[Question #5619] HIV fears

21 months ago
Hi there,
Nearly 5 years ago I was exposed to blood on blood contact during an incident in my work in disability support.  The client had no known risk factors for HIV and is from Australia (low HIV prevalance here) however they were not tested. 8 days after this exposure I became ill with the worst sickness of my life, extreme sore throat, aches, shivers, sweats, high fever of 39.9, lethargy etc. This illness lasted a week and was followed by a cough and lethargy that lasted for weeks. 2 months later I was admitted to hospital requiring IV antibiotics to treat pnemonia. My doctor told me that HIV would not take effect that quickly and that I did not need to worry. Once I googled my symptoms in the context pf an exposure to blood I became convinced I had HIV. I had a negative baseline HIV ab/ag the day after the exposure and hepatitis blood test followed by repeat negatives at 6 weeks, 3 months, 6 months and also a few years later too when I had a child as they do HIV testing in pregnancy. I told my doctor I had read about rare cases of people with HIV who remain antibody negative but are actually in fact infected with HIV and believed that I was one of them because I just can’t reconcile how I could become so ill 8 days after exposure then end up in hospital (for the first time in my adult life) I begged my doctor to order a HIV RNA test at 9 months post exposure. The lab initally refused the request but my dr explained it would help my anxiety so they begrudingly did the test and the results came back as >40 copies and my doctor told me this was negative. For a while I was able to move on because I thought ‘if there is no quantifiable virus and no antibodies then i must be HIV free’ however recently I have been feeling unwell and decided to look up this test. I discovered that on the taqman version 2.0 that a negative RNA test would actually say ‘target not detected’ rather than >40 copies to be a negative result. I am so so worried about this and that it could be p
21 months ago
sorry accidentally submitted before I finished my last sentence. I am so worried now that I have read the manual of the assay that did my RNA test and it has brought all my fears back that I was previously able to move past. I am writing to you to ask if you think it is possible that I have an antibody negative HIV infection and if you think I should try and redo the HIV RNA test or is this all a mental problem and not a medical problem. My fear is that without HIV treatment I will progress to AIDS and die or that my children could have been infected in pregnancy. How is it possible for me to have gotten so unwell after the exposure (not anxiety symptoms but genuine illness) and not have HIV?
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Welcome to our Forum.  I'll do my best to help.   HIV tests are amongst the most reliable tests in all of medicine.  In your case you have been tested on multiple occasions and for multiple different indicators of infection-antibodies, antigen (the protein coat on the virus) and viral RNA.  All of negative, conclusively proving that you are not infected.

Regarding your concern about the limits of detection of your RNA test- all tests have lower limits of detection.  In the case of HIV, when person have untreated HIV they have thousands and tens of thousands of viral particles circulating in every drop of blood.  The lower quantitative limits of the RNA assays become important in assessing the effectiveness of therapy for established infection where the therapy needs to drive the amount of virus down to undetectable (i.e. less than 40) levels.  Your HIV RNA result is one more indicator that you were not infected by your low risk exposure five years ago.  

I assume you had some other coincidental viral infection after your exposure.  there really is no scientific reason to think that you were infected and the infection has been missed with your repeated tests (FYI, antibody negative HIV infections rarely occurred years ago with less sensitive tests for HIV and now are non-existent but are a continuing source of angst for persons seeking information from the internet where so much of what is there is out of date, taken out of context, or just plain wrong).

I hope you find these comments helpful.  I urge you to accept your results.  From the sounds of things, it may be beneficial to talk your concerns through with a trained counselor who has experience in dealing with anxiety problems.  EWH
---
21 months ago
Thank you for your prompt response and for offering this service. It does make me feel alot better knowing that an expert in the field feels I am definitely HIV negative. I will just ask one more question regarding the RNA test as according to page 11 on this document (health dept of australia so is reputable) https://www.health.gov.au/internet/main/publishing.nsf/Content/F0B1B857E0B579B6CA257FD300072984/$File/HIV2016.pdf the interpretation of a result “<40 copies” states “HIV RNA detected <40 HIV RNA copies/ml” and that a result of “target not detected” interpretation is “HIV RNA not detected” my blood test result only states “<40 copies and <1.6 log10 copies”  according to this document that does mean that HIV was detected even though it was a small amount? 
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
I believe you are over reading this document (see my comments about the internet above).  In the introduction to this 4 year old document, a statement is made that "Nucleic acid tests such as PCR are not currently validated for formal confirmation of a diagnosis of HIV infection. However, they are useful supplemental tests to assist in diagnosis of difficult cases."  The document goes on to note that the recommended utility of PCR tests of for monitoring response to therapy among persons with proven HIV or in cases with unusual preliminary results (there was nothing unusual about your preliminary results- they were negative).  It is well know that when persons with proven HIV are on therapy, the amount of virus detectable in the blood declines.  the goal of therapy is to make the virus undetectable.  Obviously, the lower the limit of detection in such cases implies that there may be virus present below the limit of detection.  Over the years, the sensitivity of PCR tests has improved- early tests had a lower limit of detection of 400 copies.  Subsequent tests with improved sensitivity had lower limits of detection of 200 and now 40 copies.  In contrast, all reports of persons who have not received anti-HIV therapy typically have thousands, tens of thousands or even hundreds of thousands of circulating viral copies.  In your circumstance, your result indicates that HIV was not detected.  I once again, urge you to believe your test results.  EWH---
21 months ago
Hi there,
Yes initially the lab did not want to do the test at all and even rang my doctor to ask why they had requested it. and my doctor told me that the result I had was a negative result but I just wasn’t sure I could believe that after seeing that document online.
Thank you for your response, I am looking into some pyschology support to help me move on from this issue.
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Thank you.  Your replies indicate that you intellectually understand that you are not infected but that does not overcome the emotional stress that such an event can cause, particularly if other coincidental occurrences line up to amplify your concerns.  I would encourage you to seek the counseling you mention to assist you in working through this.  

This is my final reply as part of this thread.  I hope my comments have helped.  Take care.  I wish you the best.  EWH
---