[Question #7364] Hiv testing

5 months ago
Hi Dr,

I have a worry about hiv because of an exposure 7 months back.

I had an exposure in feb end this year and I got tested on august 7th using the CMIA combo test . The result was non reactive .

However to be sure I went to another local lab and got tested using the combo test on 21 sept 2020 . The result was non reactive as well.

My worry is that I have been feeling nodes in my neck and today I stretched my arm while working out and I noticed a small palpable node in my underarm .

I have been very worried about these nodes . 

I also got my esr tested in aug 2020 it was 2. 

Besides I did a cbc and my monocytes were 9 percent . The upper limit is 10 percent on the report . The other counts were all normal .

I read in one of your posts that monocytes are high in hiv . And this has really caused me to worry now .

Please advise what should I do . I have been reali worried about the same . Thanks doc 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
5 months ago
Welcome to the forum. Thanks for your question.

Among the most frequent and consistent aspects of our advice over the years applies here. The current HIV blood tests are among the most accurate diagnostic tests ever developed, for any medical condition. When done sufficiently long after the last possible exposure (6 weeks for the kinds of tests you had), the result overrules all other considerations. No matter how high the risk of HIV was at the time of exposure, no matter what symptoms might occur (even if seemingly typical for HIV), and no matter the results of other lab tests, the HIV test rules. Your two results prove with 100% certainty you do not have HIV. Whatever lumps you feel in your neck or underarms or your blood count results, they make no difference. And high normal monocyte counts are nothing more than high normal -- not an indication of HIV or anything else.

In response to "Please advise what I should do", my first advice is to just stop worrying about it. If you nevertheless remain concerned, see a doctor for in person exam and advice. But in the meantime, no more testing is necessary. You can be confident you don't have HIV. 

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

HHH, MD
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5 months ago
Thanks doctor .

Also just to mention , are there cases where tests haven’t picked up infection or delayed seroconversion , etc ? I was a bit confused as the Internet is filled with them .

Also is a monocytes count of 9 percent normal ? It’s in no way indication of any infection ? Considering my monocytes count has usually been around 5 percent whenever I had done a cbc.

In hiv , are nodes visible ? I mean I can feel some nodes but my doctor said they aren’t significant unless one cm in diameter . Is that true ?


I was a bit worried bcoz I could only feel one node initially , then a second and now a third in my underarm .

Request your valuable advise 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
5 months ago
There have been no proved cases of failure with the current HIV blood tests, or even significant delay in positive results -- except in a few cases of a few weeks delay of positive result in people had taken anti-HIV drugs to prevent infection that didn't work. This was a rare problem with older HIV tests, but not the kind you had and not an issue in the past 10 years or so.

Yes 9% monos is entirely normal. The percentages of all WBC types naturally varies. Any change within the normal range is almost always meaningless.

Anxious people often find various lumps here and there. A careful exam by a physician often reveals even more. Almost always these are meaingless if small and unchanging. I suppose 1 cm is a fair cut-off, but even larger ones often are normal. Stop examnining yourself!  If you feel outwardly well, you can safely assume you have no important health problem.
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5 months ago
Yes doc , I feel totally well otherwise . My only worry was the nodes .

Final questions :

1. The first lab had a value of 0.29 mentioned on the report but the second lab didn’t mention values saying it wasn’t important and didn’t matter . Is that true ? What if my cut off was 0.9 ? I Would never know in that case .

2. I keep getting worried about the possibilities of the labs making errors in testing . I stay in India and labs here are understaffed because of covid .

3. The first lab was a reputed one with clinics all over the country and some other countries as well . The second one was a local lab in my vicinity . Do all labs follow the same protocol as far as hiv tests are concerned ?

4. Everyday for me has become a struggle . I really don’t know where I’m going to feel a node next and that gets me panicking . I am unable to focus on my work because if this .

5. My exposure was with another gay man , though we didn’t gave Anal sex and he just rubbed his penis on my anus , I really can’t remember if he tried penetrating . I haven’t had anal sex ever otherwise . 

6. In case I decide to have anal sex , are condoms 100 percent safe ? I have been told that condoms work . Inspite of that I have heard that gay and bisexual men have higher rates of hiv and stds . 
How can I protect myself in the future ?


Thanks doctor for all your advise . Appreciate the great work you are doing :) 
5 months ago
Also does having alcohol a night before the hiv test or any tablets such as finax , etc interfere with the reliability of the test ? Thanks 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
5 months ago
None of this makes any difference in my opinions or advice.

1) The numerical value doesn't matter as long as it's in the negative range. There is no difference and no importance beween a value of say 0.2 and 0.8. Both are equally negative, which is why some labs don't report the numerical result.

2.3) The HIV tests are highly automated and pretty much foolproof, and each run of the test includes both negative and postiive controls, i.e. specimens known to be negative or positive. Errors in test result are basically nonexistant. The methods and test reliability are the same in any and all labs:  they all use the same test machinery and technologies. Going to your last question, there are no drugs, medications, or medical problems that alter the reliability of the kind of HIV tests you had. That includes alcohol.

4) This is a psychbological question. All I can do is advise you about your test result. If you remain anxious about it, professional counsaeling might be helpful. In the meantime, I suggest you lay off the internet. It's likely that like many anxious persons, you're being drawn to information that inflames your fears and missing the reassuring bits. It isn't worth it. For sure avoid non-professional (or non-professionally moderated) websites and especially those filled with frightening testimony by invidivudals who often are deliberately or unintentionally wrong or biased.

5) As I said above, the level of risk at the time of exposure doesn't matter. You could have mainlined HIV infected blood:  the test result can be relied on.

6) Condoms work -- but of course you need to remember that condoms sometimes break, and do so more often with anal than vaginal sex. In addition to condoms for anal sex, you should be discussing HIV status with partners before sex and probably not proceed with partners who are HIV positive (and not on effective treatment), don't know, or seem evasive about it. Also consider post- or pre-exposure prophylaxis with anti HIV drugs (PEP or PrEP). "On demand" PrEP is highly effective and easy:  two Trivada pills within 24 hr b efore sex, then one daily for 2 days. Nearly 100% proection against HIV if exposed.

Thanks for the thanks. I'm glad to have helped. That completes the two follow-up exchanges included with each question and so ends this thread. Take care and stay safe.
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