[Question #3739] HIV conclusive regardless timing/symptoms?

35 months ago
Hello. I would like to ask your opinion. I had unprotected sex exposure last year when in New Delhi.  I dont know her status and have no way of knowing now. After arriving home I came down with just an overall ill feeling after about a week. Sore throat on occasion to this day and oral stuff. I got tested through requestatest with 4th gens. who use labcorp/quest  . I did this at 3, 7,10,13,18 weeks. I continue to feel bad, with GI issues, but no fever/diarrhea. On a couple occasions I had a raised spot on torso that lasted a day and went away.  I spoke to my doctor this past week because my right jaw has been sore and I was worried about sub-mandible nodes. He felt me over and said there were none. We spoke and HE has ordered another hiv test which he told me to do at 6 months(cpl weeks). He feels unwarranted though, but doing at my urging.  I still felt anxious afterwards and went to local clinic this week and had a INSTI rapid hiv 1/2 test which was negative. 
1)Is it still possible that with tests out to nearly 6 months, hiv of ANY TYPE could be missed?
2)I get that HIV-2 is more prevalent in INDIA and tests can take longer to pick antibodies up. Is that true that HIV-2 could be being missed for whatever reason?3)getting some oral canker sores and sore throat that come and go. I know that is a symptom of hiv. How can I be sure about tests (especially the lab based I had to 18 weeks) are true and not a false negative in setting of all my symptoms?
4)Insti rapid, what are your thoughts on it? In earlier versions I read it wasn’t as good at picking up hiv-2 even though marketed for, but I think In 2015 that changed so be more sensitive for it?
5)I’m scared to take lab based test that my Dr ordered on the chances it could change. What are chances it could change for HIV 1 OR 2?
6)Is possible that HIV from that region of the world could not be picked up with any of the tests I have had(Quest, Labcorp)past 13 weeks and rapid now at 24 weeks?
Thank you

Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Welcome to our Forum.  I'll be glad to provide information.  Before I get to your questions, let me preview my overall answer and provide some perspective.  First, the perspective.  Please remember that in India and other areas with high HIV rates, most people, even most commercial sex workers do not have HIV.  Further, even if you had sex with an HIV infected CSW, your risk for infection would be less than 1/10th of 1% (i.e.  HIV is transmitted during unprotected vaginal intercourse less than 1 out of very 1000 exposures).  Thus the odds are very much in your favor.

Secondly, when symptoms and tests do not match up in situations such as your, the tests virtually always turn out to be correct.  This is because symptoms such as flu-like symptoms, swollen nodes, etc. are non-specific and have many, many causes other than HIV. 

1)Is it still possible that with tests out to nearly 6 months, hiv of ANY TYPE could be missed?
No!

2)I get that HIV-2 is more prevalent in INDIA and tests can take longer to pick antibodies up. Is that true that HIV-2 could be being missed for whatever reason?3)getting some oral canker sores and sore throat that come and go. I know that is a symptom of hiv. How can I be sure about tests (especially the lab based I had to 18 weeks) are true and not a false negative in setting of all my symptoms?
HIV-2 is slightly more common in India than HIV-1 but still quite rare.  Further the tests you took also test for HIV-2.  Canker sores are NOT a sign of HIV.

4)Insti rapid, what are your thoughts on it? In earlier versions I read it wasn’t as good at picking up hiv-2 even though marketed for, but I think In 2015 that changed so be more sensitive for it?
Believe your tests. The INSTI is a reliable test and your tests done at Labcorp/Quest are highly reliable.

5)I’m scared to take lab based test that my Dr ordered on the chances it could change. What are chances it could change for HIV 1 OR 2?
I am confident your lab tests will not change because of the exposure you describe.  Please put your fears aside. 

6)Is possible that HIV from that region of the world could not be picked up with any of the tests I have had(Quest, Labcorp)past 13 weeks and rapid now at 24.
The tests used at these labs are designed for use across the world.  I urge you to believe your tests.

I hope this information will help you.  Further testing is a waste of time and money.  You have proven you did not get HIV from the Indian encounter you mention above.   EWH


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35 months ago
Thank you much for answering. I have tried looking at various sites but there is so much information out there. If it were not for the symptoms, that continue to pester me (since shortly after exposure) I would be more easy to accept the results. It’s just that the disease can be SO different for each person.  I think that my tests for hiv-1 are  fairly certain but I remain worried about type 2. 
1) does  hiv-2 have a different window  than  hiv-1?  I have read hiv-2 has a different capsid. If yes/not, what would be absolute window?
2) with symptoms that “appear” to be consistent with hiv, when (time)can one for sure  put it out of his/her mind  and put total faith in the test results without fear of missing hiv of any sort?
3)does a lab based negative at 18 weeks and POC rapid at 24 weeks  as reliable as it gets or in what circumstances does one have to keep testing?
4)is a 6 month window still considered valid timeframe for outside window  in the absence of pep to experts?
5)What, if any test, can one do, and when to eliminate hiv of any sort, as the culprit?
6)with ongoing symptoms that remain to find a cause, how concerned should I be that I could transmit to my wife?(concerned about)
7) is it true that some people never show positive , and could have had the disease longer than thought (years??) and now immune system in trouble?
—I have now been wrestling with this latest for 6 months and want to be over it. Also, as said, had exposures in the past (and have tested last year in February negative.  I just fear I made a mistake that could haunt me either because hiv of ANY sort cannot be detected or that it is taking me longer to seroconvert. 
Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Your follow-up questions are a bit repetitive and repeating the question will not change my assessment.  As I explained above, symptoms are often misleading.  Further, if you are seeking information on the internet, I can assure you that you are going to be misled.  Much of what is said there is alarmist, taken out of context, out of date or just plain wrong. 

1) does  hiv-2 have a different window  than  hiv-1?  I have read hiv-2 has a different capsid. If yes/not, what would be absolute window?
Because most assays for HIV-2 are antibody tests, standard assays for HIV-2 are not conclusive until 8-12 weeks after exposure while because the HIV-1 assay detects both HIV-1 antibody and HIV-1 antigen, tests for HIV-1 are conclusive at 6 weeks.  That said as I said above, your test result are conclusive. 

2) with symptoms that “appear” to be consistent with hiv, when (time)can one for sure  put it out of his/her mind  and put total faith in the test results without fear of missing hiv of any sort?
Repetitive.  See above. 

3)does a lab based negative at 18 weeks and POC rapid at 24 weeks  as reliable as it gets or in what circumstances does one have to keep testing?
there is no need for you to continue testing.  The results will not change.

4)is a 6 month window still considered valid timeframe for outside window  in the absence of pep to experts?
No, see response to question 1.  Your results are (repeatedly) conclusive. 

5)What, if any test, can one do, and when to eliminate hiv of any sort, as the culprit?
You've done them.  Now you need to accept the results.

6)with ongoing symptoms that remain to find a cause, how concerned should I be that I could transmit to my wife?(concerned about)
You do not have HIV so you cannot transmit it to your wife.  If your persistent symptoms trouble you (as opposed to fueling your anxiety), my advice is to see your own doctor to look for the alternate reasons for your symptoms.

7) is it true that some people never show positive , and could have had the disease longer than thought (years??) and now immune system in trouble?
No, this is an internet-based myth.  Persons with HIV have positive tests.  After 6 weeks for HIV-1 and 12 weeks for HIV-2, all infected persons have positive tests.

EWH
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35 months ago
Dr. Hook, thank you.  By all evidence it would support that infection is unlikely, its just that my health has significantly declined over 6 months.  It seems I always have a sore throat, among other things.  I do believe I have ruled out HIV-1 with all of the duo, BUT not HIV-2.  ALL of my testing I have done on my own accord except for the one next week ordered by my doctor.  I honestly DO have real symptoms, but do not know their cause.  I just need to be sure its not hiv of any kind.
1)Is my negative Insti rapid at 24 weeks as reliable as a lab based test?
2)Does there tend to be more false neg or false positive with rapid tests?
3)At 25 weeks now, could one STILL have symptoms coming from an exposure late last year,  and can HIV symptoms continue but still test negative this far out?
4)Can one have an aggressive sort of HIV infection that causes rapid decline, but still tests negative on all tests?
5)Regarding HIV of other subtypes/strains, would the testing i have had, had picked up any type including my duos and recent rapid?
6)From a pure health perspective and in the setting of ALL my symptoms since my exposure, is there still value in me consulting with an infectious disease specialist to rule out HIV, further test?
-If I may, can I relay the results of my upcoming test?  I am going to have drawn next Tuesday or Wed?
-ALL in ALL, I just want to make sure the science I have had is true and not flawed/false negative, and if reason to suspect as possibility do all i can to rule out.  Also, if there were any doubts in your assessment, that you would be brutally blunt in your direction.
I thank you, and hope to relay good news next week.  If allowed, I will ONLY followup with the results(btw--how long will thread be open to post)?
Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Your fears are interfering with rationality.  You can test as much as you wish pursuing non-specific symptoms but I can assure you the test results will not change.  Repeat testing is like throwing money away.  Remember, persons who are symptomatic are, if anything MORE likely to have positive tests, not less likely.  I am not denying your symptoms, but I am telling you that they are not due to HIV or any sort.  Since you are unable to accept my assessments, I will provide these final answers, then, as per Forum guidelines, this thread will be closed and there will be no further responses. 

1)Is my negative Insti rapid at 24 weeks as reliable as a lab based test?
Yes.

2)Does there tend to be more false neg or false positive with rapid tests?
See above.  it is not a matter of "more" or "less" false negatives or false positives. 

3)At 25 weeks now, could one STILL have symptoms coming from an exposure late last year,  and can HIV symptoms continue but still test negative this far out?
See above.  No, this would not happen.

4)Can one have an aggressive sort of HIV infection that causes rapid decline, but still tests negative on all tests?
No!!!

5)Regarding HIV of other subtypes/strains, would the testing i have had, had picked up any type including my duos and recent rapid?
Yes.

6)From a pure health perspective and in the setting of ALL my symptoms since my exposure, is there still value in me consulting with an infectious disease specialist to rule out HIV, further test?
No.

The thread may remain open for a limited period but there will be no further replies from me.  EWH
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35 months ago
Thank you. I just saw a post about hiv-2. For us and all will you please do a HUGE favor and clarify two points about Type 2 HIV?
1) what is considered absolute window for hiv-2 with JUST antibody test?
2) is western blot even done any longer?  I thought it was geenius blot, and if so, when would that be considered final?
Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
You asked that the thread be open so you could post your result.  This was agreed to. You continue to post, therefore the thread will be closed.  Further questions related to the topics addressed here may not be answered and your posting fees will not be refunded.  EWH
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35 months ago
I apologize. I misunderstood that you were going to allow that. I thought you were closing  as regular as you mentioned in opening paragraph. I do hope you will reconsider, but if not I understand. 
Thank you