[Question #4960] Late seroconversion - scientific article

24 months ago
Thanks doctors for your continuous supports and advice.

I've never doubted the info you provide, but it happened that i read an article in one forum where the doctors says it's a late seroconversion case with 4th gen test and that it may happen. I know that use this website as a good website for info but not sure what what the article is trying to say but this is a part "The patient did not develop either HIV-specific antibodies or achieve viral suppression in plasma viral load for 4 years". 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4742638/ 

I had unprotected oral exposure and tested by 4th gen CLIA, ECLIA, and ELFA in Dubai from 84 days after exposure until 142 all negative. 

What makes me think a lot is that some of those labs told me it takes 3 months while others told me 6 and some didnt specify. Are all these methods universal? And are they the same wherever done so 6 weeks is conclusive? Do you have any idea if the 4th gen done in Dubai is good as outside like in the US? I asked them if they are approved by FDA but couldnt understand me so im not sure.. But they should be good labs. 


Appreciate your thoughts on this as an expert in this area.
Edward W. Hook M.D.
Edward W. Hook M.D.
24 months ago
Welcome to our Forum and thanks for calling this paper to our attention.  The paper demonstrates the complexity of HIV diagnosis and certainly indicates that there are rarely persons who acquire HIV who have sometimes substantially delayed antibody responses to their infections.  This person's delayed antibody response should be considered "the exception that proves the rule" regarding the reliability of current tests for HIV.  While this person's antibody tests, including Western blot tests were negative despite demonstrable HIV by PCR and the p24 antigen tests.  

Literally hundreds of thousands of persons with and without HIV infection have been formally and rigorously studied in evaluation of current tests for HIV.  The tests have gotten better and better in the 30+ years since the first HIV antibody tests became available and the addition of the p24 antigen assay to the tests for HIV antibodies has further improved test performance, both in terms of time to a conclusive test and in terms of sensitivity.  In the case report you describe, when the HIV PCR was positive, so was the p24 antigen test.  That the man did not produce antibodies for several years is, as the authors point out, very, very rare and difficult to explain.  This case report does not change our confidence in the accuracy of current combination HIV antigen/antibody tests for timely (within six weeks of acquisition of infection).

With respect to your own personal situation, I would point out that the events you describe were low risk- HIV is quite uncommon in Dubai and receipt of oral sex has never been proven to lead to acquisition of HIV.  While I do not have first hand knowledge of laboratory standardization procedures in Dubai, I am not aware of any problem either. The tests used in Dubai are the same tests as used int he rest of the world, including the U.S.  

Ihope this comment is helpful. thanks for your confidence in our site.  EWH
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24 months ago
Thank you doctor Hook for your answer and reassurance. 

So in the article i posted, the patient had an antibody test when he was tested not a Combi? I mean with Combi it would be obvious he was postitive within 6 weeks?

Because the one who posted it said that the 4th gen failed to discover the virus. Maybe he misunderstood? 

Aside from this doctor, after my negative results i resumed unprotected sex with my wife. We went to Turkey for a vacation and it was very cold 5 degrees. She had high temperature and mild sore throat for almost 2 days or less. After 10 days same symptoms? After those symptoms i had the last negative test. Are those symptoms suggestive? Maybe she has diarrhea that time (not sure) if it really is.. Please advise. Although i know the result rule but the article frightened me. 


Edward W. Hook M.D.
Edward W. Hook M.D.
24 months ago
In Table 1 of the paper, the patient had both a positive p24 assay and a positive PCR.  he did not develop a positive test for antibodies for over three years after that but there is no indication that he had other p24 antigen tests.  I presume he would have had positive p24 tests after that.  

I would not worry that you might have HIV.  Rather, I suspect that your illness may have acquired the sort of "traveler's fly" from other, non-STI viruses of the sort that so many of us get when traveling.  Please believe your test results.  EWH
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24 months ago
As it's the last reply i will ask last questions in my mind so I dont think about the encounter again.

Few days after my wife had her high temperature or fever and the mild sore throat, she had a mid-sized pimple. In here left armpit but she told me it was fat and a hair growing inside. And lasted for 2 or 3 days without temperature or anything. This couldn't be a swollen node right doctor? 

My unprotected oral encouter lasted for liks 20 mins but was mild.. Does the duration affect? The girl tested negative after a month of the encounter btw. 

Last thing, are fever and sore throat with maybe diarrhea alone suggestive for ARS? 

I know i tested negative but as the lab techs are not experts in this they make us think we need to keep testing at least for 6 months. 


Thank you Dr. Hook for your time and continuous support. May God bless you. 
24 months ago
Sorry Dr. Hook just remembered this. I once read an article saying dont have cheap tests. All the 4th gen tests i had are around 41 dollars. Is this a good price for the 4tg gen test?  
Edward W. Hook M.D.
Edward W. Hook M.D.
24 months ago
I'm sorry you are continuing to worry.  Swollen nodes do not appear as pimples of the sort you describe.  I suspect your wife is right, this sounds like folliculitis (ingrown hairs).

There are no studies which evaluate the duration of sex on HIV risk but logically this might be a factor, IF you were exposed.  The fact that your partner tested negative a month after your last encounter proves that you were not exposed to HIV.  

Fever and sore throat, even with diarrhea are not the ARS.  Further, studies have proven that even in persons with flu-like illnesses, the majority do not have HIV.  Believe your test results.

The price you paid for your HIV test was appropriate.

I hope my responses will allow you to move forward without continuing concern.  as you know, this thread will be closed shortly, as per Forum guidelines without further responses.  Take care and please don't worry.  EWH
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