[Question #6804] Follow up :6044

12 months ago
Hi doctors sadly I’m back...  In my previous post Dr Hook gave me advice.  I got my 4th generation test back and it was negative.  It has now been almost 3 years in August since my stupid but safe or so I thought choice.
I’m wondering if 4th gen tests are accurate years after infection “may” have occurred and if you always have antibodies or antigens and if it will pick it up after much time has past.  I worry because my wife recently got Pneumonia and it’s been hard for her to breathe and we were both tested for covid 19 results were negative .  Her blood Panels including white blood cells and red etc shows her to be healthy yet she can’t shake pneumonia after a week. She’s got no symptoms of pneumonia besides trouble breathing.. no fever, no cough nothing.  I’m wondering if I need a pcr test to actually look for the virus Itself, I’m worried she’s not getting better because hiv is the underlying condition keeping her from getting better again.  
I know you have heard the same stories over and over again but I’m just trying to figure out what my next move is here, can I really rely on a 4th generation test years after and would pneumonia that late be a sign since she issnt shaking the infection? The doctors simple said she has an scute case of viral pneumonia .  
Thanks in advance
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
12 months ago
Welcome back and thanks for your continuing confidence in our services. But I'm sorry you found it necessary.

I reviewed your discussion with Dr. Hook and agree with all he said. That discussion made it very clear you do not have HIV, not confirmed by your negative antigen-antibody (AbAb, "4th generation") blood test. There has never been a proved case of that test not detecting infection when done sufficiently long after the last exposure (6 weeks). And once positive, it never becomes negative but remains positive for life. The vast majority of pneumonia and other infections occur in people without HIV. There is no chance you have HIV and thus no chance you infected your wife.

There is no point in additional HIV testing, unless you have reason to believe your wife could be at risk -- i.e. other sex partner(s), shared drug injection equipment, etc. If you are confident that's not the case, move along with no further worry about any of this.

Best wishes--   HHH, MD
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12 months ago
Dr handsfield,
Thanks for encouraging reply.. appreciate it.
Follow up questions:
1. So the 4th gen tests are the final word and at almost 3 years a PCR wouldn’t be needed because of my low risk, negative test and she doesn’t have any of those habits that apply and furthermore the accuracy would be close to 100% right?
2. In someone with hiv does a CBC ever give any indicators like low wbc or High wbc?
3. Does someone with hiv get sick and recover from pneumonia the same way as someone who’s negative or has a better chance of getting it and that’s why people seem to link the two?
Tia this will be my final questions.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
12 months ago
1. Correct, except delete "close to". The accuracy of your negative AgAb test is 100%.

2. CBC is pretty much useless in giving clues about HIV. Usually it's entirely normal; and 99% of any possible abnormalities have other cuases. HIV testing per se is the only valid test.

3. Certain kinds of pneumonia are more common in people with HIV, but the most common kinds -- viral, pneumococcal, etc -- are no more frequent in HIV infected persons than anyone else. Some conservative and careful physicians would test most or all their pneumonia patient for HIV, just to be safe; but most would not do that unless there is evidence the patient is at elevated risk of HIV, which is not the case of your wife if she has no risk independent of your single oral sex event. (To remind you of one aspect of your discussion with Dr. Hook, there has never been a proved, scientifically documented case of HIV acquired from receiving oral sex. Your exposure can and should be viewed as zero risk for HIV.)

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12 months ago
Dr handsfield,
One last thing it wasn’t just an oral sex event, it was protected sex with a low grade prostitute. Protected assuming the condom didn’t rupture.
I’m sure this doesn’t change your assessment, just wanted to clarify.. thanks.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
12 months ago
Thanks for the clarification -- but no, it doesn't change the fact that a) your risk of infection was very low and b) that your test results prove you don't have HIV.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Don't worry at all about any of this. Best wishes for your wife's complete and speedy recovery. (FYI, the COVID-19 nasal PCR is highly accurate, but misses a few cases. You might discuss with your doctor wiether it would reasonable to re-test your wife. But probably unnecessary if she is well on the way to recovery.)

Best wishes.
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