[Question #3750] HIV 2 - Test and Window Period

35 months ago
Hello Doctor,

It’s my second time here on this forum and I need guidance on some new developments regarding the same exposure which was condom break with a High risk CSW.

1.)My doctor told me HIV2 testing can take upto one year as viral replication is slow and it takes time for antibody detection especially for HIV2. Is this true? 
2.) My doctor also told me to get a western blot test as it was now 175 days from my concerned exposure and I had pain in Munna underarms and absolutely white tongue. I got a western blot HIV test exactly at 175 days - it is much more expensive than normal HIV blood test but my doctor said it is more accurate and sensitive. Result I got back after 3 days and all negative. For HIV 1 they tested for many line items in the report but for HIV2 only one line item (antibody band). Why is that for HIV1 they test for almost 9-10 things and for HIV2 only one? Anyway ALL were negative. Is it true that western blot of more accurate and sensitive than normal HIV test? Percentage wise how accurate is it almost 6 months post exposure for HIV 2 specifically?
3.) Do you have any sort of figure or idea given your expertise in this field and so many years of experience that For HIV2 are there cases that take more than 6 months to test positive? My doctor told me there is a study published in which specially for HIV2 there have been cases due to extremely slow viral replication it has taken over 8-10 months to test positive? This study was done in Mumbai, India in which at 8 months a few cases had antibody for HIV2 negative and RNA PCR positive? What’s your expert opinion?
4.) The reason I am here second time is because my information is my doctor but you are experts in this field with years and years of experience and you say 12 weeks is enough from what I read on other questions here? What do you suggest I do ? I’ve really had enough and I am now really frustrated at 6 months with antibody test negative and a western blot negative, my doctor has scared me about
35 months ago
HIV2 and it’s window period. Please help me and give me reliable information  and advice. 
5.) Should I change my doctor, please just tell me honestly, do you feel that I should change ? 
6.) My white tongue worries me, it is absolutely white is this a sign of HIV?
7.) Given your knowledge what on percentage terms are chances for someone testing positive post 6 months of exposure given that there is no new exposure/risk? How many known cases are there in the history of this disease where people have tested positive after 6 months? I am negative with a western blot at 6 months and I can certainly assure you that no exposure within these 6 months? 

Thanks for your help!!! 6 months is a long time. I know CDC and all other reliable public health agencies say 3 months conclusive. Help me finish this confusion on the HIV2 window period that my doctor has put In my mind. 
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Welcome to the Forum.  On this occasion I will be answering your questions, several of which are repetitive and have already been answered by Dr. Handsfield.  Your fears regardingHIV-2 are misplaced.  As Dr. Handsfield told you, your test results are already definitive.  It is a misperception that it takes longer for HIV-2 tests to become positive.  The infection PROGRSSES more slowly but it does not take longer to diagnose.mmon to your questions:

1.  This is incorrect.  See above.
2.  The western blot is no more accurate than tests you already have.  Sometimes persons with HIV-2 have "in determinant" HIV-1 western blots but one way or another, if you had HIV-2 your test would be positive.
3.  Repetitive question.  I disagree with your "information".  Your results are conclusive.
4.  Our suggestions remain the same.  Accept that you do not have HIV of any sort.  If your symptoms trouble you, ask your doctor to look for other, non- HIV causes.
5.  If you like your doctor, other than his misperception about HIV, I suggest you stick with him.  You could show him a print out of your exchanges with Dr. Handsfield and me.
6.  No, a white you be is not a sign of HIV.  Some people confuse white tongues with other things than are associated in some cases with HIV like thrush.  The most common cause of white tongue is smoking.  Many cases are unexplained and normal variation.
7.  I have no concern that your test will turn positive for HIV1 or -2 at six months.  I have never heard or seen of a case in modern times.

As Dr. Handsfield suggested, you need to relax and move on without worrying that you acquired HIV from the episode you described.  EWH
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35 months ago
Dear Dr. Hook

Thanks for replying. I will try not to be repititive but I thought the western blot was considered gold standard in HIV testing. I have read this everywhere that a positive initial screening test with a negative western blot means negative.
Anyway, so you say negative antibody test coupled with a western blot which is also negative means 100% no HIV 2? 

Also, you say you haven’t seen or heard of a case in modern times who tested negative at 6 months and then later tested positive without any new exposure. By modern times you mean recently like in the past 3-4 years or since the past 15 years or so. I ask this just for my own confidence because I have tested negative at 6 months post exposure.

Ofcourse I don’t like my doctor because he has put this whole HIV 2 window period upto 1 year in my head. That’s really disturbing me. 

From your reply I feel my western blot was a waste of money and a simple antibody test was sufficient. 


35 months ago
Hi,
I just saw another post about HIV2 and his exposure was in India too. I agree with the guy posting there and request you to please share details about the window period about HIV2 and testing for HIV2. 
I can tell you one thing for sure that here in India doctors do feel that HIV 2 infection takes much longer to detect and hence the confusion and these questions. It would be great if you share your expert opinion on HIV2 please Dr. Hook
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
The information you cite is out of date.  Western blot tests for HIV are more time consuming than other tests for HIV-2 antibodies and no more accurate.  Years ago, HIV-1 tests in persons who had HIV were frequently "indeterminate" meaning not totally negative.  Western blot was helpful for sorting this out as it allowed detection of an antigen which was specific for HIV-2, thereby allowing people to distinguish between HIV-1 AND HIV-2.  Current tests which detect BOTH HIV-1 and HIV-2 infection contain antigens from both types of virus and are highly reliable at 6-8 weeks after exposure..  Your tests, both the earlier tests and your HIV-2 western blot confirm that you do not have HIV-1 or -2.  Further testing is a waste of time and money.  The results are not going to change.

Again, once infected, while infections due to HIV-2 progress more slowly than those due to HIV-1, there is no evidence that it takes longer for blood tests to become positive.  HIV-2 also appears to be somewhat less infectious than HIV-1 following exposure. 

The time frame I based my response on is the past 8-10 years. 

On this Forum we provide our responses based on available scientific data.  We do not engage in debates with others, nor do we have the time or energy to debate information that is out of date or internet-based incorrect statements.  This is my 3rd reply to your posts.  Thus, as per Forum guidelines this thread will be closed.  Further repetitive, anxious posts on this topic may be closed without answers and without refund of your posting fee.  This policy is in place out of concern for you, nothing more.  EWH


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35 months ago
Dr. Hook,

Thanks for your help... I’m not debating with you ... certainly not ... I don’t have the knowledge to even think of doing that .... I’m just seeking information from you as HIV2 information is confusing ... 

Your reply was not the third but second, just bringing it to your notice. I understand you don’t want to answer anymore to my concerns regarding HIV2, which is fine. Thank you for your advice and help!!!! Bye 
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Sorry, my error, you have one additional follow-up opportunity.  EWH
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35 months ago
Thank you Dr. Hook for letting me use my third follow up-
I just went and tested for RNA detection by PCR for HIV2. The result will take a week as they send the sample to an international location. If you keep this thread open then I can post my result. Also please tell me if they send a blood sample somewhere out of the country to conduct this test won’t the test accuracy be effected as it will have to transported at a certain temperature and other conditions etc. 
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Transport of specimens to distant is now routine so you need not worry that transport of your specimen would affect the reliability of your tests.  I remain confident that your test will be negative and trust that when you receive yet another negative test for HIV you will believe the result.  You need to.

As discussed above, this is now my 3rd reply and thus there will be no further replies.  I will keep the thread open for up to several weeks so you can post your result.  If you ask additional questions however, the thread will be closed without further comment.  I trust you understand.  Take care.  EWH
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35 months ago
Hi Dr. Hook,

The lab called after more than a week now they want me to go there again as they want to collect another blood sample. 

Will it be possible to meet you ? Where can I take an appointment if I want to see you ? Is it possible in the coming week? Please let me know 

Thanks
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
I am sorry, I do not see patients seen on this Forum.  If you indicate where you live I may be able to recommend a facility that you could be seen at. In the interim I suggest you go and get the re-test suggested and inquire as to why it is needed. 

This thread will now be closed.  EWH
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35 months ago
Sir

I will be visiting Birmingham on fourth June. Please meet me even if it’s for a very short period. Is my sincere and honest request. Please be kind. 

Look forward to your reply
35 months ago
Please be kind Dr. Hook. I will make all the effort of traveling and meeting you . Just spare a little time. ..... PLEASE