[Question #6594] Seeking confirmation

15 months ago
Hi, I blacked out on the night of 12/28/19 after a night out.  I was around a group of people.  Anyways, a few days later on 1/2/20, I noticed my side had a hole looking puncture on it.  It would produce a drop of blood when I squeezed it.  My mind goes to convince me I had been stuck by a needle or injected unknowingly.  Anyways, because I could not confirm, I went on the get the RNA test at 10 days which came back negative, a 4th generation at 23 days because stdcheck.com says that their FDA approved tests have a 9-11 day window for the RNA and a 3 week window for 4th generation.  I was feeling some sense of relief until I saw on medhelp 28 days was needed for 4th generation to be conclusive, so I went again on day 30 and the 4th generation came back negative.  Now I am learning that it is actually 6 weeks.  I am so sad because I just want this to be over before I leave for vacation this weekend.  However, if I go on Friday, that will only be day 39.  Could I consider this time conclusive? Has anyone ever tested positive after a negative 4th generation test at 30 days? 

Thank you in advance for your time 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
Welcome to the forum. Thanks for your question.

I have to be skeptical you really were stuck with an HIV infected needle or other object. But in any case, your HIV test results already are conclusive. Correct that the antigen-antibody (AgAb, 4th generation) HIV blood tests are not conclusive until 6 weeks. However, the combination of that result plus negative RNA test at 10 days is conclusive and you don't need any further tests.

Yes, the fact that it can take up to 6 weeks for the AgAb test to be positive means that on rare occasions someone with new HIV could be negative at 30 days and positive later. But I hve no way to know whether and how often it actually has happened. Probably very rare. But I'm confident that nobody with that result plus negative RNA at 10 days ever turned out to have HIV.

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

HHH, MD
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15 months ago
I can’t find anywhere that says the two of those would be conclusive? 

So if this happened on Saturday night at 3am, I guess Sunday morning, and I took the RNA on 1/7/20, would that be 9 or 10 days? I find this confusing.  


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
You'll find almost no online sites that address the interpretation of any combination of tests. But it's a logical conclusion from all available data, the biology of infection and the HIV tests, statistics, and common sense. If you don't trust that your results are conslusive, you're free to test again. 

I count 10 days and don't undertand what's confusing about it. 
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15 months ago
Thank you, I had a rash on top of my thigh on day 29, if it was ARS, would it have shown positive on the 4th generation on day 30? 

One last question, if I hadn’t had the 10 day RNA, and had another 4th generation on day 39, not day 42, could it still be considered conclusive? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
Why isn't this HIV? Let me tick of the reasons:  ARS doesn't cause such a localized rash. Skin rash is never the only ARS symptom. ARS cannot start 4 weeks after exposure. And it is impossible to have ARS with a negative blood test.

This depends on what you consider conclusive. If the exposure is low risk and the test is "only" 99% reliable, it still comes to zero chance of HIV. If there's 1 in a million chance of HIV from a particular exposure a negative test that's 99% conclusive makes the possibiliyt of HIV 1 in a hundred million. Obviously that's zero for all practical purposes. Please stop thinking up "what if", "yes but" or "could I be the exception" scenarios. There is simply no realistic chance you have HIV and this isn't worth any further concern. Do your best to just let this go. But if you need a test that is 100% conclusive all by itself -- regardless of initial risk -- you're free to be retested. If you do so, of course you should expect a negative result.

That completes the two follow-up exchanges included with each question and so concludes this thread. I hope the discussion has been helpful.
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