[Question #4033] Diacerein use and HIV testing

85 months ago

Hello Doctor,

My question is, can diacerein use for osteoarthritis delay HIV antibody production? My possible exposure was 1 week after I stopped taking diacerein (I had been taking it for 3 months, 100 mg daily). I will not go into the details of my exposure or possible symptoms, because at this point it would be irrelevant since I believe my test results are conclusive (except I do not know the thing about diacerein). My test history is as follows:

20 day hiv combi

23 day hiv duo ultra

28 day hiv duo ultra

35 day hiv combi

All of these tests looked for both antibodies and p24 antigen (so I guess they are 4th gen), and all came back negative.

Could the above mentioned use of diacerein delay anti body production? If the answer is yes, then how reliable is the p24 antigen part of the test and under these circumstances, do you think I need a different test, like the PCR, or can I just move on knowing I do not have HIV?

Your answer is much appreciated.

Regards.

H. Hunter Handsfield, MD

85 months ago

Welcome to the forum. Thanks for your question.

There are no medications or medical conditions that interfere with the reliability or timing of HIV test results. Certainly there is no reason to suspect diacerein would have any such effect, although I doubt it has been studied. And with the antigen-antibody tests like you had, if antibody production were impaired, antigen would still be detectable -- indeed, perhaps at even higher levels than otherwise.

AgAb tests done 4+ weeks after exposure, i.e. your last two tests, detect virtually all infections. However, 100% conclusive results require 6 weeks. However, unless your exposure was unusually high risk, probably there is no need for additional testing.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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85 months ago

Thank you for the reply Dr. Handsfield. Truth be told, i had a very low, perhaps zero risk: unprotected oral sex performed on me, protected vaginal sex followed by some more unprotected oral sex. I wouldnt have thought of it twice if it hadnt been for the problems i started experiencing afterwards:

Flu like illness after 1 week - no fever

2nd to 3rd week, joint pains that came and went, and very small and very itchy red dots - like mosquito bites but much smaller - mostly on arms, hands and ankles.

Around 3rd week until now -for 2 weeks - hurting palate (some parts)

For around 3 weeks now, a burning feeling at the back of my throat - comes and goes.

Then i started worrying if the condom was not latex or it broke, etc... you know the usual hiv fear; irrational but real.

I read that immunosupressants may delay antibody production and since arthirithis is an autoimmune disease, I was worried that diacerein may qualify as such.

A final question if you dont mind; is there a point when pcr dna test is not reliable anymore, i.e. after 28 days you can not trust pcr dna results?

I guess i will get tested again at the 6th week mark and hopefully leave this all behind. Thanks a lot for your answer again and be safe.

H. Hunter Handsfield, MD

85 months ago

I agree you had a zero risk exposure for all practical purposes. Your symptoms are not at all suggestive of HIV, and in any case, the AgAb tests always are positive in people with HIV symptoms. I explained above that why NO drugs -- including immunosuppressives -- would have any effect on your test results. You are applying information that used to be mentioned in regard to antibody tests, but not AgAb tests. Even that would require potent immunosuppression, i.e. like cancer chemotherapy or drugs used in organ transplant patients. In any case, diacerein is not immunosuppressive.

Once positive, HIV PCR tests generally are positive for life, except in people on effective anti-HIV treatment.

Don't overthink it. There is no chance you have HIV, and there is nothing more you can think of (or that you can find online) that would change my advice about it. All is well -- you can rely on it!

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85 months ago

Thank you very much Dr. Handsfield. The assurance coming from an expert such as yourself will surely allow me to finally put my mind at ease for good. Your prompt replies and all the assistance you have been giving on forums like these over the years - and at times the patience you manage to maintain while answering posts - are very much appeciated here, at the other end of the world. Thank you again and stay safe.

With love and respect.

H. Hunter Handsfield, MD

85 months ago

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