[Question #3697] Symptoms or Tests? 2nd Post- Dr. Handsfield 2nd opinion

35 months ago
High risk exposure with Asian sex worker 12/2017. About a week later bad nausea that still to this  day bothers me to some extent. I to my knowledge have not had swollen nodes BUT STILL today I have VERY stiff neck, painful joints, sore jaw/chin, and overall muscle aches. I have tested a lot and still very worried I could have hiv of some sort—particularly hiv-2 or crf that Wasn’t detectable by my test 
-4 week duo, quantitative hiv-1 rna
-5 week duo, qualitative hiv m-1 rna
-7 week duo, qualitative hiv-1 rna, hiv-2 proviral dna/rna, hiv-2 Eia
-10 AND  13 week Abbott duo
-16 week hiv-1 rna, qualitative and quantitative 
-18 week advia duo
—ALL TESTS NEGATIVE 

1)with ALL my symptoms persist,  how confident can I be in the reliability?
2)I’m very worried about hiv-2/crf. I know you say 6 weeks, but how about hiv-2? How reliable is the test at the times I took? Is there the possibility of false negative for ANY hiv at 18 weeks?
3)my symptoms  somewhat subsided after my 18 week test. could I have been seroconverting, and  tests just could have missed?
4)with STILL the symptoms I have,  do I need another test of some sort,  and what are chances of turning after my 18 week test for ANY type of hiv 1 or 2?
5)in regards to duo test in general  Abbott or advia, how much confidence no matter what symptoms I have can I put in these tests, and  would you advise one to do a repeat now at 5 1/2 month to COMPLETELY rule out, and if so what test?
6) I am going to take a syphilis test on Monday to rule that out, shoukd I add another duo?
7)How possible is it that a 18 week negative can change to positive?
I am just very worried that I could be later converter, some sort of hiv was missed, or for whatever reason. 
I need your perspective really on the tests for hiv 1 AND 2 and their window period. 
I thank you 
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Welcome to the Forum.  I'll try to help.  Your test results, using multiple different sorts of tests conclusively prove that you did not get HIV from your exposure back in December. of any sort (-1, -2, variant strains, etc.).  A few words of clarification.  First, the internet is the wrong place to look for information.  Much of the information found there is out of date, taken out of context, and/or just place wrong.  Second, when some of the types of HIV, such as variants or HIV-2 which were more difficult to detect with older tests were "missed", test results were not negative but "inconclusive" and therefore difficult to detect as either positive or negative.  This led to further investigation which led to the diagnosis of infection.  Based on the test results you describe, I am completely confident that you do not have HIV of any sort.  I hope you will accept this.

With that, let's go to your specific comments

1)with ALL my symptoms persist,  how confident can I be in the reliability?
When tests and symptoms disagree, the tests are always right.  There are absolutely NO SIGNS OR SYMPTOMS that are caused only by HIV.  All have other casues.  In your case, problems such as muscle and joint pains are very non-specific.

2)I’m very worried about hiv-2/crf. I know you say 6 weeks, but how about hiv-2? How reliable is the test at the times I took? Is there the possibility of false negative for ANY hiv at 18 weeks?
Please see my comments above.  Your 18 week results, among others, are conclusive.

3)my symptoms  somewhat subsided after my 18 week test. could I have been seroconverting, and  tests just could have missed?
No, during seroconversion tests are typically positive.  Further, the symptoms of recently acquired HIV do not occur this far out after acquisition of infection.

4)with STILL the symptoms I have,  do I need another test of some sort,  and what are chances of turning after my 18 week test for ANY type of hiv 1 or 2?
There really is no need for further testing of any sort.  Really.  Einstein said that one definition of insanity is to do the same thing again and again and expect different results.

5)in regards to duo test in general  Abbott or advia, how much confidence no matter what symptoms I have can I put in these tests, and  would you advise one to do a repeat now at 5 1/2 month to COMPLETELY rule out, and if so what test?
Please have complete confidence. Currently available tests for HIV are amongst the most accurate tests ever developed.  Obviously further testing is your decision however I have complete confidence that additional tests will be negative. 

6) I am going to take a syphilis test on Monday to rule that out, shoukd I add another duo?
Repetitive question. My answer will not change. 

7)How possible is it that a 18 week negative can change to positive?
Repetitive again.  Your results are not going to change, nor is my assessment.

I hope this information is helpful.  EWH
---
35 months ago
Thank you. What very much concerns me is that my wife has started coming down with night sweats, not bad, but mild.  She is 47 years old so could be nothing or else could be a symptom. I have kept all my testing from her because i have had a 3 month and 4 month duo as well as the RNA and all say conclusive, but possible for some reason, i could be the one that gets missed.  I had the classic timing of symptoms onset 1 week after.  Nausea(which lasted 4 months) during that time i was tested by the prior mentioned tests. 
1)It does seem that HIV-1 should be conclusively ruled out with all prior tests, beyond any shadow of a doubt?  Agree?
2)Regarding HIV-2 and the Duo test, what is the CONCLUSIVE window period for testing where i should not even consider no matter what symptoms?
3)Would having another specific eia for HIV-2 be warranted?  Is it better than the duo at 18 weeks?
4)Instead of browsing the web, I will ask  you, what is absolute window period considered these days for 3rd/4th?  CDC/WHO says 45 and 90?  your thoughts?
5)with all my testing AND symptoms bad until 18 weeks and still some new ones now(neck stiff, bad muscle twitch, jaw pain), would have at least some of my tests shown positive if infected?  Its a guess, but from what point on would you think?
6)Do you feel it would be best to abstain from sex with wife?  I am worried about her symptoms as well.
7)If you were in my position, with all my tests, would you feel compelled to tell her to get tested for HIV?  I really dont want to if I can avoid.
I just so much want to put this behind me and never look back at it, but scared still that with my ongoing stuff, and hers, HIV of some sort could still be in play somehow and I want to do everything I can to identify what is causing me these health issues.  If you feel that my testing is extensive enough, i will try and chill and look elsewhere for answers.  I just want the PRIOR tests to be correct.
Thank you


35 months ago
Forgot to prior, that Monday will be 24 weeks past exposure...no testing has been done since the 18 week mark
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Some of your follow-up questions are a bit repetitive.  I'll try to respond.  Before I do however, the symptoms you describe were not "classic" for the ARS.  First they occurred rather early, second, nausea is not a prominent part of ARS symptoms, and third, ARS symptoms which occur during the period that antibodies to infection are beginning to be made, never last for 4 months.  concerns about the accuracy of tests beyond 6-12 weeks, depending on which test is used but never beyond this period. Thus, your multiple tests since week 7 are all conclusive.  Questions about test accuracy at times like this are typically internet -fueled and off target.

As for your wife's symptoms, night sweats are not a symptom of HIV in the first several years following infection  (other than the ARS in which symptoms are severe) and are non-specific.  Common causes of night sweats include reflux. 

Now back to your follow-up questions:

1)It does seem that HIV-1 should be conclusively ruled out with all prior tests, beyond any shadow of a doubt?  Agree?
Absolutely.  You do not have HIV-1.

2)Regarding HIV-2 and the Duo test, what is the CONCLUSIVE window period for testing where i should not even consider no matter what symptoms?
The manufacturer's descriptions about the window period for HIV-2 are more vague than for HIV-1 and depend on detection of HIV-2 antibodies, not antigen.  That said, antibodies would have certainly been produced well before week 12, thus, your antibody tests at 10, 13 and 18 weeks are conclusive.  further testing of any sort will not change the result.

3)Would having another specific eia for HIV-2 be warranted?  Is it better than the duo at 18 weeks?
See above.

4)Instead of browsing the web, I will ask  you, what is absolute window period considered these days for 3rd/4th?  CDC/WHO says 45 and 90?  your thoughts?
WHO's longer window period reflects the increasingly rare use of antibody only detection tests.  We use the CDC's 45 day (6 week) window and to be honest, feel that his is a conservative guideline.  Neither of us has ever seen or heard of someone with recently acquired HIV who took longer than 4 weeks to have their combination HIV antigen/antibody test become positive.

5)with all my testing AND symptoms bad until 18 weeks and still some new ones now(neck stiff, bad muscle twitch, jaw pain), would have at least some of my tests shown positive if infected?  Its a guess, but from what point on would you think?
I advise you to look for other causes of your symptoms.  These symptoms are non-specific and you have conclusively and repeatedly ruled out the possibility of HIV with tests since your PCRA results on week 4.

6)Do you feel it would be best to abstain from sex with wife?  I am worried about her symptoms as well.
No, nothing suggests that you need to abstain from sex with your wife.

)If you were in my position, with all my tests, would you feel compelled to tell her to get tested for HIV?  I really dont want to if I can avoid
---
35 months ago

Thank you for all the information.  There is ALOT out there.  I think what worries me the most still is the timing of it all.  All symptoms started right after exposure and my Dr and me have not come to any conclusions about it at all.  I read in another post today(trying to do research before I ask), that tests are “typically positive” when symptoms “resolve”.  I still to this day have them, now a little over 5 months afterwards.  In the end, I feel I have done many tests to test for HIV, but have a couple final questions if you may.  There is NOT MUCH out there on HIV-2

1)Regarding HIV-2 specifically, you mentioned antibody test would be positive already?  Are there considerations in which you have to go past the time I took the tests?(longer than four months) to be absolutely sure? Do you need to continue to test for it after a 4month test, even with new symptoms?

2)Are the combo tests as sensitive as a specific EIA for HIV-2?

3)Can the symptoms of HIV from recent exposure(like mine) last months without a positive test HIV 1 antigen/antibody OR HIV-2 antibody?, and wax and wane in severity?

4)In the setting of ongoing symptoms(not resolved though), can I feel secure that my tests are accurate and would readily detect ANY infection by the 18 week mark?  Are there situations where one would cast doubt on their accuracy?

5)Even in light of such mysterious symptoms/timing/severity, as well as many systemic whole body things going on, should/is there a reason for me to feel compelled to test any further out from what I have done, so as to make sure ALL is ruled out for my health as well as the health of my loved ones?

6)Finally, what would you say is the outside window period for HIV-1 with the DUO test as it tests for both the antigen/antibody, and what about HIV-2 with the duo as it only has the antibody component? I was unclear on your prior response.


Thank you for your time/professionalism

Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
If you believe in chance at all, I would suggest that it should make sense that coincidental occurrence of non-specific symptoms such as you experienced is extraordinarily more likely than that you have acquired HIV that was not detected by testing.  FYI research has shown that we persons with acknowledged risk for HIV present with typical symptoms, 99% of those persons have some illness other than HIV.  In your case, you have an exposure to a partner of unknown HIV status (who therefore is statistically unlikely to have HIV), atypical symptoms, and multiple negative tests using several different test mechanisms.  I am absolutely confident that you did not get HIV from the exposure you continue to worry about.  As final answers to your questions:

1)Regarding HIV-2 specifically, you mentioned antibody test would be positive already?  Are there considerations in which you have to go past the time I took the tests?(longer than four months) to be absolutely sure? Do you need to continue to test for it after a 4month test, even with new symptoms?

The only situation where it MIGHT (but probably would not) take longer for a HIV-2 test to become positive is when someone had taken PEP (anti-HIV drugs) in an unsuccessful attempt to prevent infection.


2)Are the combo tests as sensitive as a specific EIA for HIV-2?

Yes, absolutely.


3)Can the symptoms of HIV from recent exposure(like mine) last months without a positive test HIV 1 antigen/antibody OR HIV-2 antibody?, and wax and wane in severity?

Absolutely not.


4)In the setting of ongoing symptoms(not resolved though), can I feel secure that my tests are accurate and would readily detect ANY infection by the 18 week mark?  Are there situations where one would cast doubt on their accuracy?

Yes, you should have complete confidence in your test results.


5)Even in light of such mysterious symptoms/timing/severity, as well as many systemic whole body things going on, should/is there a reason for me to feel compelled to test any further out from what I have done, so as to make sure ALL is ruled out for my health as well as the health of my loved ones?

The only thing that you will accomplish with further testing related to this exposure is wasting your time and money.  Taking the money and lighting it on fire would be equally productive.


6)Finally, what would you say is the outside window period for HIV-1 with the DUO test as it tests for both the antigen/antibody, and what about HIV-2 with the duo as it only has the antibody component? I was unclear on your prior response.

For HIV-1 the outside limit  for combination tests is 6 weeks and in my opinion that figure is conservative.  For HIV-2, because the infection is so rare (in the U.S. between 1987 and 2009 there were 166 persons diagnosed with HIV-2 or who 132 occurred among persons who were from west Africa;   during the same time 1,400,000 Americans acquired HIV).  the data are less precise but all available data suggest that by 8-12 weeks antibody tests would be definitive.


My sense is that you are beginning to accept that you do not have HIV.  I hope that is the case.  As you know, we provide only 3 responses per question set and this is my 3rd response.  Thus this thread will be closed later today.  I wish you the best and hope that you will be able to put your concerns about HIV aside.  EWH


---