[Question #4621] Follow up Question 4413

29 months ago
Hello Doctor
I understand you mentioned that my exposure was zero risk but i am still concerned. I had an alere HIV combo test at day 16, 30 and 51 and they are negative. Are my results 100% conclusive or is there any remote chance that rapid test wont pick up infection?
I read alere is a good test and reliable but picks up infection by 48 days except 1 panel PRB969 from SERACARE. this panel was detected at 70 days and even RNA detected this panel at 63 days. Is there any specific stain of HIV that takes this long?
https://www.seracare.com/globalassets/seracare-resources/ds-0600-0251-hiv-1-seroconversion-panel.pdf

1. Is my test conclusive for both HIV-1 and HIV-2?
2. Do you suggest to have laboratory test or PCR to rule out all possibilities?
3. I am at day 53 and have no sysmptoms apart from weigh loss which i think is due to constant worry and anxiety. 
4. i stay away and am travelling today to my spouse. Can i be 100% sure that i will not infect my spouse. not even 0.01 % possibility?

I know i am asking for lot of assurances but your experience will help me in moving forward. Please suggest.
I see Dr.Hook is not very much supportive on rapid tests but given test is done after 7 weeks, is it conclusive?

Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
Welcome back to the Forum although I must say that I am troubled that you have not been able to accept the detailed and science-based advice that Dr. Handsfield provided you in your earlier interaction following your no risk event.  As he pointed out, testing was irrelevant given the nature of the event you described.  I have reviewed your earlier interaction with Dr. Handfield and I find that your follow-up questions are repetitive.  My responses will not vary from those you have already received from him.

1. Is my test conclusive for both HIV-1 and HIV-2?
Yes

2. Do you suggest to have laboratory test or PCR to rule out all possibilities?
No

3. I am at day 53 and have no sysmptoms apart from weigh loss which i think is due to constant worry and anxiety. 
I agree with you regarding your guilt and anxiety.  Further testing is unlikely to affect these.  If you cannot move on, rather than further testing, I recommend that you speak with a confidential, professional counselor.

4. i stay away and am travelling today to my spouse. Can i be 100% sure that i will not infect my spouse. not even 0.01 % possibility?
There is no possibility that you were infected through the events you described in your earlier post. There is no reason for you to abstain from unprotected sexual contact.

I hope that these replies will help you to move forward.  EWH

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28 months ago
Thank you so much Dr. Hook for your response. It is great to have assurances from both TOP experts in the world.
I am certainly relaxed now with your confirmation that my tests are conclusive. To further assure, I took a laboratory based test here in Mumbai at Day 59 and result were negative. (cannot trust litmus paper test completely)

HIV DUO - (HIV I & II),SERUM
HIV DUO - (HIV BY ELFA) 
RESULT - 0.04 (Negative) 
Negative : < 0.25
Positive : >/= 0.25
METHOD : ENZYME LINKED FLURESCENT ASSAY (ELFA)

In Summary, 
Exposure - Handjob and Cut on knee with White flesh visible and massage
Test 1 - Alere HIV Combo - Day 16 - Negative
Test 2 - Alere HIV Combo - Day 30 - Negative
Test 3 - Alere HIV Combo - Day 51 - Negative
Test 4 - Lab based HIV DUO (4th Gen) - Day 59 - Negative

As i have a follow up left, I wanted to ask few things which are lingering in my mind. Request you to please provide your feedback.
1. I have caught Cold, runny/blocked nose and cough after my last test, i have been travelling, there is no fever, rash yet. Can i conclude that i am way past ARS timeline (9th week now) and any health issues are due to seasonal changes? 
2. I read that Dr. HHH confirmed on one question that he has never seen or heard of anyone turning positive after 6 weeks. Can you confirm if you have ever seen or heard of such case?
3. One of the admin (Jim Dublin) on poz forum said that he has seen one outlier turning positive at 11 weeks. do you agree with this comment? is there any scientific reason for such delays?
4. Lastly, regarding the SERACARE panel PRB969, can you confirm why a 10 member panel used for research purpose was positive only after 63 days for RNA and 70 days for 4th gen? Is it due to specific HIV subtype ?
5. Can I resume my sexual practices (protected) with my wife? 

I am sincerely looking forward for your final response on above and moving forward with your assurances. 

Thanks a lot for the help. You both are super heroes for us. Keep up the good work.

Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Thanks for your thanks. I'm pleased my assurances have been helpful.  With these test results it becomes important to not worry about coincidental sensations that you may have- you have proven you were not infected.  Now, on to your follow-up questions:

1. I have caught Cold, runny/blocked nose and cough after my last test, i have been travelling, there is no fever, rash yet. Can i conclude that i am way past ARS timeline (9th week now) and any health issues are due to seasonal changes? 
See above.  This is a coincidence, likely related to your travel.  It is too late for the ARS.

2. I read that Dr. HHH confirmed on one question that he has never seen or heard of anyone turning positive after 6 weeks. Can you confirm if you have ever seen or heard of such case?
Correct.

3. One of the admin (Jim Dublin) on poz forum said that he has seen one outlier turning positive at 11 weeks. do you agree with this comment? is there any scientific reason for such delays?
I am not aware of the outlier that you mention.  The only thing that might delay seroconversion would be if you had taken PEP or were taking PrEP when exposed.  Even in those situations such a delay would be very, very rare if it happened at all.

4. Lastly, regarding the SERACARE panel PRB969, can you confirm why a 10 member panel used for research purpose was positive only after 63 days for RNA and 70 days for 4th gen? Is it due to specific HIV subtype ?
Sorry, I am not aware of the details of this and they are not provided in the material you have provided a link to.  I would not worry, if this were due to some sort of new observation, we would know it.  There are no data to suggest that some HIV subtypes cause delayed seroconversion- that sort of thing is the sort of urban myth that misleads people who see it on the internet.

5. Can I resume my sexual practices (protected) with my wife?
Yes, there is no reason related to the exposure that you describe to hesitate about unprotected sex with your wife.

Please don't worry, you are in the clear.  EWH

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28 months ago
Thank you so much Dr. Hook and Dr.HHH for the reassurance you have provided during this difficult anxiety driven period. 
To be more confident i underwent below tests at Day 74 and result were negative. 

HIV-1 RNA (QUALITATIVE) DETECTION
METHOD -  REAL TIME PCR
EQUIPMENT USED -  COBAS AMPLIPREP AND COBAS TAQMAN
LIMIT OF DETECTION -  20 copies/ml
SPECIMEN -  PLASMA
RESULT - NOT DETECTABLE

HIV-2-RNA QUALITATIVE PCR
TEST PRICIPLE - REAL TIME PCR
TARGET SELECTED - 5 'LTR region
SENSITIVITY - 100                    IU/ml
SPECIMEN - EDTA PLASMA
RESULT: HIV - 2 RT NOT DETECTED

HIV - DUO (HIV I & II),SERUM
HIV - DUO (HIV BY ELFA) -  0.01 (Negative) 
Negative : < 0.25
Positive : >/= 0.25
METHOD : ENZYME LINKED FLURESCENT ASSAY (ELFA)

1. All of the above tests were negative. Can i be 200% sure that i am clear now? We are planning for baby and have to take some major life changing decisions (job change, immigration etc) so i want to be absolutely sure.
2. Is there any situation that will cause false negative result? Like HCV ?
3. I have a minor continuous discomfort on my left jaw, nothing swollen i can see, does this have any thing to do with HIV?
4. My both legs pain a lot went i wake up, this i have observed recently past 1 month. again anything to do with HIV?

Thank you so much again doctors, happy new year and hope this is my last post. I will never risk again as this anxiety has taken a huge toll of me. 





28 months ago
Also last thing, 
As i did PCR for both HIV 1 and HIV 2 and HIV DUO, so this will effectively rule out every possibility of presence right? at 74 days i have never seen in any report of virus not detected by PCR or DUO. 

HIV DUO for Antigen and Antibody 
 PCR for actual presence of VIRUS in body

1. This will rule out the open concern i had about the SERACARE panel PRB969 which was detected only after 63 days? 
2. PCR are the tests used to test before blood transfusion? 

Laboratory doctor mentioned that i have done more than enough to ensure i am not infected, These are the max tests anyone can get. he also mentioned they consider DUO conclusive at 3 weeks in mumbai. 


28 months ago
Please answer all questions above, I promise i wont return again. 
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
This is a repetitive question.  The testing you performed was a waste of time and money.  You had already PROVEN that you did not have HIV of any sort.  This just confirms that results.
1. All of the above tests were negative. Can i be 200% sure that i am clear now? We are planning for baby and have to take some major life changing decisions (job change, immigration etc) so i want to be absolutely sure.
See above.  This confirms that you do not have HIV.

2. Is there any situation that will cause false negative result? Like HCV ?
No

3. I have a minor continuous discomfort on my left jaw, nothing swollen i can see, does this have any thing to do with HIV?
No

4. My both legs pain a lot went i wake up, this i have observed recently past 1 month. again anything to do with HIV?
No
Further questions:
1. This will rule out the open concern i had about the SERACARE panel PRB969 which was detected only after 63 days? 
This has been answered in the past.  You have repeatedly proven you do not have HIV-1 or HIV-2

2. PCR are the tests used to test before blood transfusion? 
Correct

This ends this thread.  Further repetitive, anxiety-driven posts may be deleted without a response or return of your posting fee.  End of thread.  EWH

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28 months ago
Thank you so much doctor. I will rest and move ahead with life.. i will not relate any symptoms with hiv gng forward. 
Between PCR was cheap here only $150 for all tests so went ahead. 
Happy new year..