[Question #5561] Please help

20 months ago
Hello Dr.Handsfield. Here is my exposure details. 

This question is an update of the last question I asked here on May 4th,2019.
Condom breakage with a girl from college. I’m in the US

Tests conducted: 

Aptima Rna PCR with 20 copies/ml detection at 13 days : negative 

Duo combo test at laboratory at 36 days (Architect): negative 

Duo combo test at laboratory at 48 days(Architect) : negative 

I now have what I think is seborrheic dermatitis on a part of my scalp. This is day 90.
Do you think it’s related to HIV ?

I saw that CDC considers 45 days to be conclusive for duo and also experts . Most Guidleines like UK,European guidelines consider 6 week to be conclusive for the duo. But I understand 4 weeks is more than enough.

Considering this, Am I in the clear doctors ? 

However I came across a study which states that the combo test has an accuracy of 83% in acute infection which made me think the results I got have only 83% accuracy. I consulted Dr.tan from tan and partners and he said the time frames are important and the studies have no time frames attached. Please go over this study for me

It states that only 48 of the 58 acute infection samples were reactive using the architect assay. This is confusing. Please help me understand this.

20 months ago
I also would like to add that till now I did not have a fever, rash, sore throat, fatigue. None of the ARS symptoms except mild joint aches 14-32 days after exposure which I think was due to anxiety. 
20 months ago

CBC done at 48 days with labcorp

WBC -7.8 (Normal)

RBC-5.83 (High) Range:4.14-5.80

Haemoglobin- 17.4(Normal)  

Hematocrit-53.1%(High) Range:37.5-51.0%

Neutrophils - 4000 (Normal)

Lymphocytes - 2700 (Normal)

Monocytes - 600 (Normal)

Eosinophils - 400 (Normal)


Not sure why my RBC is high but I have been lifting weights for the past 3 years and read that can increase my rbc levels. My RBC level was also high back in 2017 too. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
Welcome back, but I'm sorry you found it necessary.

You are way overthinking all this. As discussed with Dr. Hook a month ago, your test results at that time were conclusive. Correct about 45 days for conclusive AgAb (4th generation) testing, which on this forum we round off to 6 weeks. But you also had the PCR/RNA test; in combination with the AgAb test you had at that time, the results were 100% conclusive. It is not my responsibility to "go over" the study you cite with you.

We stand by our test interpretation and advice as we state them on this forum; you clearly are misinterpreting the importance or significance of the studies you are finding through your online searching. The HIV tests, including the ones you had, are among the most accurate diagnostic tests ever developed, for any medical condition. When done sufficiently long after the last possible exposure, as your tests were, the results overrule all other considerations. No matter how high the risk at the time of exposure (which in your case was almost nil, as discussed last time), and no matter what symptoms or lab results (like your CBC) may show, the test results are what matters.

As you state, your CBC shows a higher than average RBC indices (count, hemoglobin, and hematocrit), but this has nothing to do with HIV. I suppose it is possible that being in excellent physical condition weight lifting might be responsible. 

So it's time to move on without worry and with no more testing for HIV. If you have any symptoms or other concerns, see a doctor -- but for sure you do not have HIV.

I hope these comments are helpful. Let me know if anything isn't clear.

20 months ago
Thanks Dr.Handsfield for your response. Yes I will try my best to move on. The reason I got a CBC is because I wanted to rule out HIV infection because I read low lymphocyte and platelet counts occur during acute infection.  But since my counts were normal with my hiv tests being negative and also with your expert advice, I will definitely move on with nooo concern. 

My last question is: Have you ever had a person who got infected after a one time insertive vaginal exposure ? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
CBC cannot diagnose or rule out HIV — never. And most people with recently acquired HIV have entirely normal CBC results; that was awaste of money. The only way to rule HIV in or out is with an HIV test, and you already did that.

It makes no difference whether or not I have seen any patients with HIV after a single vaginal sex exposure. To my knowledge I have not, but rare things happen. Would it make any difference in your risk of being struck by lightning if I had taken care of a patient who had?
20 months ago
I understand! , this is not gonna change anything. I looked up chances of getting hit by lighting is 1 in 3000 and chances of hiv through insertive vaginal sex is 1 in 2500 and in my case chances that the girl has hiv is very very low so it’s much lower than getting struck by lighting. 

Why are some doctors still recommending the 90 day period while CDC  now clearly state in their Hiv testing pages that retesting after 45 days for the duo will rule out hiv infection ?  Overly conservative ? Not updated ? 

For future exposures if they happen:

Do you recommend people to get tested after a single potential exposure like myself ? 
20 months ago
A question to gain some knowledge:

I saw that studies are using these seroconversion panels of infected persons. During the first bleed does the person know they are infected or does it happen somewhere inbetween the course of the bleeds ? 

That ends all my questions regarding this topic ! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
I'm sure all the persons in the panels were informed of each of the results as soon as each test was done. And probably all knew they were at high risk and should expect positive results. It would make no sense to enroll persons at such low risk as you for example; in oder to have even a modicum of efficiency, probably all enrollees were at very high risk to assure a high proportion would turn out to be infected.

That completes this thread. I hope the two discussions were helpful. This will have to be your last on this exposure, testing, etc. Thanks.