[Question #4270] Question #4267 Question follow up

32 months ago
Hi, 

I have some follow up questions regarding my exposures, current conditions and my future health. I have three unprotected exposures with three different CSWs, included unprotected handjob, breast sex with oil. 

1.) When it is to suspect false negative HIV results? I have been experiencing chronic diahhrea, getting worse in the past three weeks. Low fever around afternoon and itchy sore throat for the past week. The only thing that excludes HIV is the negative 4th gen at labcorp I did a year ago. 

2.) I have long foreskin, does that make me more vulnerable to hiv even to exposures that I mentioned above?

3.) In your clinical experience, when is retesting warranted in the face of a negative hiv result? 

Best, 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
I'm sorry to see you back after the reasoned, science based reassurance you had from Dr. Hook. You continue to seriously overthink this situation. Directly to these additional questions.

1) To my knowledge, if enough time has passed since the last possible exposure (4-6 weeks), false negative results simply do not occur with the Ag/Ab (4th generation) HIV blood tests. Lab test results always ovverrule any and all symptoms. And in any case, irritable bowel syndrome symptoms are rarely caused by HIV.

2) The level of risk at the time of exposure is irrelevant to your concerns. Whatever the risk at the time, your blood test results prove you were not infected. In any case, to my knowledge there has been no research to suggest that having a long or redundant foreskin has any effect on HIV risk.

3) Never, if testing is with an Ag/Ab test more than 6 weeks after exposure.

HHH, MD
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32 months ago
Hi, 

1.) How does a 4th gen test effectively avoid false negative after the window period? What’s the science behind it? What have I read is that 4th gen has a 99.9% specificity in clinical testing. 

2.) what is the reason behind “no risk” activity? Even shaking hands involiving blood is considered to be risky. 

3.) if a hiv negative patient comes in with fever, lymph nodes and pneumonia, should hiv be suspected? 

Best, 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
1) Within a couple of weeks of being infected, everybody with HIV has p24 antigen or anti-p24 antibody in the blood; and current testing technologies are close to 100% sensitive in detecting either one. Previous false negatives were for antibody, but not antigen. To my knowledge, there are no documented cases of HIV in which the standard Ag/Ab tests were falsely negative. If it happens, it is extraordinarily rare.

2) Where did you hear that??? Shaking hands with blood contact is zero risk for HIV. No rational scientist who understands HIV transmission and epidemiology would consider such contact to be risky.

3) No, not if a reliable HIV test had been done more than a few weeks after the last possible exposure.

These questions are argumentative and somewhat irrational. Time to stop. There is NOTHING that you can think of or ask that will change our advice and strong conviction that you do not have HIV. Suck it up and move on.

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32 months ago
Dr H, 

I understand what you are saying, and I understand that in any case I should take the result here and drop it becuz of my test results. But I just don’t know how doctors can effectively rule out false negative on a test administered to everyday to so many people when it can not guarantee a 100% sensitivity. I know close to 100% is good enough for place like the US where its low prevalence, but as people move around the world can we do today shouldn’t we rethink about this strategy? 

Also, wouldn’t antigen went away after antibodies are formed? So a 4th gen would have the same false negative rate as 3rd gen after seroconversion or 3 months. 

I understand I should just take this result and sleep on it.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
You're wrong about test performance interpretation in different parts of the world. It's exactly the same in sub-Saharan Africa (with the world's highest HIV rates) as in the US and other industrialized nations.

Yes, antigen goes away as antibodies develop; it is the antibody that clear antigen from the blood. But after that happens, antibody is always detectable. That's why there are NO reported cases, anywhere in the world, of someone who had HIV whose AgAb test became negative over time. It simply does not happen, as far as known.

Your closing sentence is correct.

Please note the forum does not permit repeated questions on the same topic or exposure. Future questions from you about this exposure, testing, and your fears about HIV may receive no reply and the posting fee will not be refunded. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.     
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