Thank you in advance for your help. Straight male who in 2014 had a high risk exposure. This was virginal sex with woman of African origin while on holiday in Spain. Complete condom tear only noticed at end. 100% exposure. Earlier that year I also had virginal sex with CSW (I am uk based) condom used no tear. No other exposures since. However, after that incident in 2014, I stupidly only took an approved 2nd gen home finger prick test and  continued with my partner afterwards ( I really don't know why I didn't go the hospital). Apart from a UTI in 2017, which cleared up with antibiotics , I have been well. But then in feb this year, I got a cough, bad chest and cold, which kept me off work for 3 days, and lingered for about 7-10 days afterwards. However, after this, thick white coating on tongue, red spots underneath, some pain. After research realized oral thrush, which is late stage HIV infection. It persists to this day. I have only seen Dr virtually and he prescribed x2 daktarin gel and then x1 nystatin, but have not been back since. Since then my health has been downward spiral. I have pain in my lower back and sides (kidney), which I had urine dip stick test which didn't show anything, sore throat on and off  for months, feeling dizzy, and some skin infections, and lots of spots with puss. I am not sleeping for the last 6 months. As the Sexual health clinics were closed due to covid, I did another two 2nd gen self test, which were both negative, but have no faith in, and eventually saw HIV Dr in June at hospital and got 4th gen lab test for hiv, and test for hep b, hep c, and syphillis. All came back negative. I told him of exposure and oral thrush, but he said to see my local Dr about it. I was surprised because oral thrush red flag As there is no walk in service it is appointment only, and they won’t see me again as test was negative and no further risks. However I doubt the results due to number of reasons: I could have been exposed to HIV2 which is prevalent in Africa and much harder to detect. I think I am late stage HIV with oral candidiasis  and I have suffered seroreversion (my antibodies no longer detectable). I am one of those rare cases of seronegative patients (I do not produce antibodies) . About 35 documented cases of seronegative cases in 2019 medical journal.

I am worried as my partner has been feeling fatigued for weeks now, has persistent cough and has foot fungal problems. I know I have passed it onto her and do not want her to get ill, so I need to know what is best test to take next? Another 4^th gen to rule out lab error? I have booked an hiv-1 rna pcr test, which expect to be returned ‘positive’ but if hiv-1 virus is not detected what test can I take rule out hiv2? Please, I am losing my mind and need to be on ART as soon as possible. 

Welcome to the forum.---

Hi Doctor,

Thank you for your quick response. I want to say I totally respect the answer received from such an esteemed expert, and do not wish to question it, especially as a non-medical\scientific professional, but I still have doubts.

Firstly, in terms of the reports, I probably need to clarify. It was not about faulty 4^th gen tests, rather reports on 35 persistently negative or intermediate results in HIV seronegative (or seroreversion) individuals. I think they all refer to antibody only tests and WB, and span a timeframe from 1994-2017, which I admit is a very small number for the number of years and tests. I think most (if not all) had late stage HIV\AIDS. Here is the link:

https://ideas.repec.org/a/abf/journl/v20y2019i2p14877-14882.html

and the PDF:

https://biomedres.us/pdfs/BJSTR.MS.ID.003423.pdf

Also, this article from HIV Dr in Singapore regarding false ELISA tests, although he acknowledges they are 1 in a million cases:

http://www.drtanandpartners.com/false-negative-hiv-elisa-test/

In terms of my prognosis, I must admit that Oral Thrush was the main driver, as lots of the literature points to being most common late stage HIV infection, and very common in HIV positive individuals. All the HIV websites I looked at seemed to suggest people were tested and diagnosed through oral thrush, and that unless you have taken antibiotics (which I hadn’t) or smoked a 100 cigarettes a day, then you had to be severely  immunosuppressed  to get it! I admit I didn’t sleep for a week after that, and that convinced me of HIV infection, but I have had other symptoms over the last few months as well as the ones I mentioned, such as lots of heartburn\indigestion, trouble swallowing, which may, in fact, be systematic candida? Plus dental issues. Together with my partner’s symptoms, it is a troubling, but somewhat compelling case.  

I guess I am worried that a) one 4^th gen test isn’t enough. I always worry I could be that 'outlier', that 1 in 1000 that is not picked up. Although the two finger prick home self-test kits also check for hiv1\2 ab, and claim 99.7%  specificity, I am not convinced by them, and I am worried that condom split with woman of African origin in 2014, from continent with high very HIV rates, and high HIV2 rates, that I was exposed to HIV2, and the tests in Europe may not be sensitive to this? As well as the other reasons I have outlined (especially sero-reversion late stage HIV).

I guess after 6 months I am past the stage of ‘Am I infected?’ to ‘how do I get it detected?’.I just don’t want me (or my partner) to end up in A&E really ill and on death beds before I\we get diagnosed.  In terms of the RNA, I have paid to take this with private Doctor. To be fair, after the online consultation, he didn’t recommend the test, based on what I said, even though he said it would cost him money. He was just as confident in the 4^th Gen test at public Hospital.  

I should get the results within 3\4 days of taking the test. I am not holding out much hope. However, if it is negative, as it is checking only HIV1 it probably still won’t be the end of my worries! Thank you for your time and expertise.

 

 

 

  

 

 

 

 

 

 

 

 

Thanks for the additional information and clarifications. Indeed, in rare cases HIV infected persons fail to produce antibody (at least the antibody detected by the standards tests; I believe they all make other antibodies). That's one of the beauties of the AgAb tests:  without p24 antibody, p24 antigen persists in the blood. As I said in my initial reply, I am unaware of credible rerports of failure of the AgAb tests when done sufficiently long after the last possible explsure (~6 weeks, or longer following PEP or PrEP that doesn't work). In other words, to my knowledge it is not true that 1 in a thousand (or any at all) have false negative AgAb tests. Your single negative test is conclusive. I'm guessing your 1 in 1000 figure comes from one or more AgAb test producers. Such statements result from a statistical calculation, not actual documentation based on patient experience. Anyway, you've had several such tests -- all negative!---
---
---
---

Hi Doctor Handsfield,

There's a lot here, especially for a follow-up question. But to the specific questions I discern:---
---
---