[Question #7547] Request clarification on testing and related questions

3 months ago

Dear Doctors:  Good-day.  I am hoping to get your clarifications and assurance about an exposure I had.

The exposure was with an individual who is from a part of the world where HIV (including HIV 2 and HIV 1) infections are high and from what I later learnt, the individual may be in a high-risk category.  I had non-reactive 4th generation AgAb tests at 43 days and 106 days post exposure.  I also have an autoimmune condition for which I have been taking TNF blockers immunosuppressants for a long while and have taken low doses of prednisolone and methotrexate in the past (not current).

Questions for you:  I am specifically concerned about HIV and not other STDs as I have tested negative for them as well.

1.       Can my 4th tests be considered conclusive for both virus strains HIV 2 and HIV 1?

2.       What is the absolute max “time to conclusiveness” for HIV (2 and 1) for the 4th generation tests for an individual with my condition and medications? 

I ask because I see online that suggests 6 months (a different timeframe for conclusiveness) for some individuals on immunesuppresants medications.  These may be well be wrong and don’t align with your advisory on this site.  I plan to ignore any such misinformation and take your expert guidance and advice.

3.       Is the riskiness of my exposure, however high, irrelevant of my results?  In other words, despite exposure level (however high) and symptoms, negative results at appropriate duration prove conclusively that an individual is not infected.  Please confirm.

4.       I know the duo test does not test for HIV-2 antigen.  What is the latest time by which the Ab part of the duo test will definitely catch HIV-2 or HIV-1 antibodies if an individual were infected and taking the medications and had the health conditions I described?

5.       I am hoping to start a family.  Do I need any addition testing?  May I go forward without any concern or worry?

I sincerely appreciate your answers and guidance.  Thank you, doctors.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Welcome to the forum. Thanks for your confidence in our services.

Perhaps the first thing to know is that even in the geographic areas where HIV2 evolved and remains most common (west-central Africa, e.g. Cameroon, Cote d'Ivoire, etc), it's relatively uncommon. If your partner isn't from that area, your risk for HIV2 probably was low. You also don't say anything about the nature of your partnership and the sexual expposure you're concerned about. I'd be happy to further assess your risk if you'd like to fill me in. But probably most important, your current test results are conclusive -- for sure the negative AgAb test at 106 days proves you don't have either HIV1 or 2.

Those comments pretty well cover all your questions, but to be explicit:

1. Yes, conclusive.

2,4. These are the same question in different words. Six weeks probably is conclusive for HIV2, but maybe not quite -- e.g. 98-99%, I would guess, because the antigen (Ag) component doesn't exist. For sure 100% by 8-12 weeks at the outside, so your 106 days result is solid. The business about immunosuppressive drugs delaying test positivity is basically an urban myth. Even with the earliest Ab tests (1st & 2nd generation), this was rare, and is not known to occur at all with the 3rd and 4th gen tests. Any site that says otherewise is either behind the times or hyper-conservative to an unnecessary degree.

3. Yes. Your negative result is equally valid regardless of the risk level of the exposure.

5. No additional testing is necessary. HIV definitely is not an issue and none of this should inhibit your plans to go forward with a committed sexual relationbship or fatherhood.

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

3 months ago

Dear Dr. Handsfield:  Thank you for your responses. It is very assuring to hear your expertise and remarks.

Exposure:  Unknown status individual from Northwestern India known through phone conversations, met up on a Friday and engaged in the following over Friday evening, Saturday and Sunday. I measured the 106 days from that Sunday given it would be the last exposure.  After the below episodes, I came to learn that she would be a high-risk individual given your descriptions on this site.

·       Unprotected fellatio (performed me)

·       Unprotected cunnilingus (I performed)

·       Condom protected brief attempts at sex.  She did not want to use condom, but I insisted. Due to nervousness and because she was on her PERIODS, the insertive sex was very brief even though I tried multiple attempts.  I became flaccid and the condom may have come out or broken – but I don’t recall this happening.

·       Lip to lip kissing and sucking of breasts

6. Given the above, what are your risk assessments?

7. If an individual were infected with any other STD at the same time, does it affect the validity (conclusiveness duration and sensitivity) of the HIV testing?

8. My test details.

I tested at 43 days: negative for HSV1 and HSV2 (IGG), non-reactive for RPR w REFL (Syphilis?), not detected for both Gonorhea, Chalmydia, and non-reactive for HIV (4th Gen). 

At 106 days, I tested only the following: non-reactive for HIV (4th Gen), and non-reactive for HSV 1 and HSV 2 (IGM), and non-reactive for RPR w REFL. 

Does my testing completely rule out all STDs including HIV?  I have not had an exposure since the Sunday mentioned above.

9. I am sorry if this is a redundant question.  Given the risks, the test results, and medications I take I take for my condition, may move forward without giving this incident another thought and plan for fatherfood?  Do you suggest any other tests?


I am deeply grateful for the invaluable service Dr. EWH and you provide.  In the age of rampant good information interspersed with rampant misinformation (about STDs), the two of you bring so much clarity and sanity.

3 months ago
Doctor: I forgot to mention in the exposure as one of the bullet points that there was also brief naked genital to naked genital frottage but it was not insertive.  When there was insertion, of whatever or brief durations , it was as I mention in the third bullet point.
3 months ago
I am sorry for inundating you doctor, please forgive me. But, when you respond, can you please confirm for me that my 106 day non-reactive HIV test can be considered completely conclusive for ruling out both HIV 1 and HIV 2 despite my health condition and immunosuppressive medications? I will take your feedback and ignore anything else I come across. Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
The exposures were quite low risk, even if she had HIV. The virus is rarely transmitted by oral sex -- no reported cases ever mouth to penis or by cunnilingus. But equally important, as already discussed, your test results prove you weren't infected, regardless of what the risk might have been at th time.

"can you please confirm for me that my 106 day non-reactive HIV test can be considered completely conclusive for ruling out both HIV 1 and HIV 2 despite my health condition and immunosuppressive medications?"  Confirmed. (Did you think maybe I might have changed my mind since my initital reply?)
3 months ago

Thank you, Dr. Handsfield.  No, I did not think your opinion would have changed.  But, given you asked about the exposure, I wondered if there was some minutia that you wanted to evaluate.  I also had nude frottage for sometime but it does not matter, based on what you confirmed.

I had asked some questions related to the other STDs.  Please let me know if I should/can ask them via a different thread.

Thank you for everything.  My sincere thanks. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Oops -- I missed it in your follow-up; I guess I was still focused on this in your opening question:  "I am specifically concerned about HIV and not other STDs as I have tested negative for them as well." Sorry!

The chlamydia, gonorrhea and syphilis test results are conclusive. HSV testing was a waste of money and time after such an exposure and no symptoms. But in any case, it was done too soon:  HSV IgG tests aren't conclusive until 4 months after exposure. But since it was a waste anyway, I don't suggest repeating.

Tbat completes the two follow-up exchanges included with each question and so concludes this thread. I hope the discussion has been helpful.