[Question #3974] HIV Window period & Test accuracy despite symptoms

31 months ago
Good morning, 

Without writing a long story I will describe my concern in timelines in Hope's someone can shed some light. 

January 15th - Potential exposure 
                        Unprotected sex with 
                        sex worker (vaginal) 

February 27th- Noticed some circular 
                         Rash on penile shaft 

February 28th- Alere HIV combo rapid 
                        Test (finger prick) 
                        Result = negative 

March 3rd    - Developed swollen 
                       Lymph nodes on right 
                       Side of the neck 
                       Largest measuring 2cm 
                       In length by 0.6x0.7cm 
                       Left side of neck: 
                       Largest measuring 
                       7x4x8 MM. 

March 4th & 5th - Night sweats two 
                             Nights in a row. 

March 4th-9th.  - Sharp back pain. 
                            Feeling of fullness 
                            After eating very 
                            Little. Extremely 
                            Fatigue for a week. 

March 6th       - Full STD panel 
                       - Clhamydia - NEG 
                       - Gonorrhea - NEG 
                       - Syphilis  - NEG 
                       - HIV AB/AG - NEG 
                       - Blood drawn from 
                         Vein (sent to lab) 

March 12th      - CBC w/ Differential 
                           All normal except 
                           The following. 
                        - Lymphs - 19% 
                        - Normal range:22-57% 
                        - Neuts  - 74% 
                        - Normal range:36-68% 

March 14th      - HSV1 Glycoprotein G 
                          Ab IgG. 
                        - Positive 41.60range 
March 14th      - HSV2 Glycoprot IgG 
                          Ab by Elisa 
                        - Equivocal 0.92range 
                          Questionable range 
                          Would be 0.91-1.09 

                        - 1.10 or greater 
                          Would be considered 

March 26th      - CBC w/ Differential 
                        - All normal even 
                          Neuts and lymphs 
                        - Lymphs - 25% 
                        - Neuts  - 64% 

March 27th      - HIV Ab/Ag - NEG 
                          Blood drawn from 
                        - HSV2 Glycoprot IgG 
                          Ab by Elisa 
                        - 0.82 = negative 
                          Ranged dropped from 
                          Last time. ????? 

April 17th      - HSV2 Glycoprot IgG 
                       Ab by Elisa 
                     - 0.71 = negative 
                       Ranged dropped even 

April 18th.     - HSV Ab IgG/Igm 
                       Reflex type 1&2 
                     - Results posted 
                       exactly how I got 
                     - HSV 1&2 - 22.40 
                     - HSV 1&2 -  0.61 

Doctor annotations: Test for herpes simplex is positive. So you are a carrier of either type 1 or type 2 or  possibly both. 

July 3rd.        - HIV Ab/Ag - NEG 
                        Blood drawn from 
                      - Syphilis and Gonorrhea negative 

My concern is the lymph nodes I have that were confirmed swollen by my radiologist. I've developed a really 
bad dry cough for almost a week now. Sore throat and tonsils look very swollen. This started on July 6th and 
it's getter better as of now but still present. I am confused about windows periods as I read and even heard from 
my own doctors say 3 months....and others have said 6 months. I've also noticed that I have only been given given the 4th generation test only. I've heard this is only good at 28th days since antigen levels can only be 
detected for so long. I am confused on that ???  When would my test results be considered conclusive despite 
confirmed symptoms from my doctors. I have not been diagnosed with anything as of today from these symptons. Also tested negative for mono and CMV.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
Welcome back, but sorry you found it necessary.

I reviewed our discussion from a couple of months ago. You're asking more question about the same exposure -- but they were answered that time. As I said then:  "The AgAb (4th generation) HIV test is absolutely conclusive any time 6 weeks or more after the last possible exposure, and the results always overrule symptoms (no matter how typical of an acute HIV infection) and exposure history (no matter how high the risk at the time). Your symptoms are not typical for HIV or any STD, and apparently you had a low risk exposure, since you call it "potential". But these things don't matter any way: the HIV test results prove you don't have it." Those facts have not changed.

Three months is old news for the window period for HIV testing, going back to the earliest (first and second generation) antibody-only tests. The current AgAb test (4th generation) is ALWAYS conclusive by 6 weeks, even though some doctors continue to say 3 months or other times. But if your doctor still wrongly believes 3 month testing is necessary, feel free to do it. If you do, the result will remain negative.

If your symptoms continue or you otherwise remain concerned, discuss further with your doctor. HIV isn't the cause and neither is any other STD. All your symptoms are unrelated to the sexual exposure last January.

I hope these comments are helpful. If anything still isn't clear, please re-read all the details in your previous thread. If still not clear, feel free to let me know.

31 months ago
Good morning Dr. Handsfield,

I appreciate your response to my concerns regarding my situation. I only called it a "potential exposure" because I do not the health status of the other person. You confirmed with a reply that it was a high risk after I verified what kind of individual it was. I understand you say that the 4th generation test is conclusive from 6 weeks and beyond from the day of the incident (Regardless of any type of symptoms. I was only simply trying to do what you have wrote on your very last reply on my first question asked. "To secure in the knowledge that I do not have HIV or any other STD's in general". I have expressed my concerns to my primary physician about my lymph nodes and all he can say is that "all we can do is observe and monitor". In your professional opinion Dr, what would you suggest on what I can do in finding out
why are my lymph nodes enlarged. Right Side of the neck 
                                                                       Largest measuring 2cm 
                                                                       In length by 0.6x0.7cm 
                                                                       Left side of neck: 
                                                                       Largest measuring 
                                                                       7x4x8 MM.

Can it all be coincidence that these symptoms started to occur after my suppose exposure.  Was this going to happen anyway?. It's concerning because I was see the 
raised bumps on my neck. It keeps reminding me why they can potentially be there. 

Thank you Dr. Handsfield

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
First, self assessment of enlarged lymph nodes is highly unreliable, especially by medically untrained persons. Second, previously inflamed nodes can stay enlarged indefinitely, so past colds, localized infections, etc can cause such bumps that don't mean anything. Third, there are tissue irregularities that can seem abnormal but are not (one of the main reasons self assessment is hard to interpret). Finally, even with true lymph node enlargements, minor, unimportant infections and other problems often are responsible.

Having said that, any potentially enlarged nodes or unexplained lumps that persist more than 2-3 weeks should be professionally evaluated. Some causes are dangerous, e.g. tuberculosis and other infection; and lymphoma or other cancers. The doctor or clinic evaluating you will first determine whether these things are real or important. If so, they will also be in the best position to decide how to diagnose the underlying problem. There are several possible means for doing so.

In any case, from your test results, you know for sure you don't have HIV. But as just suggested, you should see (or continue to work with) your doctor if you are convinced the lumps are real or if you otherwise remain concerned.

That concludes the two follow-up comments and replies included with each question and so ends this thread. This will have to be your last one on these symptoms and your HVI test results. Thank you. But I do hope the two discussions have been helpful.