[Question #4514] False negative HIV Gen 4 with symptoms

28 months ago

Dr. Handsfield please

 

I had unprotected sex with a woman on Oct 10th. She was on her period but I didn’t realize until after. I took an HIV Gen 4 test from Labcoro weeks later on Nov 7th...result was non reactive. I started having symptoms about the 2nd week following the possible exsposure. Tender and sore lymph nodes around groin, armpits and neck, fatigue, sweating, feeling hot and cold, chills, sore throat, body aches. I’m still having symptoms today including severe joint pain, muscle pain and weakness, loss of appetite, sore stiff neck, flank pain, skin peeling on feet, rash on top of feet, a few spots on my palms, headaches, feeling cold, sore tender lymph nodes all over, fatigue. I had a couple of steroid shots about 2/3 months before the exsposure. I was also taking 20mg of prednisone a day for almost 2 months leading up to the possible exsposure. I had started tapering off about 2 weeks before. I was also taking colcyrs twice daily at that time and just stopped taking it a few days ago. I also had 3 shots of Cosentyx around March/April. I suffer from psoriatic arthritis and gout. Could the meds have affected the antibody portion of the test? I’ve read that prednisone can do that, as well as lower the amount of HIV virus in the blood. Apparently colcrys affects the immune system as well. I was having symptoms when I was tested, though they are worse today. What affect would that have had on the test results? How accurate is the antigen portion of the duo test? I also took a flu test same day, which was negative. Where do I stand with the 4 week negative on the Gen 4...also considering the type of exsposure( blood ) and symptoms? I have a really bad feeling! I feel certain that I’m positive. Your assessment please.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
Welcome back to the forum, but sorry you found it necessary. In three threads about 3 years ago, there were extended and detailed discussions about essentially the same situation descrbied here. This apparently is a new exposure event, but all these questions were asked and answered back then. Therefore, my comments are brief; for more detail, re-read the previous threads.

1) There is no such thing as false negative results with the antigen-antibody (AgAb, 4th generation) HIV blood tests, as long as testing is done sufficiently long after the last possible exposure. That time is 6 weeks (slighly longer than the 4 weeks we were advising at the time of your previous questions); but even at 4 weeks, the tests detect 98-99% of infecitons, and your negative result Nov. 7 is very strong reassurance. The antigen portion of the test is equally reliable as antibody. We discussed how the AgAb tests work during your previous threads.  It is not posssible to have HIV more than a few weeks and not have either detectable antigen or antibody in the blood.

2) If symptoms are due to HIV, the test is ALWAYS positive. Therefore, your negative test results prove HIV is not the cause of your symptoms. In any case, the symptoms you describe are not typical for acute HIV anyway.

3) Immunosuppressive drugs have no effect on reliability of the HIV AgAb tests; and certainly the modest immune suppression with 20 mg prednisone daily. The same is true with cytokine inhibitors like Humira and Cosentyx.

If you need still further reassurance, I suggest you speak with your recent new partner and ask her to be tested for HIV. If negative, you will know for sure you could not have been infected. 

I hope this helps settle things for you. Let me know if anything isn't clear. But please try to avoid asking questions already addressed here or in your previous threads. Thanks!

HHH, MD
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
I forgot to comment about exposure to your partner's menstrual blood. Sex during menstruation carries little or no increased risk compared to no blood exposure. That's because the concentration of virus in blood typically is no higher than in genital fluids. ---
28 months ago
Thank you for taking the time to answer my questions. I apologize for some being repetitive.  You suggested that I ask her to get tested to see what her status is.....I was going to, but we are not one speaking terms so thT is not an option. I wanted to add a little more info and ask a few more questions. I had some breaks in the skin on my penis when I had sex with her. Also, I had several other partners over the summer. The last before her was around the end of August. You said that my symptoms are  not typical for HIV infection, but from what I’ve read they are.....so I’m a little confused.  What are the chances that my test result was wrong and that it changes when I retest at 6 weeks or later? I also worry about clinical error with the testing facility. Something is going on with me. The symptoms are real and the timing of the symptoms is concerning. Could it be something else that I could have contracted? I’m suppose to start infusions of Orencia soon for my psoriatic arthritis, I just have to make sure I don’t have an active infection of any kind before I start the treatment. Do you think I’m in the clear as far as HIV goes.... that my negative status could change based on the information I’ve provided along with your professional knowledge? Thanks again for your time.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
You cannot read lists of ARS (acute HIV) symptoms and conclude anything just because you have some of them. Typicality is determined by the pattern, not by just counting listed symptoms. Further, even with classical symptoms, they are nonspecific:  i.e. identical to symptoms of multiple other problems, mostly far more common than ARS. The bottom line is that symptoms are rarely helpful at all in judging a possitlbe new HIV infection.

There is almost no such thing as lab error in HIV testing. The tests are highly automated and pretty much idiot proof.

I'm not arguing nothing is wrong, only that it is not HIV. As I said above, if your symptoms were due to HIV, and had been present a few days or more at the time the test was done, the test would have been positive. Period, full stop, no exceptions ever known.

In the entire US, I'll bet not 10 persons a year catch HIV from one-off heterosexual exposures like this. The large majority of heterosexually transmitted infections occur in the regular partners of infected persons. The odds any single event like yours will transmit HIV probably is under 1 in a million. Comnbine those odds with your negative test results and your not very typical symptoms, and there's just no chance of it. Believe it!
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28 months ago
I dated a woman for about a year and broke up with her around March.  She had genital herpes...so I just found out. I had done an std panel about 6 weeks after and everything was negative. I don’t think I tested far enough out for HSV2.  Since that time I’ve had a few episodes of bumps and flat red spots. I dismissed it because they were not blisters. I didn’t have any other symptoms. I just recently had it happen again but it was worse. 1. Could a reocurring outbreak of HSV2 cause tender lymph nodes all over...neck, groin, armpits...as well as other symptoms? When I took my 4 week HIV test I was having some lymph node pain. I remember it starting behind my ears then spreading. Some of the other symptoms I was having like chill, fatigue, feeling hot I’m wondering if was from taking oercocets. I do know that my lymph node pain was worse and after I tested. You said if I was having symptoms at the time I tested it would have been positive. 2. If I was just having some lymph node pain at the time of testing, even though it got worse after, would that still be true? I’m asking because it seems like my lymph nodes and muscle pain was worse after I tested and I’m not sure if some of the other symptoms was from meds, but I know meds don’t affect lymph nodes.  My lymph nodes don’t hurt like they did a week ago. Every now and then one will ache a little in one armpit or the other, or around my groin. I feel fine other than some sweating at night. I’m going Wednesday to take my 6 week HIV duo test and complete std panel. I’m definitely concerned that my test result could be different this time around. I’m 46 years old and I’ve never had my lymph nodes hurt like they did all over and for so long. 3. How confident should I be in my 4 week test because my symptoms were lighter at test time, I do know my lymph nodes were tender? If I test negative at 6 weeks can I move on? Some sites say test a 3 and even 6 months. I need to start my orencia infusions for my arthritis ASAP because I’m having trouble walking. It does seem like my tender lymph nodes come and go
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
These symptoms do not change my opinions or advice, and nothing you describe suggests HIV. Even if it did, the test results rule, as discussed above. The opportunity for follow-up questions is intended for clarity or additional details about the original question, not entirely new problems or questions. If you would like address the possibility you have HSV2, you'll need to start a new thread. Choose the Herpes category and the question will be answered by Terri Warren.

That completes the two follow-up comments and replies included with each question and so concludes this thread. Please note the forum does not permit repeated questions on the same topic. This will have to be your last one; future new questions about 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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