[Question #7480] Follow up question

4 months ago
Dear Doctor,

I have a few follow up questions regarding my last conversation with you and I will make sure all details to be included. This is not repetitive information, but rather clarification. 
We both discussed that my finger prick result after 14 weeks concluded that I was safe from HIV and that my 4th gen AG/AB test at 4 months and then 5th gen AG/AB test were superfluous. Furthermore, you said that 4th gen test at 6 weeks is 100% accurate. I have read some publication posted by university studies that suggest for some it takes up to  6 months to develop antibodies, does that hold true with you? Were they not using 4th gen tests? I think the reason that I tested so much was that I didn't trust the results. My 4th gen test was done by lab corp, are the a good center? Then I had another done by medical access labs as well. Do you think testing at 6 months would calm my anxiety knowing that there is nothing else but negative that it could be?

My Questions are as follows: 
1 - Does that 4th gen need to be taken at 6 weeks or anytime after 6 weeks works just fine?
2 - Do you think that I could be suffering HIV phobia and convincing myself that I have an undetected viral load?
3 - In your experience or in the medical world has anyone that tested 6 weeks negative using 4th gen ever turn out positive?
4 - could you also debunk the myth of delayed seroconversion to me? What would even cause a delay in antibodies?
5 - Additionally, I was originally using the website "justanswer" and consulting those "experts" and some had some really inconsistent answers 2 weeks 4th gen was conclusive, 6 weeks, 3 months and 4 months, and then there were the occasional that said cases at 6 months had found to have been positive? Perhaps using a first gen test in the 80s and 90's
Edward W. Hook M.D.
Edward W. Hook M.D.
4 months ago

Welcome to our Forum. Thanks for your questions. As I suspect you know, Dr. Handsfield and I share the Forum and today I happened to pick up your question.  FYI, Dr. Handsfield and I have worked together for over 35 years and the reason we work together on this forum is because the substance of our answers are always in agreement with each other.  I have reviewed your recent exchange with Dr. Handsfield and agree with all that he said, including that you have tested more than necessary to be confident that you were not infected.  With that, let's get to your specific questions:

1.  4th generation tests give entirely reliable results at 6 weeks and all times thereafter.  Testing after more than 6 precisely six weeks will confirm the results of 6 week tests.

2.  I think that there is a widespread misunderstanding of the risk of acquiring HIV. Thus it is not surprising that on occasion when a person has a sexual encounter that they, in retrospect, are not entirely comfortable with, anxiety can lead to concerns.  Plenty of people test more than they need to.  If now, after your interactions with Dr. Handsfield and me, cannot accept your negative test results, it is time to seek outside help in understanding the basis of your unwarranted concerns.  Mental health professionals are typically good at this, highly confidential, and very helpful. 

3.  No, not ever unless they were taking anti-HIV medication. Even in such cases, virtually all results are reliable at six weeks. 

4.  Delayed seroconversion is an internet myth. The process of antibody production occurs reliably over time.  Decades ago when antibody only tests of varying sensitivity were used for HIV testing, there were occasions when persons could test too early and this may have led to the spurious concept of delayed seroconversion.  It does not exist.  

5.  I cannot comment on the misinformation you may have seen on other sites.  All too often however, such statements are out of date or taken out of context. Once they are on the internet however, they are hard to get rid of.    

I hope that these comments are helpful. EWH

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4 months ago
Thank you Doctor! I know i will be just fine. The anxiety comes and goes 

I think the trauma comes from the fact that during the unprotected encounter with the female she gave me chlamydia. I got it treated and taken care of. Though my mind soon after raced with the thought of what could have happened versus what did happen. However, this girl refused to go get tested because she was afraid of needles and that she would puke. Additionally, she mentioned that HIV is rare, therefore she is not worried. She has also had a high amount of sexual partners. It was a very dumb decision on my end. It was also my first time ever having sex, which is why I am so fixated on this. A little thing inside of me still says, "well what if it was dormant this entire time and it's just now starting to activate." Basically, I play out the impossible situations. 

I have a couple more questions just to some it all up 
 1 - Basically, further testing will only confirm what I already know and likely give me more anxiety. So with that being said, if I committed my life to not have sex again, I could die of many things, but HIV would not be one of them? (Obviously no needle sharing and blood transfusions) What would be your best advice as far as moving on with your life? Just when in doubt, results rule it out?
2 - Additionally, you would say that labcorp, where my first test was performed is a reliable place to trust results. My second test was performed at access medical labs in Florida. Are you aware of these testing facilities?
Edward W. Hook M.D.
Edward W. Hook M.D.
4 months ago

Please remember that among heterosexuals, chlamydia is about 100 times more common than HIV.  OTOH, I can see how her reticence to get tested would be upsetting. 

My advice. No one is suggesting that you give up life as a sexual being. Instead, adopt a respectful sexual health lifestyle with periodic testing (for most people this os once a year) for the purpose of detecting unanticipated, asymptomatic infections.  Part of a sexually healthy lifestyle is also being comfortable with talking about testing and past STIs with partners.  As you point out, your risk of getting struck by a car or being struck by lightening at some time is about as likely as getting HIV is you don't do unwise things.

I do not know about Access Medical Labs but I do know about LabCorp.  LabCorp is highly respected.  For most U.S. labs, to be licensed to run and report tests, you have to pass a series of strict requirements.  I would have confidence in all your test results.

EWH

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4 months ago
Yes, I do agree, Doc. In fact, today I went to planned parenthood and did another fourth gen rapid test, which was obviously negative. I think this is something that I am just going to have to live with. I have become obsessive over this. I consistently answer my own questions. Additionally, as a straight male, this particular STD should not concern me. It is so difficult for a man to get it from a woman

Further testing is just going bring back the same feelings. I mean the test I did was 23 weeks out. If I can't trust that, what can I trust? 5 negatives over the course of 5  and a half months. It does not get better than that. It's just not there and I have to accept that. 

I tell myself that there must be a delay in antibodies. Doesn't happen. I don't want HIV by any means. It's sick, my obsession that is. The science is there. I have been tested at 3 DIFFERENT locations. The tests would have for sure picked something up if it was there. Nothing is there.

I know that the 6 month positive myth is out there and while my tests do fall short of the 6 month window, that is so outdated. Most experts consider 4th gen conclusive by 4 weeks and all by 6 weeks. Antibodies would be present.

As you both have stated, that there are NO reported positives after a 6 week 4th gen test, which was negative. It's time to live and let go. Test once a year. 

I even spoke to an HIV+ women who said I need to drop this stuff and live my life. It's funny because it seems that this stresses heterosexual men out way more than it should. It just doesn't happen.

Just to be clear, and under your medical recommendation, I could engage in a loving relationship and no without a doubt I am HIV negative?

I also know that I won't be able to post on this forum for 6 months, which is why I wanted to get everything in.

God bless you. I am HIV free. No more testing.
4 months ago
When i do see publications that say that individuals have tested positive at 6 months, I just think it's not real at this point. Those medical journals have to be outdated, using bad technology. This and or they must be going to chemo or be horribly sick.

Aidsmap, 
Hiv.org.
CDC

They all say conclusive at 6 weeks. It's just time to take a big deep breath and let this go. Like I said, I could pass away from many things, but this will not be the reason. 
Edward W. Hook M.D.
Edward W. Hook M.D.
4 months ago
I agree with the analysis you have provided above and confirm the advice that others have given to you. It is time for you to put this aside and to move forward without concern, knowing that you are not a risk for future partners and that you can live a happy loving life going forward.If you are unable to do this, my sincere advice is to talk this through with a trusted professional counselor. Further testing is not going to provide answers but counseling may be helpful. 

As you also know, with this third response this thread is now complete. Take care. EWH
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