[Question #6747] Still worried..

11 months ago
So mid May 2018 I had unprotected sex with a girl. long story short I made her mad, she told me she had aids. Later said she didn't.  Got tested 5 weeks later, again in October 2018, again  June 2019. belive the test were "Two HIV serologic assays are utilized as part of an HIV testing algorithm. Initial screening for HIV-1 p24 antigen and antibodies to HIV-1 (including Group O and subtypes) and HIV-2 is performed using an immunoassay (IA)"  Done at a NC public health department. Also in a January 2020 took oraquick home mouth swab all negative. My new partner is wanting to have unprotected sex, and talking about children. Now the doubts are coming back. Can I be sure I'm truly negative after that many negative test done buy a state health department?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
11 months ago
Welcome to the forum. Thanks for your confidence in our services.

I certainly understand your alarm in learning a sex partner had HIV, even if it later became probable that she was lying. But that's now water under the bridge for you -- at least it should be. The HIV blood tests are among the most accurate diagnostic tests ever developed, for any medical condition. When done sufficiently long after the last possible exposure (and yours were plenty long), the results overrule all other considerations. No matter how high the risk of HIV at the time of exposure, your test results prove you don't have it. And where a test is done makes little diference. There are only a handful of laboratory-based blood tests on the market in the United States, all are highly standardized and automated, and the results are equally valid no matter what lab does them. All public health departments have high lab quality standards, and the NC state health department is highly professional and respected nationwide. In fact, they have done the lab work themselves for important research on HIV diagnosis.

So all is well. Please stop worrying about HIV:  you're in the clear. Best wishes for a successful new relationship from all angles:  personal, romantic, and sexual.

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

HHH, MD
---
---
11 months ago
Thank you, what you say is very clear and assuring. It's just so much confusion about the window period makes me doubt everything. CDC Duo= 45 days cdc antibodie= 90 days. Then I see Kaiser Permanente website say "3-6 months to developed antigens or antibodies". " WHO says up to 6 months or longer (unusual)"Also about delayed antibodie response, also no antibodie response due to some human genetic defect. Omg... I guess this follow up question would be, I've seen yall say 8 weeks would be 100% confidence in a hiv test, what confidence do you think the CDC  is putting in there 45 and 90 day window period would you assume? And can the CDC be trusted? Also I've read different opinions about the p24, it drops off when antibodie is detectable. There both detectable while p24 is being eliminated, and neither is detected while antibodie is attaching to the p24 antigen. How sensitive are these test? Sorry for all the questions, And thank you greatly for your time. I just want this behind me, it's almost 2 years now.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
11 months ago
Part of the reason for the varied advice is that the data on time to conclusive testing ("window period") are not very robust, so various experts and agencies make their own interpretations and base their advice on the principles of how the tests work, in addition to the data. I'll just point out that there are no reported cases in the medical literature of someone with newly acquired HIV who tested negative with an AgAb (duo, 4th gen) test more than 6 weeks after infection -- with the occasional exception of persons who were taking anti-HIV drugs prophylactically (which didn't work but delayed test positiviety). In any case, you had several tests, and for sure there is no chance you have HIV with in view of all those results.

And yes, p24 antigen typically becomes undetectable as antibody develops. That's because it's the antibody itself that clears antigen from the blood. It's also why the test is so powerful: if somehow antibody production were to wane, antigen would reappear. Therefore, everybody with HIV more than a vfew weeks has either antigen or antibody (sometimes both) in the blood, for life. 

I'll also point out that the exposure wasn't as risky as you might think, even if your partner in fact had HIV. The average transmission risk for unprotected vaginal sex, if the female has HIV, is 1 in 2,500. That's equivalent to having daily sex with an infected partner for 7 years before infection would be hihgly likely. (Which is why many spouses of infected persons remain uninfected for years, which perhaps you didn't know.) 

Thanks for the thanks. Let me know if anything remains unclear.

---
11 months ago
Alright so to be repetitive I guess, would you say I'm safe 100% without a doubt?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
11 months ago
Indeed repetative, but you can be sure I haven't changed my mind since yesterday! For sure you do not have HIV, assuming no more recent exposures you haven't mentioned.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.
---