[Question #4206] HIV test

32 months ago
I did HIV test after unprotected sex, HIV-1 Quantitative, Real-Time PCR + combo all were negative : Day 24 pcr= N Day 30 combo=N Day 50 combo+pcr= N ... Should i repeat? Im i free of HIV? Please advice DR
32 months ago
sorry Dr, i reply to clarify my points. I am confused with different information on the internet,
1- some Drs, says "4th gen tests are conclusive at 4 weeks only, because they pick up the p24 antigen on HIV 1 which desaper from 4-6 week so then your antibodies need 3 months to develop for both HIV 1 and 2 to b conclusive". please clarify
2- Is my negative combo (HIV p24 Ag & Abs) test at 30 & 50 days + negative PCR test at 24 & 50 days, post high risk exposure is conclusive that i am HIV negative? 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
Welcome to the forum. Thanks for your question.

1) The website you quote is simply wrong. Whoever wrote that does either not understand the science behind the antigen-antibody (4th generation, combo, duo) blood tests or has been intentionally misleading. It is true that p24 antigen goes away, but not true that it can also take 3 months for antibody to develop. It is the antibody itself that clears p24 antigen from the blood. In other words, if the antigen has gone, antibody must be present. Accordingly, once these tests are positive -- usually by 2-3 weeks, almost always by 4 weeks, and for sure always be 6 weeks, the test is then positive for life. There is no such thing as a 4th generation test being positive (because of antigen), then negative, then positive agains because of antibody. It never happens, in fact is impossible with this kind of test.

2) Your negative AgAb result at 30 days was 99% reliable, and the one at 50 days was conclusive all by itself. The two PCR tests at 24 and 50 days were a waste of money (maybe a lot of money!), but they confirm the negative AgAb test results. Your tests prove you were not infected with HIV. No further testing is needed.

I hope this information is helpful. Let me know if anything isn't clear. (But please do not ask me to confirm the same information in different words! There is no information you possibly can provide that would change my advice on this.)

Best wishes--   HHH, MD
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32 months ago

Thank you Dr you returned me to the life.


I took PCR to confirm that there is no virus no antibody no p24, because i was confused with guideline that says all the test considered conclusive after 3 months. 


1- Is PCR accurate/conclusive after from 21 days? and dose it remain the same accuracy months after?


2- can i now have unprotected sex with my wife safely as i don’t have HIV to be transmitted to her?  

32 months ago
One more question:
3- Is it possiable negative combo Ag/Ab + PCR at day 50 post exposure, turn positve later?

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This is the last questions dr, thanks alot for the all information you provided and clarification.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
1) In itself, the PCR is probably around 95% conclusive at 21 days. PCR alone is never sufficient to be 100%; it should always be accompanied by an antibody (or antigen-antibody) test. Anyway, the 21 day negative PCR result plus your first AgAb test (30 days) was proof you were not infected. 

2) It is impossible you have HIV and you cannot transmit something you don't have! (You could have safely resumed sex with your wife as soon as you received the negative AgAb result at 30 days.)
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32 months ago
Is it possiable negative combo Ag/Ab + PCR at day 50 post exposure, turn positve later?

..
This is the last questions dr, thanks alot for the all information you provided and clarification.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
Already answered in my iniitial reply:  "these tests are positive...sure always by 6 weeks." A negative result at 50 days can never become positive later.

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