Firstly, I want to ask if I can be sure I am getting a 4th generation duo test? The blood work paper only states “HIV 1 / 2” and the label they put on the vial says “HIV AB”.  And both my doctor, and the anonymous testing clinic both state that 3 months is the window period. I did read up on CATIEs website that “all labs in Canada use the 4th generation duo as a screening test”  and I even emailed them and got basically the same response in an email that all blood drawn tests in labs use the 4th generation test, with the exception of POC testing. 

My first oral exposure, MSM, he tells me tested negative 26 days post our exposure, and I tested negative at 31 days post that exposure. 

My second exposure, sex with a CSW, A condom was used from start to finish for all acts, including oral, and there was no kissing or anything, it didn’t break as in an obvious break and it had my cum in it when I was done. I even checked it with water afterwards. My biggest concern with the condom is I am uncircumcised and I am not fully confident if the condom could of slipped up enough during the act and exposed my foreskin. She answered me first and said she was clean but then ignored me for over a month but after a number of distressed emails to her she responded and said she doesn’t have HIV and gets checked regularly because she “works” and that she was last tested 2 weeks before we met. However I don’t really trust her, and I don’t want to take her word for it. I couldn’t handle the stress until the full 6 weeks, so I got tested at 5 weeks (35 days) which came negative. I am unsure of how long it took the clinic to get the blood to the lab and I am not sure if that would have any factor in my results. However, that gives me a negative result at 15 days post that exposure, when I got checked first, and a negative result at 35 days post exposure. 

Of coarse, I got so excited over my 5 wee

To finish: of coarse I got so excited over my 5 week negative that I stupidly went home and had unprotected sex with my girlfriend which now leaves me back with a feeling of guilt and anxiety of infecting her. 

My last concern is the possibility of HIV 2. I’m not sure how common it is around these parts, and since the p24 antigen isn’t part of it, and I didn’t wait the 6-8 weeks, I feel like it’s possible to have hiv2. 

I did have some strange “syptoms” that I convinced myself were due to HIV, however I guess my 5 week test proves it isn’t. I had red patches and spots on mainly my left hand, sometimes my right for almost a week or close to two. And I had strange pains in my throat but they weren’t persistent and they would come and go. 

HIV A/B test indicates antigen-antibody. The term "4th generation" is now discouraged by CDC and other experts, but that's what you had. Many providers and websites continue to advise waiting 3 months, but that's just inertia, conservatism or in some cases, laziness. The Ag/Ab tests are nearly conclusive by 4 weeks and 100% conclusive any time 6 weeks or more after the last possible exposure. But in your case, you can consider your 5 week result as conclusive:  before that test, the chance you had HIV was probably as low as 1 in 10 million. With a 99% reliable test, that becomes 1 in a billion. That is, zero for all practical purposes. It was entirely correct for you to resume sex with your wife.

If I understand correctly, both your partners were tested and negative for HIV, so you know you weren't exposed. Even if you were, the test results rule:  even without knowing your partners' negative test results, your result shows you were not infected, no matter how high the risk might have seemed at the time of exposure. I'm glad you did not seek PEP, whose main effect would have been to just prolong your anxiety, since conclusive testing after PEP needs to wait at least 3 months and, per some experts, 6 months.

The standard HIV Ag/Ab test is valid for HIV2 as well as HIV1. In any case, HIV2 remains extremely rare in North America. Your "symptoms" shouldn't concern you at all. Test results always overrule all symptoms, no matter how typical for a new HIV infection -- and anyway, your symptoms don't suggest HIV anyway.

I think those comments address all your concerns. If you would like to have another test at 6+ weeks after the last exposure, feel free, but it really isn't necessary. For sure you don't have HIV.

Let me know if anything isn't clear.

HHH, MD

Can the amount of time it takes a clinic to get the blood samples to the lab alter results? (2-4 hours I assume)

My concern in regards to HIV2 is the p24 antigen is not a part of it, and I’ve read posts from dr. Hook that state 6-8 weeks testing for HIV2

CATIE states only 95% of infections would be detected after 34 days of infection; how can I be confident that my 35 day test is 99% reliable (I don’t mean to offend an expert, I just remain nervous). They also state that only 99% of infections would be detected at 6 weeks (1.5 months), so I’m not sure why or when the other 1% comes in.  I also thought the DUO was just a test that checked for p24, and after that was essitenally a 3rd generation checking for antibodies, but 3rd generation has a much longer window period then the DUO (or the “4th generation”)

Also when talking numbers, I got slightly confused. Dr hook said my risk was between 1:1000(unprotected), and 1:100,000(protected), and you state a risk of 1 in ten million. I think this is you using numbers such as actual infected females in comparison to my risk, but in my risk assement I continue to assume she is positive anyway. 

Is there a window of time (after 3-4 weeks) at all that neither p24 or antibodies would not be detectable or missed in a test? Just because I read that p24 peaks around 28 days, but we need to wait 6 weeks for 100% conclusive result. For example, if the DUO detects antigens and antibodies, and if the antibodies clear the antigens, and antigens peak at 28ish days, how come the duo is only “98%-99%” at 4 weeks but not “99%(CATIE)-100%(yourself/dr hook)” until 6 weeks, two weeks later. I tested at 15 days, and 35, both negative. 

I tested 51 days post my oral exposure (which is a neglible concern anyway), negative so I assume I’m completely safe on that one and no more discussion or thought is needed on that. 

The problem with the CSW is she was tested 2 weeks BEFORE I was with her, leaving her in a possible window period even, IF she even tested at all, and if she was even actually negative. I honestly don’t trust her and will remain with the assumption she is positive for risk assement purposes.  All acts with her were condom protected, from start to finish, and the condom didn’t break, I’m just not sure how much condom slippage there was and if any foreskin was exposed during the acts. 

The red spots/patches really resembled a rash to me on my hands, and came around 2-3 weeks afterwards and stayed for 1-2 weeks and has seemed to clear up completely now. Which scares me. Also today makes officially 6 weeks and I feel some bumps/possible sores on the side of my mouth that I instantly want to link to HIV. 

I love how you ended with “for sure you don’t have HIV”. That was very nice, and fairly reassuring, however, I still keep thinking  that I’m still within a 95%-99% window, and maybe my infection hasn’t been picked up yet. I’m very worried of being infected, and every time I sleep with my regular partner now I get very concerned of infecting her

I'm not familiar with CATE -- some sort of AIDS agency or website, I presume.

The odds any particular person are in a window period when tested also are very low. So the numbers above actually are a major over-estimate of the chance you have HIV2. That you're in a "95-99% window" doesn't mean there is a 1-5% chance you are infected. That's the factor that you need to multiply into the other measures of risk. Hence probably under one chance in a billior (or lower) you are infected, even without waiting for a truly conclusive test.

Really, don't worry about this! It's truly a waste of emotional energy.

1. Almost all sources (and they’re dogs) says to test at 6 weeks, and then 12 weeks to confirm. Have you ever seen any tests turn positive after the 6 week test? Assuming they’re regular healthy people, not on chemo and have regular immune function. 

2. Can the amount of time it takes a clinic to get the blood samples to the lab alter results?

2) The HIV blood tests are extremely robust. Transport time, temperature, etc have no effect.

3) No. Once antigen appears (typically 10-15 days), then antigen or antibody (sometimes both) are present for life.

4) See my original reply; in which I estimated 99% reliability at 5 weeks. I haven't changed my advice:  "...you can consider your 5 week result as conclusive:  before that test, the chance you had HIV was probably as low as 1 in 10 million. With a 99% reliable test, that becomes 1 in a billion. That is, zero for all practical purposes."

"now I’m going to continue being stuck unsure, and possibly infecting my regular partner. " Nonsense. You can and should be 100% certain about it. But if you really feel you need an additional negative test result and your doctor won't order it for you, surely you can find a different doctor or contact a lab directly for another test. You truly don't need it, and I wouldn't do it if somehow I were in you circumstances -- but you can get tested if you insist.