[Question #6963] Follow up to question 6889 - 9 weeks Ag/Ab test results

11 months ago

Apologize for being back. First thank you for your counsel in the two earlier threads. Doctor Edward has fully answered every single question with no exception. Doctor HHH also answered my queries however all the details were not present at that time.

I am asking again  to report additional testing at week 9 and ask additional questions. I will be meeting a psychiatrist tomorrow as I feel I have PTSD  signs and persistent worries effecting me that your answers will help. I won’t detail all the exposures as you can refer back to them in the earlier posts.


  1. I have now tested laboratory 4th gen Ag/Ab tests every week from week 4 through week 9 (7 tests) negative.
  2. Tested for HCV ab in week 9, negative.


I am really struggling to move forward, reason for that are multiple but will summarize  them in the follow questions:


1) Is my 9 week test conclusive, given my level of risk? And is 9 Week HCV test conclusive?


2)I still don’t fully understand has the condom protected me or not? I don’t have warts/lesions on the base of my penis as far as I can see.For sake of argument, if there was any breakage in the condoms ( don’t recall there was), will my tests and your assessment still be valid?


3)While intellectually I understand 3 month window period it applies for earlier tests, it still persists, and I suspect tomorrow will be put on more tests. I need your confirmation on the following qoute of DR. Handsfield, and does it apply to my situation given the higher risk? “As for different window periods depending on risk, Dr. Hook and I have always had a similar perspective as Dr. Bob Frascino. (This gets into the statistical weeds.) Consider someone with a truly high risk exposure, say 1 chance in 100 of catching HIV. If that person has a test that is 99% reliable, e.g. an antibody-only test at 6 weeks, a negative result drops his risk from 1 in 100 to 1 in 10,000. That's a lot better, but probably not good enough. (Would you play Russian roulette with a pistol with 1 in 10,000 loaded chambers? Probably not.) Now consider someone potentially exposed but at much lower risk, say 1 chance in 100,000 of being infected. A negative result with the same test drops his risk to 1 in 10 million. That's low enough to be considered zero for practical purposes -- you might even be tempted to play RR at those odds, if the payoff were were high enough ($10 million?). Identical test, but much greater reassurance for the low risk exposure versus the riskier one.”


4)Although I saw the testing machines, and the result paper mentions they test for P24 antigen, the reporting itself gives value for the antibodys only. I asked them about this issue and they advised its a reporting issue only and that the do test for antigens. For sake of argument if it was a 3rd generation test , how accurate are my results thus far?


5)Is HIV 2 prevalent in Thailand? and would the 9 week Ag/Ab test be sufficient to rule it out given no ag test for HIV 2?


6)Finally, given all your clinical experience, did you see situations like mine? And what’s your final assessment for me? Have I 100% conclusively ruled out HIV1/2. No more testing required?


7)Any re-assurance /advise from you that I can use to overcome my fears/doubts?


I will end by thanking you all again, for everything you do. First time Dr. EWH helped me 10 years ago on medhelp, and Dr. Handsfiled also helped me on this forum couple of times. But this time I think I pushed things a bit too far. Hope all ends well. Appreciate not closing the thread as I might have further queries following my appointments tomorrow.

11 months ago
I final question. I just need your clarification on PCR tests. At this stage will they add any value (now 10 weeks following exposure)vs Ag/Ab tests. Can you run my through your rational as I see a lot of people using those tests. I confess I have a fear of them given the long time to get results and what I hear about false positives rates.
Edward W. Hook M.D.
Edward W. Hook M.D.
11 months ago

It saddens me to see that you have returned to our forum for a 3rd time in three weeks.  In Dr. Handfield's initial response to you he stated "you can be confident you don't have HIV".   Since then you have repeated the question both to Dr. Handsfield and to me on multiple occasions.  the answer is not going to change.  This is the case irrespective of the fact that one of your partners had untreated HIV at the time of your encounter.  You are seriously overthinking this.  This is unproductive.  I will provide brief answers, most of which will repeat  information you have already received:

1.  Level of risk is irrelevant.  Believe your multiple tests. You did not acquire HIV or hepatitis C from your encounters of concern.  This is a FACT.  It is not going to change!

2.  Risk if a matter of probability.  Condoms reduce the probability of infection.  I cannot say whether the reason you did not acquire HIV was because of the condom or not although I can absolutely assure you that the condoms you used decreased the probability of infection.  The probabilities have paid off.  You did not acquire HIV!. 

3.  I agree with Dr. Handfield's statement. More importantly however, with the testing your RISK for infection has now been scientifically assessed through testing on multiple occasions and you have now PROVEN that you did not acquire HIV. 

4.  These sorts of "what if" questions serve no purpose.  You had 4th generation tests, they were negative.  Even if you were tested ONLY for antibody, your results would still be valid.

5.  HIV-2 is rare in Thailand.  Your 9 week test would have detected HIV-2.

6.  You have conclusively ruled out the possibility that you acquired HIV of any sort through the exposures you described.

7.  You have seriously over reacted to the fact that you were exposed to a partner who has HIV.  Testing is not going to change this.  I would urge you to speak with a trained counselor or mental health professional on how to move forward.  If you wish, you could print out and show them some of your earlier interactions with Dr. Handsfield and me.

8.  There is absolutely no reason for PCR testing.  You have been tested using two different types of tests, one for antibodies, one for the virus protein (antigen). both a repeatedly negative.  PCR adds nothing.

Finally, please note that you have two additional follow-ups on this thread.  Following closure of this thread however, future repetitive, anxeiety0driven questions may be close without a reply and without return of your posting fee.  I trust you understand.  EWH

---
11 months ago

I acknowledge these were repetitive questions. Sorry about that, and thank you for responding to them. I am in complete mess. I usually take your advice to the bank directly. But this time given that there was a positive partner I lost the plot. 


1)Can you expand on why the level of risk doesn’t matter now after my testings? No risk/low risk + 99% conclusive results seems good enough. But since I was at real risk this time, I cannot rely on 99th percentile for 45 day results. I read the CDC studies and they refer to 99 percentiles. Applying 99th percentile to a population seems logical from a disease control perspective, but looking at it as an individual it’s worrisome.I guess I am asking how long does the 1% tail extend to?


2) You said I am overthinking this in an unproductive way. I am glad to hear this, and would say you’re probably correct. But if I were  to ask you to advise me on testing 5 days after my exposure, how would my testing plan be? I ask this to see what the proper medical advise would look like vs me doing all this alone.


3)I understand that abstinence is the only way to be 100% sure. Makes sense on many levels. But looking at how condoms work post-facto, if it didn’t break can I assume protection was full? I ask from a post event perspective. Because this was my only protection, and understanding how it worked will help me reduce my anxiety. I read that latex under laboratory conditions doesn’t allow viruses to pass through latex condoms, is this correct? So if urethra was covered, and I am circumcised, what other modes of transmission that can happen? This is an important question for me which will effect my testing patterns.


4)I went for a 10th week (70 days) AgAb test, it returned negative thanks God. When you say my risk was assessed by multiple tests, what are the chances that certain strains can be missed, including hiv 2 by week 10, using two different labs (8 tests)? I say this because the CDC  sponsored studies for determining the window periods mention that HIV 2 and certain other strains were under studied (North American centric study). And if I am over-anxious, on testing at the 90 day mark, is there a value to be obtained for me by testing every week or should I test at day 90 only?


5) For AgAb testing, is there a difference between 10 weeks, 12 weeks and 90 days tests? 


6)Does the six month window still exist with the current testing, under any circumstances?


6)I am 33 years old. Is HPV vaccine good choice for me? Are you aware of any reported side-effects ,bad reactions?  Would it interact with other vaccines?And how can I know if I have HPV? 


7)Does all Gonorrhea /Chlamydia clear itself alone? Or I should be tested for them? Last time I tested in 2017. 


8)1 year ago I had a flat red patch near the urethra opening that used to sting. It healed itself alone after a month, I thought it might be due to friction.I didn’t engage in oral sex at that time. Would that be a syphilis chancer ? 


I live in a country with limited/ non existent STD clinics/experts despite Labs being available. So please bear with me. Again it is an honor to be able to speak with people of your and Dr.Handsfield caliber. It really baffles me how such expertise is readily available. Your patience in giving advise to worried people is no less than humanitarian work.

11 months ago
Sorry doctor meant to add this question:
9)I did the following test for HSV1&2 both negative . VML HSV 1&2 PCR (Real Time PCR). Is this the correct/best test, and when is the best time to take it?
Edward W. Hook M.D.
Edward W. Hook M.D.
11 months ago

You state that you understand that you are overthinking this but the repetitive nature and number of your questions suggests that you continue to do so.  Follow-up responses will be brief:

1.  The test results supersede risks.  Please understand that most exposures to infected persons do not lead to infection.  The 99% estimate is overly conservative.  You have tested and PROVEN that you were not infected.  I urge you to accept this result.

2.  Testing for HIV 5 days following and exposure is too soon to expect a conclusive result.

3.  An intact condom is completely protective.  You are correct, the HIV virus does not pass through the latex of latex condoms.

4.  Repeat testing was a waste of time.  The result was conclusive earlier.  Albert Einstein stated that "one definition of insanity is to do the same thing over and over again and to expect a different result." 

5.  No different.  All results after 7 weeks/45 days are conclusive

6. the HPV vaccine is safe and highly effective.  It does not change test results or interact with other vaccine.  If you have an HPV infection that you are unaware of the vaccine would still protect from the other types of HPV contained in the vaccine. 

7.  Over time most gonorrhea and chlamydial infections do clear on their own however testing would certainly rule out the very low possibility of infection.

8.  Syphilis chancres are typically painless ulcers.  What you describe does not sound like a chancre.

9.  Testing for HSV in the absence of lesions is not recommended. The PCR test you had is the appropriate test for the evaluation of lesions and is the most sensitive test for HSV in persons with lesions.

EWH

---
11 months ago
Thank you Doctor Hook. 


Sorry about repetitive nature of questions. I printed your initial response and will discuss this aspect, and reluctance in accepting results with the counselor soon. I feel I can’t stop testing, and whenever I pass a window period, I find myself focusing on another longer window period, 12 weeks, 3 months,6 months..other types of tests. I am trying to deal with that. 


I want to make use of my final questions/reassurance if you don’t mind:


1.Is there credence that intact latex condoms have tiny holes that pathogens the size of hiv can pass through? I read this in couple of websites that refer to a 1993 FDA study about condoms. Is this why you sometimes give a figure of 99% condom efficacy?


2.With 10th week AgAb test( 7 tests before that) would you be comfortable advising me to continue unprotected intercourse with partner without worry (after testing for the other STDs)?This is repetitive but the assurance will help. 


3. Is it possible that till now my body didn’t produce antigens/antibodies? And therefore I am handicapped by not performing the PCR test?and is the p24 antigen produced for all hiv 1 strains? Can the virus lay dormant for 10 weeks without producing antigens/ antibodies?


4.Finally, you said I am overthinking/overreacting to this, can I ask how is that? Is it because I used condoms + testing at multiple intervals + frequency of transmission per act?  Are these collectively enough to give me the 100% certainty? I just don’t want to miss anything. Can you please give me a percentage wise figure,based on all the information provided, of how certain my results are till now? 


This is the 2nd follow up, and I understand the thread will be closed. Thanks for providing the best/ only accessible scientific advise there is, and for your patience. God bless. If there was any misunderstanding it wasn’t from lack of clarification from your side. 

Edward W. Hook M.D.
Edward W. Hook M.D.
11 months ago

Thank you for your  thanks. I hope that my responses have been helpful and hope that your work with a counselor will help you to move forward.  In response to your four final questions:

1.Is there credence that intact latex condoms have tiny holes that pathogens the size of hiv can pass through? I read this in couple of websites that refer to a 1993 FDA study about condoms. Is this why you sometimes give a figure of 99% condom efficacy?


This information is incorrect.  HIV does not pass through latex condoms.  The 99% estimate is based on research studies which acknowledge just how difficult it is to study how well condoms work since researchers are dependent on patient self-reports of their condom use and whether the condom was used throughout an entire exposure. There is a tendency for persons to not accurately remember whether or not they used a condom and whether or not it worked correctly. 


2.With 10th week AgAb test( 7 tests before that) would you be comfortable advising me to continue unprotected intercourse with partner without worry (after testing for the other STDs)?This is repetitive but the assurance will help. 


Yes.


3. Is it possible that till now my body didn’t produce antigens/antibodies? And therefore I am handicapped by not performing the PCR test?and is the p24 antigen produced for all hiv 1 strains? Can the virus lay dormant for 10 weeks without producing antigens/ antibodies?


You misunderstand. The HIV p-24 does not come from your body but is a part of the virus.  Antibodies on the other hand are your body's response to infection.  if you were infected and did not produce antibodies, you would have large amounts of virus in your body which would be detected as p24 antibody.  Combination HIV antigen/antibody tests are really two separate tests- one for the virus in the form of the p24 antigen and one for the body's response to the virus in the form of antibodies.  When the test is negative, you can be confident that the virus is not present.  Your test results are conclusive.  You should believe them. 


All HIV-1 strains do have p24 antigen.  The virus CANNOT lay dormant in the body for 10 weeks. 


4.Finally, you said I am overthinking/overreacting to this, can I ask how is that? Is it because I used condoms + testing at multiple intervals + frequency of transmission per act?  Are these collectively enough to give me the 100% certainty? I just don’t want to miss anything. Can you please give me a percentage wise figure,based on all the information provided, of how certain my results are till now? 


Your failure to believe your repeated test results is an over reaction.  Your testing provides 100% certainty that you were not infected.

this completes this thread which will now be closed. Future questions may be deleted without a response and with outreturn of your posting fee.  Take care. EWH


---