[Question #6916] My Partner and I

9 months ago
Experts, a pleasure. 

Fingered a woman, after having a fresh cut around my nail/cuticle about 30 mins earlier. (Obviously drinks involved and thinking was not clear. Not a major bleed but imagine biting on the side of your nail and just pulling a little to much off that would cause a small hole with blood). Ended up testing at 42 days and 69 days (4th Gen lab based test using blood from vein - Non Reactive for both).  After speaking with her about testing, she decided to get a full std panel including HIV using 4th generation test, all lab based blood from vein 105 days post the night in question. Non-Reactive for HIV as well. 
(She also showed me her labcorp results). She’s a sweetheart. 

The questions I have are the following:

1)  She had literally got her booster shot 2 days before her HIV test. Would that cause an incorrect result for her test?

2) I can’t shake the 12 week or 90 day rule out of my head. It’s been around so long. My last test was at 10 weeks basically (69 days) and non reactive. Can you please help me out here by explaining why 12 weeks is not needed anymore? 

3) When a person decides to get a Full STD panel including HIV test, can they (the lab techs) confuse the test results for another test?  She had 6 tubes of blood taken for all those tests from LabCorp. 

4) It confuses me that all these studies out there that state the 6 week window period for 4th Gen but a handful still make there own conclusions.  (Example: some state at 4 weeks its 95% conclusive but fully at 90 days using a 4th gen hiv test. (These pages are updated even in 2020). You can imagine the “pretzel brain” that this can cause a person. Why?

5) Between her results and mine, there is nothing to second guess and question here, correct? These combined tests, I should believe the conclusive results, 100%. 

Thank you for your time.  
Edward W. Hook M.D.
Edward W. Hook M.D.
9 months ago
To our forum and thanks for your question. I’ll do my best to provide the reassurance that it appears you were seeking. My answers below are intended to reassure you that your test results both at 42 and 69 days are absolutely conclusive, that you have no risk whatsoever for HIV from the event you described, and that there is no reason for continuing concern or additional testing.  Working through the questions, question by question:

1.  HIV tests are not impacted by vaccinations, other medications or any other influence. The results she has received at 105 days or conclusive and should be believed.

2.  As you pointed out about the 12 week and 90 day recommendations have been around for a very long time. So long that they are out of date and do not reflect current tests. Those recommendations were made at a time when the combination antigen antibody tests were not available and the technology was less mature than the current methods. Again, I urge you to believe the results.

3.  No, the lab tests win an STD panel is requested a run and recorded independently. There is no risk of confusion in the results.

4.  We live in a world in which free speech is encouraged and people are permitted to provide contrary opinions.  Having said that, as you already seem to acknowledge, scientific studies, official scientific bodies such as the CDC, and expert opinions all concur that results of current HIV test are conclusive  after six weeks-42 days.

5.  Correct, nothing to second guess. Your results are absolutely conclusive and need to be believed.

I have a suspicion that there may be a certain amount of guilt involved in your continuing concerns. Please do not confuse this sort of guilt or resulting anxiety from the science which makes your results conclusive. Believe them.

I hope that this response and my explanations are helpful to you. If there are further questions you may use your up to to follow up questions for clarification. Take care. Please don’t worry. EWH
9 months ago
Thank you Dr. Hook and you are absolutely right. A very high level of guilt indeed. The partner and I was a one time situation. We are friends and drunk and regret what happened. We both have our own lives. My plans involve having a family in my current state, thus the anxiety. 

It’s amazing how a person can read so much information that comes from agencies and experts that favor what I know but the mind dwells on information that is outdated or simply opinion and it takes priority over everything else. This is what fuels the anxiety of so many on here including myself, obviously. 

For some follow up questions. I understand 6 weeks is 100% conclusive. But I’m confused a bit for the confirmation test. 

1) Does a second test for confirmation purposes only apply if HIV tests are done before the window period or for any time? For instance her test at 105 day, a secondary test to confirm the first would not be needed? At that amount of time, the test can’t miss infection past 6 weeks, correct?

Clarification for possible exposure. 

2). Curious about the nail bleed. I have read that “any cut, fresh and bleeding, can be possible exposure to hiv infected bodily fluid.”  It seems like a very broad statement. For future reference, it seems like my example is not a concern in your eyes. Does this so called cut, wound or lesion need to be fairly large and deep for possible infection? 

3) There seems to be possibilities of being infected in different ways. With your history in the field combined with Dr HHH, is it safe to say unless it’s sex or sharing needles, there is really no other way to contract HIV?

4) Obviously it’s impossible to know who is infected or not. That being said, I do have friends and family that I would share a drink with from the same glass. Share food with from the same plate. (Possible siliva being shared). Closed mouth kiss on the cheek or lips. These would NOT be considered ways that it could be transmitted if they have the virus?

Thank you for your time and expertise Dr. Hook. 

Edward W. Hook M.D.
Edward W. Hook M.D.
9 months ago
I’ll go straight to your follow-up questions:

1.  Confirmatory testing is recommended only for positive tests in order to rule out the very unusual possibility of a falsely positive result. Otherwise there is no need for confirmatory testing. In fact however, the fourth generation tests actually are two tests in one. One is the test for P.-24 antigen and the other is for antibodies. When both of these tests are negative at any time more than 42 days after an exposure, it is absolutely conclusive that you do not have HIV.

2.  Concerns of cuts, scrapes, and abrasions proposed as possible entrance points for HIV infection are overstated. While there is strong evidence that lesions caused by STIs like Syphilis or herpes may increase risk for acquisition of infection, there is little or no evidence that cuts, scrapes, or abrasions meaningfully increased risk. As you can imagine, millions and millions of persons have engaged in masturbation of partners with cuts on their fingers yet no one has been infected in the course of mutual masturbation.  Mutual masturbation is completely safe sex.

3.  Correct.

4.  Sharing the same plate, using the same implements to eat, sharing a glass, or kissing including open mouth kissing have never been associated with acquisition of HIV. These are no risk events.

Your questions suggest that you have researched the topic of HIV risk on the Internet. This is one place where the Internet is not your friend. Much of what is said on the Internet is out of date, taken out of context, or a misinterpretation. The Internet is more often than not misleading.  

I hope my comments have been helpful in situations.  EWH
9 months ago
Thank you for all your answers. I appreciate your time and patience. You have fulfilled my questions and I understand. 

One of the reasons why many people have issues understanding the window period and so on is because we don’t know how these test work and how the virus works. 

To use my last follow up, could you explain how this 4th gen works and how the process of antigens and antibodies work in the body. What would slow would slow the process of antigens or antibodies if any. 

I appreciate it once again and have a wonderful weekend. 
Edward W. Hook M.D.
Edward W. Hook M.D.
9 months ago
Final responses. When a person becomes infected with HIV the virus begins to multiply, increasing in numbers. HIV p24 antigen is part of the protein coat of the virus. As the virus circulates in the blood it can be detected As p24 antigen. After a period of time, typically more than 12 to 14 days, the body begins to develop antibodies to try to fight the virus.  After by the time six weeks have passed, everyone who has been infected with HIV has either detectable P 24 antigen, antibodies to the virus, or both. This is the basis of fourth generation tests.  Believe your texts.

As you know, we provide up to three responses to each question. This is my final response. Therefore this thread will be closed shortly without further responses. Take care. Please don’t worry. EWH