[Question #5192] HIV test results evaluation

25 months ago
Hello Doctor, 
During 6 weeks, I had different HIV tests below;
10th day: HIV PCR RNA: negative
15th day: HIV PCR RNA: negative 
16th day: HIV Duo Ultra 4thgen: HIV 1-2 antibody 0.04, P24 0.00
29th day: HIV Duo Ultra 4thgen: HIV 1-2 antibody 0.06, P24 0.11
37th day: HIV Duo Ultra 4thgen:  HIV 1-2 antibody 0.05, P24 0.10
43th day: HIV Duo Ultra 4thgen: HIV 1-2 antibody 0.06, P24 0.11
Reference range of Duo Ultra is <0.24 negative, >0.25 positive (All my results are negative)

My questions are; 
1- from 16th day to 29th day, value of p24 increased from 0.00 to 0.11 (all the results are under the limits / negative). What is the reason of this increase? and should I worry about this increase? 
2- Were my tests done on right time period? and should I have any test after day 43? 
3- What is Your review about my test results?  Can I drop the subject ? 

Have a good day..
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
Welcome to the forum. Thanks for your confidence in our services.

Unless you had a very high risk exposure, you have been very excessively tested. If you'd like to describe it, I'd be happy to advise. But pretty much no matter how high the risk at the time, and regardless of what symptoms you might have that worry you, for sure you did not catch HIV. Your test results are absolutely conclusive. To your specific questions:

1. The numerical result is entirely unrelated to partial detection of antigen. The very same specimen tested 10 times generally gives different numbers. In fact, it's somewhat unusual for the results to be as closely grouped as your first four p24 test numbers. Anything up to the cut-off (usually around 1.0) is completely negative, with no difference between, say, 0.1, 0.3, 0.7, or 0.9. All are totally negative.

2. As implied above, the "right" interval depends in part on the nature of the risk. But the antigen-antibody ("4th generation", "duo") tests always are 100% conclusive by 6 weeks. Also, the combination of negagtive RNA at around 2 weeks plus negative antibody at 4+ weeks also is conclusive, so you could have stopped testing after the 29 days blood test.

3. For sure you can drop the subject and move on without worry you have HIV.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
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25 months ago
Hello Mr. Handsfield,

Thank you for your clear and kind answers. 

Actually, I want to ask some more things; 
By apologizing, I don't understand what You mean on answer 1 "In fact, it's somewhat unusual for the results to be as closely grouped as your first four p24 test numbers" ? 

I want to explain my story;
I had protected sex with a sex worker. During sex, she removed condom and continued with oral sex. After that she put another condom and continued.  She was just before her period (regl), and I think she have me oral sex with her blood smeared hand (because I saw some bloodstain on bedclothes). Is it possible to infect HIV?

During this period, I faced night sweating (last 2 weeks) and short-term diarrhea. This is the reason why I'm worry. After tests, I talked with different experts of labs, and answers were same "drop the subject". 



H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
Sorry if my "closely grouped" comment wasn't clear. It is unusual that three of your p24 results all gave the same number, 0.11. Usually with three different tests, those numbers woud not be the same. They could vary anywhere from 0.0 to 0.9. That your first result was 0.0 and the next ones 0.11 does not mean anything. All four results are equally negative.

The details of your exposure do not matter. Neither does your diarrhea or any other symptoms. This was still a low risk exposure, but even if the risk were high, or even if your symptoms were typical for HIV (they were not), the test results prove you do not have it.
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25 months ago
Hello Mr. Handsfield,

I droped the subject (HIV) after now. No tests anymore. 

I have some more questions about syphilis and hepatitis
At day 29, 
Anti-HCV : 0,15 negative (worked with Vidas anti-HCV test kit)
VDRL : negative
TPHA: negative

Can I re-test again for syphilis and hepatitis C?

In May 2018, my check-up values for hepatitis-B 
HBs Ag : 0,423
Anti HBs: 157.2
 
Do I have immunity for hepatitis B? Should I re-test again for Hep-B?

Have a good day..



H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
Your test results indicate you are immune to the heptitis B virus (HBV) -- probably because you were vaccinated; or less likely, that you previously were infected and it was cleared by your immune system.

Your test is negative for HCV, but it can take 6 weeks. However, the ONLY proved sexual transmission for HCV is by potentially traumatic (i.e. potentially bloody) rectal sex between men. If you had any other kind of sexual exposure, you were not at risk, did not need testing, and need not waste any more money, time or energy for a repeat test at 6 weeks or any other time.

Similarly for syphlis:  it takes up to 6 weeks. But also extremely low risk for most potential exposures -- but not knowing your exposure, I can't say more about it.

That completes the two follow-up comments/replies with each new question and so concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe.
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