Dear Doctors,

Following a sexual risk for HIV exposure in September, I went to get tested with a lab-based test around seven weeks later to exclude infection.

The result of my test was negative. I then felt fine for some time but developed weird gastrointestinal symptoms. I was unsure if I was perhaps the one in a thousand whose test doesn't pick up the infection, so went to a checkpoint for sexually transmitted infections. They tested me for syphilis and chlamydia which also came back negative.

Right there I asked if I could get another HIV test. They performed an INSTI test with a drop of blood from my finger and the doctor said the result is visible immediately. This was negative, too. At around 20 weeks post possible exposure, I thought this was reliable.

However, since then I have had persistent issues, especially loud noises from the stomach area, irregularities in digestion and excessive flatulence. I got scared because I read that HIV could cause such symptoms. So by then the whole COVID lockdown had started, which is why I bought a home test for HIV. It is called "Autotest VIH" in Belgium but looks exactly like the BioSURE they sell in the UK. It also was negative after 15 minutes. This was at 24 weeks.

Having read that in rare cases antibodies don't become detectable until half a year post exposure, I repeated the home test at 27 weeks with a new kit. Negative again. With so many results I should think I am conclusively HIV negative but I wanted to check with experts:

1) is it not worrying for HIV that I have such gastrointestinal symptoms out of nowhere?

2) How reliable are home tests where just one drop of blood is used? It's EU certified.

3) What do you recommend I should do now?

Thansk so much for your time!

You do not have HIV. The current HIV blood tests are among the most accurate tests ever developed, for any medical condition. When done sufficiently long after a possible exposure, the resutls overrule all other considerations:  no matter how high the risk at the time of exposure and no matter how typical the symptoms might be, the HIV test result reliably tells the truth. And you have had several tests beyond those time limits (6 weeks for the antigen-antibody tests (4th generation). Any information you have found that "1 in a thousand whose test doesn't pick up the infection" negative or "that in rare cases antibodies don't become detectable until half a year post exposure" are urban myths without scientific basis. And anyway, the AgAb tests detect the virus itself (antigen) as well as antibiody. If antibody somehow did not develop, the Ag component would still result in a positive test result.

1) These symptoms are not at all suggestive of HIV. Although HIV can cause certain GI symptoms, they would never be the only symptoms. But even if suggested HIV, your test results prove you don't have it.

2) All blood tests are highly reliable, and you have had several tests well beyond their 100% conclusive dates.

3) My advice is to your best to stop worrying about HIV. See a doctor if your GI symptoms continue or you otherwise remain concerned. Do not have any more HIV tests.

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

HHH, MD

Dear Doctor Handsfield,

Thanks so much for your quick response.

So if I understand you correctly, you have faith in rapid tests and home tests as well, provided enough time has elapsed since the encounter of concern? The INSTI website says, that a control dot can only appear if enough blood was added... so I guess that sounds promising? Same is true for the Autotest VIH where the control line is supposed to appear only if the test was performed correctly.

Anyway, I went to see my GP today to talk about some results she got back from the lab where she sent my blood and a stool sample last week. It turns out that the one value that seems off to her is for pancreatic elastase which she said was at 120 but should be 200 or more.

She prescribed medication called Kreon and told me to eat less fatty food and avoid alcohol. I'm just telling you because I though while I can, I'd ask whether that seems like a red flag to you in terms of any sexually transmitted infections? She said everything else looks fine, including red and white blood cells, kidney and liver function, etc.

I know, your area of expertise are other diseases, but is it conceivable that insufficient amount of this elastase has been causing my symptoms?

Thank you again for your valuable time!

I have no knowlege at all about pancreatic elastase testing or Creaon (pancreatic enzyme) treatment, but I doubt this is causing your symptoms. You are correct that this is unrelated to HIV, therefore off topic for this forum. 

Thanks for the thanks. I'm happy to have helped.

Dear Doctor,

Thanks for getting back to me again. I understand this is the last time I can post on this thread. I just wanted to clarify that all legal rapid tests (including home tests) in the EU are blood tests. That said, I had four of them — so that should be enough.

I tried these two:

https://www.youtube.com/watch?v=TaIxOi1AlXE

https://www.youtube.com/watch?v=N4CAqsmN_6g

I trust that doesn't change your assessment.

The only thing that still worried me were my symptoms, which is why I paid to be able to write to you. You wrote that they are not indicative of HIV, so another test seems superfluous. However, I hope this medication for the pancreatic stuff will resolve the symptoms because they make it hard for the scientific facts to reach the brain...

Either way, thank you for your patience and informative replies to my questions.

As I also said, I have no prior knowlege or clinical experience with the pacreatic exocrine function test (the elastase test) or treatment. But you've given me the opporuntity to educate myself, which I appreciate. I have learned that this test is done primarily to address the possibility of malabsorption syndromes, i.e. impaired absorption of nutrients from the GI tract. That in turn can cause the sorts of symptoms you have had. Poor pancreatic exocrine function is one potential cause, but this occurs primarily in people with other manifestations of serious pancreas problems, especially acute or chronic pancreatitis. Those conditions always cause other symptoms, in particular bouts of severe abdominal pain requiring hospitalization and sometimes surgery. From the little I know from my quick ride up the learning curve, there is little chance you have such a problem. But your doctor may be much mor knowledgeable about all this than I am. In any case, GI symptoms like yours, or abnormal pancreatic function, are not common manifestations of HIV -- and would never be the only manifestation of HIV. That fact, combined with your negative HIV test results, should give you total reassurance about HIV. Do your best to drop all thoughts of it.

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.