[Question #5321] Conclusiveness of RNA + 4th Gen Tests together

21 months ago
Good day doctors. A bit of factual background before my question(s): I had an unprotected penetrative encounter with another male approximately one year ago. I cannot confirm this partner's history, although he maintained he had a clean bill of health and several weeks after the encounter, he tested negative for HIV--this was probably a 4th generation test because he used the local LabCorp. On days 10 and 22 after the encounter, I took "HIV RNA QL TMA" (LabCorp) tests and both returned "not detected". On day 29, I took a "HIV Screen 4th Generation wRfx" (LabCorp) that came back "non-reactive." Assuming I was in the clear, I did not do any follow-up testing at 6 weeks, 3 months, etc. 

Recently, my current partner, who I have been having unprotected sex with for close to a year, became quite ill. For the last week, she has an extremely sore throat, swollen and exudating (sp?) tonsils covered with small dots, alternating chills and hot flashes, difficulty swallowing, fatigue, and has been coughing up phlegm. She has never felt this sick before, and rapid strep and flu tests have come back non-reactive. She has been sick several times recently.

My questions therefore are:
1) How conclusive were my tests results from last year? I understand that the 4th gen test is not completely accurate at 4 weeks, and that RNA tests are similarly not always reliable. Could I have gotten a slow-manifesting HIV infection that would not have shown up by the time I took the various tests due to the virus or my body's response (i.e., not enough RNA was detectable by day 22 and not enough antibodies were present by day 29)?
2) Should I get tested again to ensure once and for all my status? Even if just a rapid oral test?
3) Do my current partner's symptoms change the analysis? At what point if these symptoms do not go away should I be concerned? Could it be that I infected her months ago and now her immune system is more susceptible to other illnesses, which explains the recent sickness(es)?
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Welcome to the Forum.  I'll be glad to comment

1.  The encounter you describe was essentially no risk for HIV.  The fact that your partner tested negative for HIV several weeks after your encounter virtually assures you that he did not have circulating HIV present at the time of your encounter. Thus there was no risk for you to acquire infection.  The combination of tests that you took subsequently serve to confirm that you did not acquire HIV through the encounter.  I see no need for further testing related to this exposure. 

2.  I see no scientific or medical reason for further testing related to this encounter.  If you choose to test, irrespective of the test type, I anticipate the test will be negative and should be believed.  

3.  It sounds like your partner has acquired a sore throat and respiratory tract infection which is most likely the sort of viral infection or bronchitis that many people iacquire from time to time.  It is unrelated to your other encounter about a year ago.  

I hope these comments are helpful.  EWH  
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21 months ago
Thank you Doctor for the comprehensive answer. 
21 months ago
To add another wrinkle to this, I just had a CBC in connection with a routine yearly doctor's visit. The test showed I have abnormal neutrophil and lymphocyte counts. Does this alter your analysis? 
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Not in the least.  You may be catching your partner's sore throat however. EWH---