, even when used with petroleum products do not fail.  When they fail, they typically break wide open leaving no doubt that they have failed.

end of thread.  Future questions of this sort will be deleted without response or return of your posting fee.  EWH