[Question #7815] Subtypes/hiv that cannot be diagnosed/detected?

14 days ago
Hello. I have read MANY posts so I will keep it as brief as possible. Over the last 10-15 years I’ve had low risk envounters(massage parlors) and have always tested negative. A little over 3 years ago I visited one and the lady gave me a prostate/finger insertion massage without gloves. About 2 weeks after I developed abdominal pain which last to this day. I also have developed anemia and sometimes have what I would see Ms decrease muscle mass along with some facial fat loss. I tested at 7 weeks with the abdomen RNA as well as fourth generation test. I recently at over 3 years had and Abbet fourth generation, HIV one RNA, as well as a third-generation test. All negative. 
1) can multiple tests over 3 years miss some sort of hiv subtype. (She was Asian)
2) with 3 kinds of 4th gen test at 1,2,3 years along with rna, and blood donation, can I assure myself no matter what symptoms, that I am hiv free?
3) is there anything else to do?
Thank  you
Edward W. Hook M.D.
Edward W. Hook M.D.
14 days ago
Welcome to our forum and thanks for your question. Your question is one that we have received a number of times.  Before I address your testing, let me assure you that the exposures you describe were no risk for acquisition of HIV or any other STI. No one has ever acquired HIV by having a massage or anal masturbation of the sort you describe..

The simple answer to your questions is that you have now been tested for HIV using three different sorts of tests - a test for antibodies to mark your body‘s response to infection if it were present, a test for antigen which represents protein coat of the virus itself it were present, and a PCR test for HIVRNA which would detect the nucleic acid which defined a virus, if present, as HIV.  Taken together there is absolutely no question that you did not acquire HIV from the exposure you describe. I am confident that the symptoms you describe are not due to HIV.

While variants of the HIV  virus do exist, these viruses are associated with changes to the virus activity within the body and still would have been detected by the testing you have had. COVID-19 is an analogous situation. I’m sure you’ve read in the newspaper about the detection of COVID-19 variants.  While these variants are of interest because of the potential for them to be more or less virulent With me because infection, all our detested by standard testing for COVID-19.

I am not discounting your symptoms.  Anemia and loss of muscle mass are each symptoms which have a number of potential causes. I would suggest that you work with your own doctor to evaluate their origin but I would not worry in the least that they could be due to HIV.

I hope the information I have provided has been helpful. If their further questions or anything is unclear please feel free to use your up to to follow up opportunities for clarification. EWH
13 days ago
Thank you for the info. It’s just very odd that symptoms started a week after and have continued for over 3 years. There were others but some tests were  Aptima, cobas, and 4th gen at 7 weeks.  Advia 1 yr./ Abbott architect+cobas rna+hiv2 dna@2.5 years/alere determine@2.75yr/bioplex 5th gen@3 yr/cobas mpx+prism 3rd@3.25 year— all negative. 
1)with all those tests as well as other similar ones from exposure to current, can they ALL miss infection ?
2. Are there any other tests one should consist?
3)could I be an elite controller and have false negatives after all this time on all tests?
4)should I disregard any/all symptoms and the possibility they are related to hiv?
5)any strain would be picked up after 2 years by at least one of advia, architect, oraquick,Alere, sure check,insti, bioplex, mpx rna, cobas rna, pcr hiv 2 dna, prism 3rd gen?
Is there anything left in regards to hiv testing I am missing(sample to cdc?)
Thank you. I just need to be 1000% certain I have  done all things possible to rule out. 
Take care 

Edward W. Hook M.D.
Edward W. Hook M.D.
13 days ago
Your follow up is a bit repetitive.  My assessment will not change.  Tests for HIV are amongst the  most reliable tests in all of medicine.  You’ve been tested multiple ways.  The answers are not going to change.  Accept that the onset of your and your partner’s symptom timing are coincidental.  Thus:

1. See above 
2. No
3.  Elite controllers have positive tests.  What makes them elite controller is is that they do not progress.
4.  You should not disregard your symptoms but you should not a tribute them to HIV. I would work with your doctor to sort out the real cause.
5.  Correct 

I sincerely urge you to except your test results. EWH
4 days ago
Thank you.  I still need to be CERTAIN that I am not infected and not a danger to others.  
1.In your opinion am I any danger to my wife?
2.Are there any other tests that are more sensitive than my tests and all those after 2 1/2 years(archictect, Hiv-1 Cobas, HIV DNA, HIV-2 DNA, Alere rapid, Prism antibody, Bioplex 5Th gen, and HIV MPX by Roche) that would aid in confirmation?
3.With certain subtypes, could even the best infectious disease doctor miss an infection with these tests?
4.Is there value in a CD4/CD8 count, other cell counts?
5.Can one be seronegative even with all the serology/molecular tests, regardless of subtype/strain?
6.Could one have a long term infection( from maybe an earlier exposure) and test negative on all tests regardless of strain?
7.Any different RNA test that could be better(min were Cobas by roche, and MPX by Roche, and Aptima at 7 weeks after last exposure)? (abbott, other, CDC)?
8.If there was an odd strain, that now was present, or i was infected with, how would a doctor be able to diagnose it?
9.How are the variants found and tested/diagnosed, if the test(s) were not designed to pick them up?
10. Can I give blood safely?
11.  Should i suggest any other testing to my doctor?
12..Lastly, how can one ABSOLUTELY sure they are not infected despite multiple tests of various types, but lingering/unexplained symptoms for multiple years now.  
I really really want to put this issue to rest and move on with life not worrying about this, my health in regards to this, and as well as health of my loved ones.  I really don't want to be that medical oddity that gets written up in the papers/journals.  
Thank you much much for your time
Edward W. Hook M.D.
Edward W. Hook M.D.
3 days ago
This final response will be brief as many of your questions are repetitive and reflect a baseless concern regarding HIV 

1.  No
2.  No
3.  No, not with the testing you have had
4.  No
5.  No
6.  No
7.  No
8.  Yes
9.  Testing looks for common antibodies, antigens, or nucleic acids (depending on the test) shred by all HIV.
10.  Yes
11.  No
12.  Believe your test results

Your continuing concerns are medically and scientifically unwarranted and suggest an underlying psychological issue or unmanageable guilt. More testing is not the answer.  You do not have HIV.  I urge you to seek counseling from a trained mental health professional to assist you in addressing your unwarranted, persistent concerns.

End of thread.  EWH