[Question #396] Follow up

35 months ago
Hello doctors,

Thanks again for this phenomenal service.  I am following up on my previous question.  For reassurance, I tested again at 6 months using Oraquick oral swab(my doctor says it is the most advanced oraquick test).  This was after a 3rd gen test at 7 weeks, oraquick at 4 months, and clearview rapid test at 5 months after possible unprotected vaginal sex.  Reading your posts, I now see Oraquick lags in sensitivity by up to a month, is that right?    I was hoping to eliminate any tail risk with this 6 month test and get as close as possible to 0% chance.  Have I done so?  Incrementally, do the better tests offer more assurance?  My symptoms have persisted.  While I dont believe I had itercourse in june(i had a massage), i can not help but wonder and am trying very hard to eliminate hiv as a possibility.  Thanks.
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago

Welcome back to our Forum.  I'll try to help.  We have several clients who have logged into the site using the screen name A including one person who I relied to last about a month ago.  if this is the case, you may find that my responses have not changed much over the past month.  There is a fair amount of confusion about HIV tests and their accuracy. This reflects the evolution of HIV test performance over the three decades since they first became available, as well as improvement in the performance of the tests themselves.  Within classes, no test "lags behind" similar generation HIV tests by a month.  At the current time all available HIV tests used in North America are either 3rd (antibody only) or 4th (combination HIV antigen/antibody) tests.  The Oraquick tests are third generation tests which have to pass the same laboratory performance standards as 3rd generation tests used in laboratories.  These tests will detect more than 99% of recent infections at 8 weeks following exposure and do not lag behind the performance of other 3rd generation tests performance wise.  Thus your Oraquick test result at 4 months should be considered conclusive and you should be confident that no further testing is needed. 

My advice is to stop worrying about HIV.  If you have persistent symptoms, rather than perseverating in worrying about HIV, my advice is to put these concerns aside and work with your doctor on what might be causing the symptoms you are experiencing. EWH

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35 months ago
Thank you.  Am I thinking about this incorrectly?  You say 1% of people who had a risk and had similar symptoms actually have hiv.  Is this number higher for people who's symptoms persisted longer than a week or 2?  If so, is my current risk this % * the possibility of me not having antibodies after 6 months (maybe .1%?).  This could still be high, like 1 in 100,000.

I took the Alere combo rapid test at 6 months and 1 week.  I am confused about this tests accuracy.  I see antigen specifity in the high 90's, but the case studies range 50-80% for antigen detection.  It also checks for hiv1 antigen only.  I am awaiting a lab based gen 4 test, anxiously.  Many thanks.
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago

You are really overthinking this, not to mention making assumptions about performance and the prevalence of infection which are far too high.  The Alere test is WHO approved and in wide use and its results at 6 months should be believed. The figures on the sensitivity of this test are of relevance only in the first 4 weeks after exposure, then the antibody test takes over.  Your anxiety is misplaced.


I have nothing more to say.  EWH

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35 months ago
Thanks for your prompt reply.  Appologies if I'm overthinking, I am just trying my best to accept the information you are helpfully providing.  
34 months ago
Hello Doctor, 1 follow up question as I anxiously await the results of my 4th gen lab test.  Can Ginkgo Biloba or Rhodiola supplements affect antibody production?  Thank you.
34 months ago
I ask because Ginkgo Biloba extract has Ginkolic Acid, which has been shown to inhibit hiv protease activity.  I was drinking a Ginkgo tea somewhat regularly for about a year prior to August.
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago

There is no evidence or medical proof that ginko bilboa or rhodiola supplements have any effect on HIV test results or antibody production.  the advocates of these supplements often argue that they tend to STRENGHTEN the immune response and, if so, this would be expected to make HIV tests positive sooner, not delay the test results.  I am confident that your 4th generation tests, like your prior tests will be negative.  At that time, I hope that you will be able to move forward without further concerns.  It is past time for you to do so.

This is the third and, as per Forum policy, final response to these questions.  the thread will be closed late today.  Take care.  EWH

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