[Question #7267] Hiv test and Biotin

5 months ago

Hi, 


Last year I had 2 encounters of unprotected oral, giving and receiving with 2 different males. I am also male. have since been fixated on these 2 encounters and the risk I have of hiv. 


About 210 days after the oral encounters, I had a single 4th generation hiv test, which was negative. 


I recently read about biotin and how it can affect blood test results, including  combo hiv tests. And this is because the immunoassays use biotin in the test itself in the reagents or other parts of the test, which then gets affected if the person being tested also has elevated levels of biotin. 


I remember I drank a lot of this vitamin fortified chocolate malt drink called milo, before this test. I was in a different country and drank about a juice box sized pack almost everyday until my flight back. So I think i stopped drinking it about 11-12 days before my 4th gen test. I believe this drink included biotin along with other b vitamins in the added vitamins and minerals, I cannot find out how much it contained exactly. 


Is 11 days enough to clear the biotin from my body to avoid affecting the tests? Should I need to test again? Recently I’ve been drinking this vitamin c mix which also contains biotin for the past 2 days, how long do I need to wait to clear the new biotin from My system in case I need to retest. 


I was finally moving on before I read about the biotin and remembered the biotin I may have taken, so now I’m scared again. 


Thanks 

Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago
Thanks for your questions.  I’ll be glad to provide some information and hope that it will relieve your concerns.  Let me start by pointing out to you that most people do not have HIV, that oral sex is amongst the most inefficient types of exposure in terms of HIV risk, and that currently available tests for HIV are entirely conclusive at any point more than six weeks following an exposure.  In fact, HIV is transmitted less than once in every 12,000 times that oral sex is performed on a HIV infected person and there are no instances in which HIV has been proven to have been acquired as the result of receiving oral sex from and infected person.  Please fax and your negative test result assure you that you did not acquire HIV from the encounters you described and there is no reason for concern.

Regarding biotin, there is much on the Internet and other sources which raise the possibility that biotin may interfere with test performance for detection of HIV. In fact however there are no data proves that taking biotin prior to having an HIV test has any meaning full affect on the performance of tests for HIV.  I would have no concern that the biotin you may have ingested had any affect on your test results. Nor do I see any reason for  repeat testing.

 I hope that this information is helpful to you. If there are any follow-up questions or clarification is needed, please don’t hesitate to use your update to follow questions. EWH
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4 months ago
Thank you for the response! 

Do you know how long biotin takes to clear from the body? Do you think there might be data in the future that might say biotin has an affect? 

I haven’t had any sexual contact since my last exposure more than a year ago. Was the single 4th generation test at 210 days enough even with biotin intake? Is there any need for a confirmatory test?  I am planning on abstinence for now, until I’m married.  Would you give me the clear to have unprotected sex in the future with a married female partner and have no chance of infecting her if I am abstinent until marriage? Since my test was negative about 6 months after my last exposure. 

Thank you! 
Edward W. Hook M.D.
Edward W. Hook M.D.
4 months ago
In the interval since my original reply, we have become aware of the theoretical possibility that supplemental biotin in high concentrations could interfere with the detection methods of some fourth generation HIV tests. Because of that we will be modifying our recommendations to future clients to suggest that persons who have been taking supplemental biotin wait 2-3 days before testing.  

The serum high half-life of supplemental biotin is 15 hours. Therefore supplemental biotin should no longer be contributing to meaningful serum levels in 2 to 3 days after ingestion.

In your case while I understand that you may choose to retest for your own peace of mind, given the very low risk nature of your exposures and the fact that these partners were of unknown HIV status I am confident that repeat testing will show that you were not infected.

Personally, I would have no concerns about the risk that you have HIV or pose a risk to new sexual partners through unprotected exposure’s. I hope these comments are helpful. EWH
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4 months ago
Thank you for the response and update on the biotin! 

The last possible biotin I may have ingested was 11-12 days before the test. So this would mean that it was no longer present in my body? 

I also forgot to mention that I took an insti rapid test at another clinic about 3 days before my 4th generation test, and I contacted insti who said that biotin does not interfere in their tests. Would a 3rd gen test be accurate in general? 


To be honest I was hoping I wouldn’t have to retest, as I have anxiety about getting a false positive. Would your opinion be that it is ok for me to not retest considering I took the biotin well before 2-3 days? 

Thank you for all the help! 

Also final additional question, besides biotin, are there any other medications (steroids or antihistamines or such) or foods that affect a 3rd or 4th generation test? 


Edward W. Hook M.D.
Edward W. Hook M.D.
4 months ago
Thanks for your clarification on the bio tin timeline. Yes, after 10-11 days all excess biotin would certainly have left your body and would not interfere with your test results.

I cannot comment on the basis for the statement made by INSTI. As I mentioned above,  the potential for excess biotin to interfere with testing is theoretical, there are no clinically proven interactions of the sort.

Steroids, anti-histamines, and other medications are not known to even theoretically interfere with test results.

Hey Siri I have said above, I would not feel the need to retest. On the other hand if you do feel that need I understand. Hope this helps. EWH
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4 months ago
Thank you. 

I know this is more than the 3rd response, and I won’t ask anymore questions. 

In general, not talking about biotin anymore,  Are 3rd gen rapid tests considered conclusive at 200 days? If I had taken only the 3rd gen test, would that have been enough to conclusively say I was hiv negative? 
Edward W. Hook M.D.
Edward W. Hook M.D.
4 months ago
Yes, third generation tests for HIV are entirely conclusive at any point more than eight weeks after an exposure. Thus your results are definitive.

As you point out, which I have kept this thread open a bit longer than is usual because of the emerging information on biotin.  However at this time the thread will be closed without further responses. Take care. Please don’t worry. EWH
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