[Question #4267] Possible false negative result due to strain variability and genetic disorder?

29 months ago
Hi, 

I have a total of three encounters with three different CSWs in China. All three encounters do not involve protection. No oral sex or vaginal sex are performed. Two encounters involve hand to genital masturbation with massage oil, one with hand to genital masturbation and breast to genital masturbation (titsex) with massage oil. No Prep is used. During the next two years there is significant weight gain of 30lbs. A year ago unexplainable diarrhea is experienced and chronic. Through physical using HIV 4th gen (labcorp, HIV 1/o/2 with reflexes) produce non reactive results. Diarrhea is later diagnosed as irritable bowel syndrome. During the past year, there were episodes of sore throat, headache and enlarged lymph nodes. The longest episode is about two weeks, currently experiencing said symptoms with reduced pain in lymph nodes. 

1.) Should I expect HIV infection from these symptoms? 
2.) Could my 4th gen screening a year ago be false negative. I have no identifiable risks except the ones above.
3.) Should i retest due to possible false negative? 
Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
Welcome to the forum. I'll be glad to comment.  Most CSWs in China do not have HIV or other STIs.  Even if they did, there is no risk for STI incluidng HIV from any of the exposures that you describe.  These facts are supported by your negative test results which indicate that you have not aquired infection from the no risk exposures you desribe.  Thus

1.) Should I expect HIV infection from these symptoms? 
No

2.) Could my 4th gen screening a year ago be false negative. I have no identifiable risks except the ones above.
No

3.) Should i retest due to possible false negative?No

I see no reason for further testing.   Your exposures were no risk and your test results prove that you did not get HIV from the events you describe.

I hope these comments are helpful.  EWH
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29 months ago
Dr Hook, 

Thank you for your response. I have some follow up questions to be made. 

1.) I have read that different geographic areas have different strains of HIV. In US and in Europe is HIV-1 M-b, while in other areas like Asia has HIV -1 M-non b clase. Can testings in the U.S. effectively recognize different strains of HIV? 
2.) I am a chronic marijuana smoker, should I expect a longer duration of window period or affected testing results? 
3.) there r cases where people do not produce antibodies due to a.) genetic disorders b.) late stage AIDs c.) someone who just don’t produce HIV antibodies. How do I know if I’m not one of them? 
 Thank u 
Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
Your questions suggest that you have been looking for answers on the internet.  We strongly advise against this.  Statements on the internet tend to be out of date, taken out of context or just plain wrong.  We spend much time on this Forum trying to correct internet-based misinformation.  In answers to your questions:

1.) I have read that different geographic areas have different strains of HIV. In US and in Europe is HIV-1 M-b, while in other areas like Asia has HIV -1 M-non b clase. Can testings in the U.S. effectively recognize different strains of HIV? 
Currently approved tests for HIV accurately detect all HIV clades and strains, including HIV-2.   Concerns about strain to strain variation in the ability to detect HIV are internet-based myths.  You can have complete confidence in your HIV test results

2.) I am a chronic marijuana smoker, should I expect a longer duration of window period or affected testing results? 
No

3.) there r cases where people do not produce antibodies due to a.) genetic disorders b.) late stage AIDs c.) someone who just don’t produce HIV antibodies. How do I know if I’m not one of them?
Early in the epidemic there were persons with far advanced AIDS who were about to die in whom antibodies could not longer be detected- these people were very, very sick and, as I said, on death's door.  I have not seen or heard of such a case on over 25 years.  There also people who have genetic defects which prevent them from producing any kind of antibodies - these people become sick very early (during childhood) with a variety of severe, life-threatening non-HIV infections.  Once again, despite internet-based misinformation, any adult walking around in anything approaching normal health can have complete faith in the accuracy of current HIV tests which detect not only antibodies but the virus itself in the form of the HIV p24 antigen.

I hope this information is helpful to you.  EWH
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29 months ago
Hi, 

I understand that medicine is a systematic learning process and me reading off the Internet could be problematic and create unnecessary stress. But if I haven’t go through the Internet I wouldn’t have consider hiv and might put myself in greater risk in the future. 
I learn during this process. 

I understand what you are saying and I agree that the most reasonable thing to do is to left this behind and move on. However I do have one question regarding p24, doesn’t the antigen go away after 4-6 weeks, at least fall to undetectable level? 

I appreaciate what you have done throughout the years and I will follow experts advice instead of relying on Internet. When is it time to be evaluated for hiv due to symptoms?
29 months ago
I forgot to mention that the exposures happen 3 years ago and i took the 4th gen test a year ago. I agree, if anything it would’ve show up at the test a year ago.
Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
The p24 antigen may or may not remain detectable after antibodies to the virus appear.  If there are no antibodies, the p24 antigen will be present.  In person with higher viral concentrations in the blood the p24 will also be present.  ALL untreated persons with HIV will have either a positive test for antibodies or for p24 antigen at all times when tested more than 6 weeks after initial infection.  With effective treatment the p24 antigen may no longer be detectable (like the virus) but antibodies will still be present.

Don't get me wrong about the internet- it is a great means of communication and some of the information there is helpful. The problem is that a substantial portion is also incorrect or misleading (not the same thing) and there is no good way for most people to discern the veracity of what they read.

I hope this information is helpful.  Stay safe. 

As per Forum guidelines, as this is my 3rd response to your questions, this thread will be closed later today.  Take care.  EWH
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Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
Your most recent post crossed with the response above.  Thanks for the additional information.  I agree, given an exposure 3 years ago, a test one year ago certainly would have detected infection if present.  You are in the clear.  EWH
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