[Question #5260] Follow up #5147

76 months ago

Hi Dr's
Following Dr EH grear advice, I wanted 2 explain what has happened since - to get a updated assessment & ask abt conclusivity of a 6 week Ag/Ab test
Recap:
March 16th - receptive msm oral, refused PeP by A&E
March 18th - GP appt for swollen tonsil/cough; diagnosed with enlarged neck lymph nodes. Negative HIV test 2 set baseline
April 4th - Negative 5th gen Ag/Ab test & rapid test 19 days post exposure
April 15th - Negative 4th gen Ag/Ab test 30 days post exposure
I understand clients cannot choose who answer q's, but i must state my q's all relate to Dr HHH previous comments
My Q's
1) I have had a mild-moderate headache consistently all day for the past 7 days. 3 days after headaches I had 30 day neg 4th gen test. Does this mean my headaches are not due to ARS? As i understood it, if symptoms due to hiv, test will be +ve. I ask because of Dr HHH comment on #5253 - symptoms present for a week or more test will be +ve? My test was 3 days after - is this still case? ENT/Dentist say headache due to TMD/TMJ disorder recently diagnosed

2) Dr HHH and Dr EH - 4th gen hiv test 99% reliable after 28 days. But as a previous user questioned iBase 95% reliability i am confused. Is it 99% or 95%? Why is this different? Is 99% based only in the US or worldwide reliability?
3) If 6 weeks is conclusive, why do most websites say 3 months? Or 8 weeks for 4th gen? Legal liability? Or again is 6 weeks only conclusive in US? Should i get test at 6 or 8 week or 3 month?
4) Dr HHH did a risk assessment for another client & i used his comments to do the same. If 1/7 gay men london scene have HIV, & oral according to UK guidelines is 1/2500 risk, & a 4th gen test is 95% reliable: (1/7) ×0.04×0.05 = 1 in 350,000 risk - is my assessment accurate or too conservative? Is my % of infection lower?

I hve yesterday noticed a small swollen lymph node behind my ear. i would not have worried about headache, but as lymph nodes still swollen, & idk how long one behind ear has been there, i worry

Edward W. Hook M.D.

76 months ago

Welcome back to the Forum. I'm sorry that you continue to worry about the very, very low risk episode that we interreacted about previously. My assessment and advice will not change. As for your follow-up questions:

1. Correct. If your headache (or any other symptom were due to the ARS) your 4th generation test would have been positive. Dr. Handsfield's earlier response was conservative. Further, you have an alternate explanation made by a trained professional. I urge you to accept it.

2. at 4 weeks more than 99% of persons who have recently acquired HIV will have a positive 4th generation test. In the past we used to state that 4 week result were totally conclusive but about a year or so ago the CDC guidance stated that there were a very few patients who took up to 6 weeks for tests to become positive. Neither Dr. Handsfield nor I have ever seen such a case but we accept the observations of our CDC colleagues and now use that more than 99% figure.

3. Those websites are either out of date of overly conservative. Further their advice may reflect the package insert of test manufacturers which are likewise conservative. The 6 week figure can be relied up world-wide.

4. I would say your estimate is too high and that your true risk is still lower than you estimate for all of the reasons noted above

Please don't worry. EWH

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76 months ago

Dr Hook,

Thank you once again for the prompt advice and information. Headache still ongoing

I will save my 3rd reply - either to thank you again or to ask for further information dependent on 6 week test result, so please do not close the thread

1) Regarding the production of antigen/antibodies, is the time taken for this to happen - i.e to test positive - dependent on the sort of exposure? For example, if it was unprotected anal with ejaculation, surely this person - having been exposed to much more of the virus - will test +ve faster? My concern is that the 6 week may be positive due to my only potential exposure being a small amount of pre-cum, some of which will have been destroyed by saliva

So the Q is: does the type of sexual activity affect how long people take to test positive?

2) As i understand it, 4th gen tests are incredibly reliable and one of the most effective diagnosis tests invented for specificity, for HIV and in general medicine. Does this mean I should not entertain the possibility of having received/receiving a false negative result?

Side Note - The fact you mentioned you nor Dr HHH have seen a 4 week -ve then 6 week +ve is is very reassuring, due to both your years of experience I highly appreciate this comment

3) I have voiced my concerns to:

---- GUM trained doctor, and she - i quote - stated 'you did not have a risk at all'. She told me this, then asked if i wanted to test anyway, so i did, and that i needed to address my underlying anxiety

----- HIV specialist/Dr in charge of running the entirety of the UK's PreP trials (if you were not aware, PreP is not available via the NHS in Britain, it is only trialled to high risk individuals at a limited supply - i personally think it should be widely available to quell the epidemic) >> he again said to me 'you do not have hiv'

However, guidelines for US and UK - and your and Dr HHH brilliant advice note a risk

So i ask, just for general curiosity now, is this common practice amongst std clinicians/dr's to advise of zero risk? I know oral is almost negligible risk, so I wonder if to calm people's worries it is typical to say zero?

Do you personally agree with their advice? I.e. a confident assessment that I should not be HIV concerned at all?

4) Is it atypical for ARS (i know, it likely isnt) to be just a headache? No sore throat, no rash, no night sweats

5) My last Q - what can affect a HIV test? I am taking creatine (a muscle building supplement) I do not know if you are aware of it, this will not have any effect I presume? Is it just PreP/PeP and chemotherapy treatment that impact a test?

Many thanks for entertaining my worry, I again understand it must be repetitive. I have tried to vary my Q's from what I have previously asked, so as to get more information whilst not violating forum policy

Regards

Edward W. Hook M.D.

76 months ago

1. No, the time frame you have been told repeatedly is the same irrespective of the type of exposure.

2. Correct, there is no reason to worry about a false negative.

3. I cannot comment on the approaches taken by other health care professionals.

4. Atypical ARS is a myth. An isolated headache is not a sign of HIV seroconversion.

5. Nothing other than medications designs to treat or prevent HIV would affect your HIV test, including creatine.

EWH

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75 months ago

Hello Dr Hook,

I want to repeatedly thank you for your affirmations, and hope that you will answer my Q's as thoroughly and best you can one last last time

Before I begin, I acknowledge my severe sexual health anxiety and I am due to start therapy to address it.

I cannot, however, dismiss my current symptoms as anxiety: the 3 same painless enlarged neck nodes for nearly 2 months; swollen tonsils for nearly months; persistent cough for 2 months; persistent 2 week headache at the 4 week mark; recurring painless mouth sore exact same spot 4 times; TMJ and suspected laro-pharyngeal acid reflux

- Everything points to HIV or cancer and I have a cancer referral appt this weekend, something is DEFINITELY up and cancer is unlikely as I am v. young

I had a negative 4th generation Ag/Ab test at the 41st day post exposure.

1) My test was at 41 days post exposure. Is there an appreciable difference between 41 and 42 days in terms of reliability? Or, as the CDC site have it, 45 days?

2) 2 months ago Q#4960 was about a 'late seroconversion - scientific article' that you answered. I came across the same piece of research and now I am confused. If - potentially - I was one of the few people to not produce antibodies, does the p24 antigen remain positive? Or does this fluctuate and disappear as it normally does? Can this 4th generation be negative if I were not producing antibodies at 41 days? Can you please clarify this piece just like you did for #4960?

3) I have struggled to understand what the p24 antigen is. Is it part of the virus or is it an immune response? If it is an immune response, can some people not produce the p24 antigen just like rare people's don't produce antibodies?

4) Does the p24 antigen not disappear till antibodies are produced? Apologies if this is the same as Q2

5) I planned to get an RNA PCR test at this point so I can be sure, as it looks for the virus itself. Is this a waste? Will the 4th generation test detect an infection if I have one and dont produce antibodies? I just want to be 100% conclusive and move on with my life - regardless of cost. Can the RNA PCR test provide this for me or has the 4th gen test already done so?

6) I have browsed many many of your, Dr HHH, and Dr Cumming's Medhelp posts, and recently came across Dr HHH referring a client to Freedom Health clinic by Dr cumming if he was still concerned. I then, having seen your and Dr Cumming's similar advice, tried to book an appointment with Dr Cummings at a London freedom health clinic. Alas, Dr Cummings retired in March. Do you recommend the Freedom Health clinic - if you know of it - even if he is no longer there? I might see another practitioner for a 8 week 4th gen, though none seem to be HIV specialists.

7) BHIVA/BAASH revised a statement on 4th gen tests in 2015 - low risk exposures conclusive 28 days, at 8 weeks for a high risk exposure to be sure. Is this out of date and 6 weeks is conclusive?

8) What do I do about HIV-2 infection? Is there a PCR test to detect HIV-2 if Im not producing antibodies? Is 6 weeks conclusive for HIV-1 AND 2? Need I worry about HIV-2 in England?

9) Potential cancer cant affect the test right? (You answered this one already, I am just checking)

10) My existence has been a wreck and on hold for the past 6 weeks. Can I confidently and 100% reliably MOVE ON WITH MY LIFE at this 41 day mark? Or, if I am willing to pay, should I get the RNA PCR now and then put this in the past?

Regards and well wishes, I will try to not bother you/return again

Edward W. Hook M.D.

75 months ago

Thank you for acknowledging your sexual health anxiety. Despite that however, the tests provide valuable information which should be believed. To continue to believe that your symptoms are due to HIV despite negative tests is non-productive and illogical. I will now reply to your final set of follow-up questions and then this thread will be complete. I must also warn you that future threads on this topic may be deleted without a response and without return of your posting fee. While I acknowledge that anxiety is a major problem, it is neither The reason for this thread nor something that we are expert in.

Further, I should add that I am not debating your symptoms. What I am saying emphatically however is that you have proven that they are not due to HIV.

1. No, your results are conclusive.

2. If you did not produce antibodies (I am confident you do) to HIV your P 24 antigen test would be positive and stay positive.

3. The P 24 antigen is a part of the virus it is not an immune response.

4. The P 24 antigen does not disappear in untreated infection until antibodies are produced.

5. Yes, a PCR test is a waste of time and money.

6. To my knowledge, freedom health continues to provide high-quality healthcare. There are other very knowledgeable and able clinicians who work there.

7. This recommendation is overly conservative. The six week test is conclusive.

8. HIV-2 is not a problem in England. When persons have HIV-2 their test for HIV typically not negative but are indeterminate. There is no reason for you to worry about HIV to from what you have said.

9. Correct, my answer has not changed. The presence of cancer would not change your HIV test results.

10. My advice continues to be, as it was before, that you acknowledge that you do not have HIV and move forward without continuing concern about HIV.

This now completes this thread. There will be no further answers.

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