[Question #6452] Took your advice .. now need scientific reasoning

16 months ago
Hello dr hook and Handsfield,

I spoke to both of you about a year and a half ago and dr Handsfield about 6 months ago... I had a couple of negative Oraquick in home oral swab tests overdevelop because I kept them after the read time.  I then took more oraquicks and multiple blood lab based 4th generation hiv tests and they were all negative ...I had some issues with typos in some of your responses and I was just all around confused and in a bad state of mind..

Anyway I took your advice and have been in counseling for my OCD    It has helped tremendously.   I’m here to ask a couple of things that we didn’t get into.  Dr Handsfield you said

 “ CDC is correct: the antigen-antibody (4th generation) HIV tests are the conclusive final test method and if enough time has passed, the result overrules any and all previous results, including a possibly false positive ("overdeveloped") oral fluids test. “  

 Can you please explain to me why the fourth generation is the final method if someone had a false positive rapid test or “ overdeveloped “ Oraquick oral swab after it was negative in the read time ?   I have came a long way and I think knowing the scientific reasoning along with my continued counseling will help get me over the last bump and finally relieve me from these overdeveloped scares.     Like I said I had negative blood 4th generation HIV tests all the way out to almost 3 years after the last overdeveloped Oraquick 

 Thank you for your time and I hope y’all had a wonderful Christmas.   sorry I couldn’t remember my old name and login info too
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
Welcome back. I don't recall your previous threads, although I vaguely remember writing the statement you quote. I'm glad to hear you've received counseling and seem to be less dominated by OCD, at least as evidenced by lack of intervening questions for more than a year. Congratulations. Directly to your question.

The AgAb tests are the final word in HIV testing. They depend on detecting not only antibody against HIV (the body's immune response to the virus) but also the virus itself (p24 antigen), compared with antibody-only for 3rd generation and previously developed tests, including Oraquick.) It is not physiologically possible to have HV for more than a few weeks and not have antigen or antibody in the blood. There has never been a person with HIV who had negative AgAb testing when done more than 6 weeks after being infected (or 3 months in a few who ihad taken HIV drugs for post-exposure or pre-exposure prophaxis that doesn't work). In contrast, the oral fluids test (OraQuick) misses 1-2% of infections regardless of how long you wait, and is known to give false positive results on rare occasoina.

Therefore, I stand by the quote above. With negative AbAb tests beyond 6 weeks, you can be 100% certain you don't have HIV.

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

HHH, MD
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16 months ago
Thank you.  Very informative information.  So 3 quick  questions just to verify that I understand.   Been a long tough road but I believe I understand now.  

1) Does Multiple negative HIV 4th generation lab blood tests out to almost 3 years after my NEGATIVE Oraquick in home hiv oral swab tests  overdeveloped prove I am HIV negative ?

2. Is there any other test I need to prove that I am HIV negative ? 

3) Is it time to realize my oraquicks were negative and just overdeveloped because I failed to follow directions and discard the test after they were negative in the read time ? 

Thanks again Doc.  Happy Holidays 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
1) You're asking me to repeat what I already said, just different words. I won't play that game.

2) Nope.

3) Yup.
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16 months ago
Thanks Doc for letting me know with my negative 4th generation HIV lab based blood testing I can forget about my overdeveloped Oraquick in home HIV oral swab tests and know they were negative in the read time and that 4th generation testing out to almost 3 years after the overdevelopment of the oraquicks prove I am HIV negative.   2 more quick things since I know this is my last response per rules.  

1.  When you said “ It is not physiologically possible to have HV for more than a few weeks and not have antigen or antibody in the blood. “.  I know HV was meant to be HIV.   Is the reasoning that one would have either antigen or antibody is because the antigen comes first then the antibody overtakes and that’s why one or the other would show up on the fourth generation test ? 

When I said I had trouble with typos , I’m going to quote what you told me and please just let me know with a simple yes or no .   You wrote in my last question 6 months ago 

 “ It doesn’t  change the advice that you do not and connot possibly be infected “.

A big part of my anxiety is just making sure that was a typo and connot meant to be 
( Cannot ) 

So could you please answer this with Yes or No 

2. Was (Connot) a typo that actually was meant to be  “ Cannot”?  

I know it sounds dumb but to get the validation that is was just a typo would help ease my mind more than you could ever imagine.   So please just answer them last two questions     I been wanting to ask you that for 6 months and it’s the only thing holding me back.  Please understand 

Thanks again for everything and I appreciate your replies.  Your an amazing person for doing this for people.    God Bless and have a wonderful New Year.   


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
1. Correct. Also, it's the antibody that clears p24 antigen from the blood. That's why either one (sometimes both) are always detectable in blood more than 6 weeks after infection.

2. Wow! Of course the answer is yes. Counseling or not, your OCD really is out of control! You might consider printing out this thread to discuss with your counselor. S/He will be impressed!

As you probably have been told in the past, repeated anxiety driven questions are not permitted. The forum doesn't accept responsibility as part of your OCD management and reassurance that probably doesn't help all that much anyway. And such questions have limited educational value for other users, one of the fourm's main goals. This will have to be your last one (ever) about HIV risk, test interpretation, etc. Thanks for your understanding. But of course I do hope this final discussion has been helpful.
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