[Question #75] Need some Gudiance

39 months ago

Hi Dr. Edward or HHH.

 

 

A person who was HIV +  (likely  an elite controller)with undetectable viral load had false negative on well known rapid tests as well as lab based 4th generation test. This is definitely a concern as this happened three times over 1 year.

 

I  am sure you can throw some light on this case or may be you have information to most recent studies on elite controllers

 

1- how this person was different medically from other elite controllers as rest of 17 elite controller were detectable on all tests including rapid or person have some other medical condition that can cause this. 

 

 

2- My unprotected MSM encounter was 6 years back starting from 2003 and I tested with multiple rapid blood test for almost three years (Oct 2012 - June 2015). I am not questioning rapid test as person also have repeatedly negative 4th generation lab based test. I just want to make sure that I am not an elite controller who able to suppressed HIV for six long years and undetectable on blood rapid tests. No more testing needed, Correct?

 

3- How a person having test especially rapid test know  that he/she  is not an elite controller.

 

4- when you have undetectable viral load, will you continue to produce antibodies?

 

5- In the beginning if you have less antibodies (lets say if I am an elite controller with undetectable level from first day of infection as this case was) but as your body producing more , they will STACK UP to make detectable level ?

 

6- Does virus stay same undetectable for elite controller throughout the time they are classified as elite controller or it goes up and then again become undetectable? Usually how long an elite controller stay an elite controller?

 

7- The only issue i have my MRSA RETURNED back after a year (it happened when i started to have anxiety).

 

 

 

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4167641/

 

CASE 1.

 

In this case, the OraQuick test was nonreactive at all 3 study visits (both at study sites and at the centralized laboratory). The UniGold HIV rapid test and the fourth-generation Combo CMIA were also nonreactive at all 3 visits. The INSTI rapid test had a weak reactive result at enrollment, but was nonreactive at both follow-up visits. In contrast, the third-generation Vitros EIA was reactive and the Western blot was positive at all 3 study visits. At all 3 visits, HIV RNA was undetectable using both the ultrasensitive Roche viral load assay and the APTIMA HIV RNA qualitative assay, which is cleared by the FDA for diagnosis of HIV infection. No ARV drugs were detected in the samples, indicating that the participant was most likely an elite controller who may have been unaware of his HIV status.

 

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

Welcome to the Forum. I will try to help.  Elite controllers are extraordinarily rare, constituting less than a fraction of 1% of person with HIV.  Further, as noted in the excerpt you included in your post, only 1 in 17 elite controllers who were studied had negative test for HIV- this would translate into an extraordinarily uncommon event and is not something for an otherwise healthy person to be worried about.  With this as background, let me address your specific questions below-

1- how this person was different medically from other elite controllers as rest of 17 elite controller were detectable on all tests including rapid or person have some other medical condition that can cause this. 

You (and I) must take this report at face value, both for what is there and where I not.  if the authors had further insights, they would haveinidcated this in their report.  That they did not indicates that they do not understand while this occurred.  That however does not change that you are at very low risk for infection, should believe your test results, and do your best not to worry further. 

 

2- My unprotected MSM encounter was 6 years back starting from 2003 and I tested with multiple rapid blood test for almost three years (Oct 2012 - June 2015). I am not questioning rapid test as person also have repeatedly negative 4th generation lab based test. I just want to make sure that I am not an elite controller who able to suppressed HIV for six long years and undetectable on blood rapid tests. No more testing needed, Correct?

They only way to be more sure is to have a PCR test for HIV and repeated p24 antigen tests on your part make PCR testing unnecessary.  No further testing is needed.


4- when you have undetectable viral load, will you continue to produce antibodies?

Yes, despite having an undetectable HIV viral load, infected person would have a positive HIV antibody test.

 

5- In the beginning if you have less antibodies (lets say if I am an elite controller with undetectable level from first day of infection as this case was) but as your body producing more , they will STACK UP to make detectable level ?

Yes, the detection level of antibody tests is very, very low.  Believe your test results

 

6- Does virus stay same undetectable for elite controller throughout the time they are classified as elite controller or it goes up and then again become undetectable? Usually how long an elite controller stay an elite controller?

These are not questions for which there are good data.

 

7- The only issue i have my MRSA RETURNED back after a year (it happened when i started to have anxiety).

Your repeat MRSA is not a sign of HIV.  The fact is that once a person has had MRSA they are more often than not colonized with the organism and tend to recur.


I hope my comments are helpful. Please don't worry further.  Your tests prove you do not have HIV and you should move forward without concern. EWH


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39 months ago

Thanks Dr. Edward. I NEVER  had 4th generation antigen test. All I HAVE  rapid tests. (Almost 15- 20 rapid test oral and rapid blood over period of three years and until 2009 I was involved in high risk activity.  I was just mentioning about that person in question for 4th generation test

 

Did that change your assessment. ?

 

Do you think I need further test before having kids?

 

Rapids test I took 10 Oraquick rapid oral, 6 Clearview rapid blood test and 1 Unigold Rapid.  I am 36 year old male.


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

Thanks for the clarification. The advantage of 4th generation tests disappears after about 4-8 weeks as that is the time when antigen tests may detect person who are antibody negative because they have not yet produced antibodies.  That your tests may have been antibody only tests does not change my assessment.  you should not be concerned and have no reason to worry about having children related to your past sexual experiences.  EWH

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39 months ago

Thank you very much Dr. Edward for your help.  After an explanation from you I kept away from Internet from sometime. Thank you very much I am very better now. :)

 

Before We close this post I just need little insight to have last nail in coffin of my anxiety. I have dark brown/black spot of different sizes on my leg and recall having them from at least 4 years now. They are not growing and are not raised from skin This does not match  definition of KS? correct.

 

I can not have KS  for 4 years and undetectable antibodies on rapid test? My this assumption is correct? (An assistant dermatologist looked at it last year and recommended fade cream )

 

 

I am again very appreciative of your help you provided online. Please close my thread

 

Thank you

39 months ago

Also I had fever and cough with MRSA. I was prescribed with bactrium. My condition are improved now  However Urgent care referred me to ID for further treatment.  Still no need to relate it to HIV?

39 months ago


Hi Dr Edward, I was tested conclusively before even I had MRSA. Please close my thread, these if and else question will do nothing just fuel my anxiety. I know how healthy I was before this episode of anxiety.

 

As per you and Dr. HHH "test results always rule symptoms and exposure"!

 

Thanks Sir again