[Question #4155] A question about hiv testing

32 months ago
Hello doctors. I tested with the 4th generation hiv test at 16, 23, 53, 60, 78 days from a lab and 88 and 101 days at clinics with a finger prick. All were negative. My exposure was brief unprotected vaginal sex. I am worried because I have hypothyroid and type 2 diabetes was wondering if this could affect my testing or affect my production of antibodies. Thank you very much for your time.I have been very anxious about this. Would you recommend PCR RNA testing? Or should I move on? Thank you.
32 months ago
Sorry for replying to my own question. My main fear and concern is that my wife developed crazy swollen lymph nodes around her neck, and I know you guys do not like patients diagnosing lymph nodes but she was looked at by a nurse and they were swollen and tender. No fever and she didn't feel sick. They went down after a few days like 4. I went that day and got tested that was my 53 day test. Is there anyway all my tests missed an infection? Does that ever happen? I am sorry for being so anxious.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
Welcome to the forum. Thanks for your question.

Most important, the 4th generation HIV tests are conclusive any time more than 6 weeks (42 days) after exposure. The 53 day test made it 100% certain you did not have HIV; the two others were unnecessary.

There are many causes of enlarged or inflamed lymph nodes. Among the many causes, HIV is one of the least common. And lymph node inflammation from HIV would never clear up in 4 days, but would last a few weeks -- and there always are other symptoms. In any case, your test results prove that you could not have infected your wife with HIV. I recommend against any further testing either for you or your wife.

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

HHH, MD
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32 months ago
Thank you Dr. Handsfield. I have been reading your comments on Medhelp and appreciate all you do. I have had horrible anxiety about this.

My Hypothyroid and Type 2 diabetes (not on insulin), would those have any affect? My Hypothyroid was out of control and I had high TSH levels not sure if that has any affect on testing or if those systems even interact that way. I know my medication (synthroid) was off .

I am sorry for asking so many questions. I tested a bunch because I read that 28 days and 42 days and 90 days and then that some people don't make anti bodies or that some never have detectable antigens for 6 months or delayed seroconversion.  Your explanation on how the antibodies clear the antigen out is pretty much the only explanation out there. I have not read it anywhere else.  That doesn't make it less cerdible as it makes sense. Is there any possible way my tests did not pick up an infection? I am not trying to be a nuisance but I am so happy I am able to communicate with you on this.

I have had diarrhea and nausea. I am guessing from stress and anxiety. Fever a few times but inconsistent. Thank you so much for your time.

Are the finger prick test just as accurate as the blood draws?

Again THANK YOU SO MUCH!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
No medical conditions have any effect on HIV test reliability. Certainly hypothyroidism or diabetes would not.

You have misinterpreted or misunderstood some of what you read about HIV testing, or found unreliable resources. For the 4th generation tests, testing for both antibody and HIV antigen, it is the antibody that makes antigen go away. That's why these tests are so reliable:  it is impossible to have HIV for more than 2-3 weeks (or rarely up to 6 weeks) without either antibody or antigen being present. There has never been a known exception.

Diarrhea and nausea are not HIV symptoms. As you seem to know, they are extremely common physiological responses to anxiety and stress. "Inconsistent" fever "a few times" is not consistent with HIV either. In any case, the test results overrule any and all symptoms. You could have absolutely classical symptoms of HIV. It wouldn't matter. The test results never lie; symptoms often do.

Finger prick is just fine, no different than blood draw.

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32 months ago
Thank you again. 

I have only read you say that about antibodies clearing out antigens. All other sites make it very vague.

Sites that supposedly have "experts" have been what makes me question my results. Stuff like "you will never know unless you have a PCR" or "6 months" or "2 years dormant" or the worst is delayed seroconversion stories. I mean I figured by now one of my 9 tests would have shown something.  I also did Oraquick last week. 

I'm not an irrational person. I just made a mistake and do not want my family to pay for it. That's why so much anxiety and fear. If I was single I would just deal with it. 

The "window period" is such a hard subject to interpret. I have been bombarded with info on this all my life and that's why it's hard to understand for me. Thank you for clearing it up. 

So I do not have to test anymore and I can move on, is what you are saying. I probably have to seek counseling.  I have had a rough few months. I convinced myself I had this right after the encounter.  

So to clarify. There is no way the tests would have missed it by now? I promise I'm not trying to be a pain. I know you deal with a lot of paranoid people. 

Thank you so much for everything. This exchange and all the forum work on Medhelp. 



H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
"So to clarify. There is no way the tests would have missed it by now?"  Correct.

I have no excuse for the various supposedly professional sites and experts that do not understand, or at least do not clarify, the numerical/probability aspects of risk. That something is possible (e.g. exposure and infection from a partner in the window period) says nothing about how likely it is. I agree it's too bad that many sites and experts don't make the distinction.

Thanks for the thanks. I'm glad to have helped.
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