[Question #4562] HIV tests wrong/false negative/HIV-2 ??- even after 6 months

28 months ago
Hello Doctors.  I to this day am having significant health issues, but we have not found a reason.  My exposure was November 2017 with an Asian woman, therefore possible different subtype/hiv-2, that could be more accounted for in the US.  I have had multiple NEGATIVE HIV tests up until now with the latest being an Abbott architect, HIV-1 RNA, HIV-2 DNA(quest), Geenius 1/2 differentiation.  These latest tests were at 308 days past the exposure with no new exposure. I still worry for the fact that my wife has also lost weight like me, and has on and off health issues/nausea(like oral lesions).  I know you say that these tests are very accurate, but worry that some subtype, strain, is being missed.  I am particularly worried about HIV-2 and maybe a longer window?
1)When can one ABSOLUTELY be assured that tests aren't missing some sort of HIV?
2)If an odd subtype, or other, are there any better tests to conclude this is not HIV(like going to CDC)?
3)I understand window may be longer for HIV-2 and also no antigen in the test, what can a person do to make sure this has been ruled out?(Quest test only a lab developed test and not FDA approved)?
4)What is the consensus on the outside window period for HIV-2?
5)I have not mentioned to my wife my concern as i have been told that HIV is no longer a possibility.  But I want to make sure for her health she does what she needs to.  I am just in deep at this point(308 days) and if mention something to her now(an not needed), our marriage is likely over.  Your thoughts?
6)Doctor, can all tests up to this point be falsely negative for any sort of HIV no matter how rare(elite, seronegative) or do you feel I need to put it behind me?  
I will do what I need to do to exclude this as a possibility, I just don't know how long to keep testing for.......1 year, more?
Thank you for your insights as I really want to know the options/steps needed to be sure or reliability
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Welcome to the Forum.  This response is coming to you a bit more quickly than is usual as I happened to be on the Forum when your question hit.  Follow-up relies may take longer.

I'll be glad to comment and hope that you'll find my response helpful.  I'm sorry to hear of your undescribed health issues.  After read your your description however, I find no credible reason for concern that those health issues might be due to HIV-2.  As you know, HIV-2 is less common than HIV-1.  Even in locations where the infection is relatively common, less than 25% of infections are due to HIV.  Further, the clinical course of HIV-2 tends to be less sever and somewhat more gradual than is the case with HIV-1 but the idea that currently available tests for HIV-2 require longer than for HIV-1 or that they miss more infections has not been borne out by numerous studies.  In my opinion, you have ruled out HIV-2, as well as HIV-1 as the basis for your illness.  
kground.  You do not know that you were exposed to HIV of any sort.  Most women, even in locations where the infection is common do not have HIV and even if you were, the risk for a single episode of unprotected sexual intercourse to an untreated infected person is less than 1 infection for every 1000 exposures (i.e. transmission rate is less than 1/10th of 1 %).

In response to your specific questions:
1)When can one ABSOLUTELY be assured that tests aren't missing some sort of HIV?
Most experts feel that antibody detection tests for HIV-2, as well as HIV-1 are conclusive at 8 weeks following exposure.  Certainly any tests taken beyond the older, 12 week "window" would certainly be completely conclusive.

2)If an odd subtype, or other, are there any better tests to conclude this is not HIV(like going to CDC)?
No, you should believe the results you have.  The tests performed at the CDC for their research are the same commercially available tests that are available through commercial laboratories.

3)I understand window may be longer for HIV-2 and also no antigen in the test, what can a person do to make sure this has been ruled out?(Quest test only a lab developed test and not FDA approved)?
See my comment above about tests.  The Quest lab-developed test is reliable and while not FDA-approved, had to undergo a College of American Pathologists validation process before it could be offed commercially.

4)What is the consensus on the outside window period for HIV-2?
Repetitive,  See comments above.

5)I have not mentioned to my wife my concern as i have been told that HIV is no longer a possibility.  But I want to make sure for her health she does what she needs to.  I am just in deep at this point(308 days) and if mention something to her now(an not needed), our marriage is likely over.  Your thoughts?
You have ruled out HIV-2 as a consequence of your indiscretion.  At this time, there is no health-related need to comment to your wife  

6)Doctor, can all tests up to this point be falsely negative for any sort of HIV no matter how rare(elite, seronegative) or do you feel I need to put it behind me?

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Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Continuing my response (computer locked up)
6)Doctor, can all tests up to this point be falsely negative for any sort of HIV no matter how rare(elite, seronegative) or do you feel I need to put it behind me?
It is certainly time for you to put your concerns about HIV behind you.  You have not described your symptoms but whatever they might be, neither HIV-1 nor HIV-2 are causing them.  If they are troublesome, my suggestion would be to work with your personal doctor to explore their cause.  I hope my comments are helpful.  EWH
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28 months ago
Thank you very much for your reply.  In regards to symptoms, just a lot of nausea, bloating, heartburn since my exposure 11/2017.  Ive had lots of lab tests and diagnostic tests but nothing revealed yet.  Its just that ALL of symptoms started about a week after my encounter with her.  Again she was Asian from China, and my mind goes to the fact that maybe she has a type of HIV that is quite uncommon in the United States and tests not picking up.  So in regards to this:
1)What did you mean my your statement that "that currently available tests for HIV-2 require longer than for HIV-1 or that they miss more infections has not been borne out by numerous studies"?
2) Besides the moral part, is there reason to come clean at this point with my wife with symptoms and my worry that this could be HIV or some sort, or has that been conclusively been ruled out by the 10 month mark?
3)HOW long do you have to test to be entirely sure for either type of HIV?  It seems that testing could go on and on and on.
4)With  HIV-1 and latest tests done, is it entirely safe to cross that off the list?
5)Is there an instance where one should still be concerned about this disease, despite my testing, and seek infectious disease consultation?  I am not sure what more they would do besides repeat.  Thoughts?
6)I did have some lab work last week and lymphocytes are in normal range but a tad less than a year ago.  If HIV, generally does lymphocyte counts help or do you need a CD4/CD8 test, and would that be advised at this point with all normal HIV tests?
Thank you very much for your concern.  
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Final responses to your questions which are a bit repetitive.  I think you are overthinking this and that you really need to look elsewhere for the cause of your symptoms.  The symptoms you describe (nausea, bloating, heartburn" are not typical symptoms of HIV.  OTOH, they are symptoms of anxiety and reading between the lines of your post, it appears to me that you are worrying more about a low risk situation than you should be.  As I said, statistically, it is unlikely that your partner had HIV or any sort and even in Asia, while HIV-2 is present, the substantial majority of HIV in the region is HIV-1.  further, if you had HIV-2 you would have had a positive test by now.  As for your questions:

1)What did you mean my your statement that "that currently available tests for HIV-2 require longer than for HIV-1 or that they miss more infections has not been borne out by numerous studies"?
Just that- experts agree that current tests are ACCURATE for HIV-2 diagnosis. In other words, you really should believe your test results.

2) Besides the moral part, is there reason to come clean at this point with my wife with symptoms and my worry that this could be HIV or some sort, or has that been conclusively been ruled out by the 10 month mark?
No, you have conclusively ruled out HIV of any sort form your encounter months ago.

3)HOW long do you have to test to be entirely sure for either type of HIV?  It seems that testing could go on and on and on.
Any testing done after more than 8-12 weeks is unnecessary and a waste of time and resources.

4)With  HIV-1 and latest tests done, is it entirely safe to cross that off the list?
Absolutely.

5)Is there an instance where one should still be concerned about this disease, despite my testing, and seek infectious disease consultation?  I am not sure what more they would do besides repeat.  Thoughts?
Believe your results. There is no need for further testing or an infectious diseases consultations

6)I did have some lab work last week and lymphocytes are in normal range but a tad less than a year ago.  If HIV, generally does lymphocyte counts help or do you need a CD4/CD8 test, and would that be advised at this point with all normal HIV tests?
CD4.CD8 tests are non-specific and beyond there use for staging persons for PROVEN HIV have little diagnostic use.  You do not need a CD4/CD8 test, really

This will end this thread.  I hope my comments will help you to move forward.  EWH


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28 months ago
Dr Hook, thank you for your reply.  As far as all 4th generation tests go, there seems like there is only a handful available in the United States of which the Abbott Architect and Advia Centaur is what I have tested with.  When dealing with specific tests, wouldn't it make sense that they have to be equal in their sensitivity?  I understand that there are patents and one company wants to outdo the other, so why is one 4th generation better than the other?  Better said I guess,  should one believe any 4th generation test approved by the FDA when past a window now matter what?  A couple other specifics
1)The most recent tests i had were 45 week Abbott architect and now 52 week(ONE YEAR) Advia centaur 4th generation test.  I am going to see my physician this week.  Is there a reason where I should insist on a repeat(will be 54 week) Abbott so they are both after a years time?
2)When you get to this time frame are symptoms irrelevant?
3)a 45 week architect and 52 week Advia would not miss HIV-1 or HIV-2?

I just want to make sure that beyond any reasonable doubt, and with symptoms, have ruled ANY sort of HIV out.
I appreciate your understanding and know this is my last post.
Take care
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
This thread was inadvertently left open.  It should have been closed.  I will provide a few additional comments which I hope will help you move forward from continuing to consider that there is any possibility that you have HIV, something that you should have rationally believed long ago.  There are multiple so-called 4th generation HIV tests available in the U.S.  at this time following your exposure, there performance is equivalent in verifying, once again that you do not have HIV.  

1. Both tests would be fine.
2.  Correct, your symptoms are irrelevant.  Believe your tests.
3.  Correct.

This concludes this thread.  Further repetitive, anxiety-riven tests on this topic may be deleted without comment and without return of your posting fee.  EWH
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