[Question #3917] HIV - 51 days alere rapid ag/ab test - Fresh breakout

32 months ago
Dear Doctor 

This is in relation to my first question which I asked a few days ago. You mentioned that I should trust my Alere determine ag/ab test taken at 51 days post incident ( Handjob of one minute and I touched the vagina of the CSW for less than 3 seconds - no penetration etc)

My worry is that iv had two oral herpes break outs in less than two months. The first was 10 days after the incident and the second was today at about 8.5 weeks after the incident. Iv been quite stressed out now for over two months and missed sleep one night day before yesterday due to an overnight shift on my job. Iv had HSV1 break outs since childhood but never twice in such a small period. Usually its once a year. 

I read on the internet on the following link (http://amp.health.com/health/gallery/0,,20539037,00.html) that 

 Cold sores (oral herpes) and genital herpes can be a sign of both ARS and late-stage HIV infection. And having herpes can also be a risk factor for contracting HIV. This is because genital herpes can cause ulcers that make it easier for HIV to enter the body during sex. And people who have HIV tend to have more severe herpes outbreaks more often because HIV weakens the immune system.

My question is that given this second outbreak should I get tested again ? I haven't had any fever in the last 8 weeks and as mentioned my tests were 
A) HIV 4th gen lab based test 25/26 days after incident / exposure . 
B) Alere rapid test ag/ab 50/51 days after exposure 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
Welcome back to the forum, but sorry you found it necessary. I'll be responding this time, but I reviewed your recent discussion with Dr. Hook and agree with all he said. I would also encourage you to read my replies to user timeking in question 3907. (The situation and timing is sufficiently similar to yours that I have to wonder if you're the same person, with a different username. If so, please delete one account and stick with only one of them, per forum rules. If not, accept my apology for my assumption.)

The modern HIV antigen-antibody (AgAb, "4th generation") tests are among the most accurate diagnostic tests ever developed, for any medical condition. If done sufficiently long after the last possible exposure (usually 4 weeks and always by 6 weeks), the result rules out all other considerations. No matter how typical symptoms might seem to be for ARS, or no matter how high the risk at the time of exposure, the test results rule and the symptoms and exposure are to be ignored.

For Alere's Determine test, there was a brief period soon after the test was marketed in which the antigen component of the test was not working well, so that a few infections might have been missed until 6-8 weeks after exposure. However, Alere quickly fixed that problem and currently the test performs like all AgAb tests.

To repeat Dr. Hook, you had a zero risk exposure:  nobody ever gets HIV by hand-genital contact, fingering, etc. There was no need for you to be tested at all. However, your negative result at 51 days (and perhaps earlier, question 3907) is conclusive, even if your partner had HIV and you were infected. Having genital herpes due to HSV2 roughly doubles the risk of sexual acquisition of HIV if exposed. But it can have no effect for exposures like yours. And contrary to what you think you learned on time, HSV1 or oral cold sores have NO proved effect on HIV risk. And new HIV infections do not generally trigger oral herpes outbreak.

So for sure you do not have HIV and your test results are reliable. Do not have any more tests and do your best to stop worrying.

HHH, MD
---
32 months ago
Dear Doctor
I'm.very confused due to point 1

I hope that you will believe me when I say that I have no clue who timeking is : while I will try to find his questions - it's not very easy to search on this website. My follow up question is 

1. You have written " your test at 51 days is conclusive even if your partner had hiv and you were infected " But if I'm infected it would be positive , no ?  I didn't understand . It was negative my test . How can I assume I'm infected if I'm hoping I'm not ?  I'm very confused now 

2. I did not have genital herpes and I'm not worried about the increased risk of HIV due to hsv1 .
I'm worried that iv been hit twice with a breakout of have 1 in 45 days . That's never happened before . The first one 10 days after exposure and the second one being yesterday - 7.5 weeks after exposure. That sounds worrying according to timelines . What could be causing this . Should I just put acyclovir cream and forget about it? 

Warm regards 




32 months ago
Just read timekings post. I can see why you may think it's the same person . Maybe you can check cc nos etc to check . I'm not sure how to convince you. I hope you will believe me

Anyways one difference is that he says it's a vane test. Mine was a rapid ag/ab determine Alere test 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
No worries -- I believe you!

Apology for my poorly worded reply. "Infected" should have been "exposed". The point is that even if your partner had HIV, and if you had a truly risky exposure (such as unprotected vaginal or anal sex), it still would not matter. And as I also said, testing always also overrules any and all symptoms that might suggest HIV infection. In fact, acute HIV [i.e. ARS] has not been reported to result in increased frequency or severity of HSV outbreaks. But even if that were a possibility, your test results prove you did not catch HIV. Period, full stop, no need for further discussion of it. 

I'm not familiar with the "Vane" test. If it is anAgAB (4th generation) test, all the above comments still apply. If it is a standalone antibody test (3rd generation), then you could consider a final test 8 weeks after the event. But even here, it's really unnecessary. The 3rd gen tests detect 98-99% of HIV infections by 6 weeks, well before 51 days.
---
32 months ago
The vane test was by timeking - not me . ( The guy whose quedtion you said I should read ) - I took the Alere determine rapid ag ab test at 51 days . 
Is that 100 PC conclusive ?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
Apologies again for reading too quickly. But I skimmed over it for the reason that should be obvious to you:  Of course the test used by someone else can have no effect on the reliability of your own test. I have already said (twice, now three times -- even more including Dr. Hook's replies) that your test result is 100% conclusive. 

That concludes this thread. Please note the forum does not permit repeated questions on the same topic or exposure. This will have to be your last one; future new questions about this exposure and testing for HIV and other STDs will receive no reply and no refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.

I hope both discussions have been helpful. Best wishes.



---