[Question #7739] Follow up question indeterminate hiv test

1 months ago
Hi there 

Thank you so much for your time. I previously asked a question which doctor hook graciously answered but I wanted to ask a follow up . 
I’m a straight American female and have only had unprotected oral sex twice and no other sexual exposures. The guys I was dating had travelled well but non were from Africa etc.
In august (1.5) year after my last exposure I had a check up and my hiv test done with a 5th gen screening test was reactive for hiv 2 antibody and negative for hiv 1 and p24. The signal was 1.22 so it was very low. They then tested the same sample with geenius or multispot I believe and it was negative for both hiv types. 6 months later I tested 4th generation from two other labs and they were both negative and I also tested with insti and the hiv2 ElA from biorad and those were negative as well. I never did the hiv 2 dna test because it wasn’t fda approved. My gp doesn’t seem concerned but I also wanted to know your opinion as specialists.

Unfortunately I suffer from severe anxiety and ocd now and I’m getting mental health help but having these issues is making it difficult for me to figure out real risks. In your expert opinion can I move on from this. Unfortunately having read too much google I’m scared of having contracted a divergent type of hiv 2 and it not showing up in my lab work. If that was the case the hiv2 eia which is a whole virus lysate would still be reactive right?

I only take spironolactone 50 ml and Luvox currently.

Best
Edward W. Hook M.D.
Edward W. Hook M.D.
1 months ago

 

Many experts feel that to call the tests which differentiate HIV-1 infections from HIV-2 infections should not be called “5th generation tests” since they do not change the time-related sensitivity of detection but rather differentiate HIV-1 infections from HIV-2.  Here in the U.S. more than 99.9% of all HIV infections are caused by HIV-1 and the few (typically less than 50 HIV-2 infections which are diagnosed are diagnosed in persons who have traveled to or had sex partners who have been in India or West Africa.   In your case, the chances that you have HIV-2 are virtually zero.  The reasons for this are abundant and include:

 

1.       Your exposures are low risk.  HIV-2 is more difficult to transmit that HIV-1 and the risk of acquisition of HIV from performing oral sex on an infected, untreated partner is less than 1 in 12,000.

2.       Your partners did not share the characteristics of persons in whom HIV-2 is found on those occasions when it is diagnosed.

3.       Since your test, you have had multiple additional tests which would have detected antibodies to HIV-2 had you been infected- all are negative and by now you certainly would have developed antibodies to infection.

4.       The numerical value of your solitary positive test is low, in the range where false positive typically fall while true infections typically have far higher values


I agree with your PMD.  This is NOT HIV-2, or HIV of any sort.  In our past interaction I suggested you stay off the internet, something that has proven hard to do.  I encourage you once again to do that.  I see no medical reason for concern of any sort and no scientific reason for further testing.  I sincerely hope that this reassurance will help you to move forward.  EWH

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1 months ago
Thank you so much Dr.Hook 

The logical side of me totally understand what you're saying, the ptsd and the mental health issues are of course making it really hard to  calm the anxiety down which is why I wanted to come to you instead of doing further internet research.  just one question, having been worried about different sybtypes, I took the hiv-2 whole viral lysate eia test. I was under impression that whole viral lysate tests cover the subtypes due the virus being used so that way I can fully move on.  is that true about the whole viral lysate tests coverage, so I can finally breath?


Edward W. Hook M.D.
Edward W. Hook M.D.
1 months ago
Yes. the whole viral lysate would cover subtypes although I'm not sure that it is approved by the FDA.  EWH---