[Question #814] HIV test assessment

51 months ago
Hello doctor,
About seven weeks ago I had an exposure. I hired a CSW and received an unprotected BJ and did frontage. After that I had protected vaginal sex with her. As I was done with vaginal sex I saw some blood on the condom and it freaked me out . I checked the condom and it was ok. After 12 days as I was very worried I did a PCR RNA test which came detected and my antibody test came negative. I rushed to my doctor and he said he needs to confirm it , so he put me on HIV combo tests. I did HIV ab/ag combo test ( Abbott architect CMIA, blood drawn lab based tests) after 19, 21, 23, 25, 26, 27 and 28 days of exposure and all of them came non reactive. My doc told me that is very good. After which he put me on more test so I did HIV ab/ag combo test after 29,31,33, 35,37,40,42,45 and at 49 days of exposure ( lab test) all came non reactive. My doctor believed that my PCR RNA was a false positive. I have spoken to two more doctors and they say I am I've negative and do not need more testing.
I have also done all other STDs test all came negative. 
My questions are:
1. Looking at all my test what do u think?
2. Was my PCR a false positive? 
3. Do u think that I need more tests that  is at 8 and 12 weeks?
4.  Can I have unprotected sex with my wife?
Kindly answer as soon as possible. 
Kind regards 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
Welcome to the forum. Thanks for your confidence in our services. Directly to your questions:

1,2) Your three doctors are correct:  clearly your initial PCR test was falsely positive. You don't have HIV.

3) You have been seriously overtested and don't need any more tests. (If all those tests were ordered by your doctor, he was being overly careful. But I have to suspect that most of them were done at your insistence, right?)

4) You could have safely resumed unprotected sex with your wife after the negative Ag/Ab combo test at 28 days. For sure you should do so now.

Probably you realize that being in this situaion is the result of your own wrong decision to be tested in the first place. I'm not blaming you -- anxious people often go too far in HIV testing in low risk situations. But this is the occasional price that people can pay: several weeks of anxiety and worry, and many dollars spent on testing, all of which was avoidable and unnecessary. Oral sex is exceedingly low risk for HIV, with no proved cases of HIV transmission by oral sex from mouth to penis: not one case in the world, ever. Therefore, you should not have been tested for HIV at all. And for sure should not have had the PCR test that proved to be false positive. Those tests are well known to rarely give false pos results, which is exactly why experts recommend they only be used when the risk of HIV is especially high. For sure they should never be done in situations like yours. You should never have been confronted with that test result, in which case all the rest of the tests wouldn't have been done (or maybe a single combo test at 4 weeks).

So a lesson learned for you, and perhaps for others who might read this. In any case, you can go forward without worry and with no further testing for HIV.

I hope this has helped. Best wishes and stay safe (as you have done 'til now!).   HHH, MD


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51 months ago
Thank you Dr HHH , 

Doctor I know my exposure was very very low risk and it was my stupidity to ask for a PCR RNA test, but I have few more question just to clarify some concept that all the test which I did are fully conclusive regardless of the risk whether very very low risk or low risk? 
And that I am conclusively HIV Negative?  And that all my HIV combo test overrule the PCR RNA test?  Well u are right my doctor was of the opinion to do two test a week  till week 6, but I insisted on it. 

Doctor I have read all yours and Dr. Hook's post on medhelp and it helped me a lot for which I am really grateful and to get assurance from you people will help me a lot to overcome this episode. So your assessment is that I should forget about the whole thing and move forward. 

With best regards.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
You're asking the same questions as before, just different wording. I haven't changed my mind!

Yes, you are conclusively HIV negative. And yes, you should "forget about the whole thing and move forward". I hope my comments help you do that. Best wishes and stay safe.

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51 months ago
Thanks Dr. HHH for the confidence. 
I hope u understand my position that after getting a positive HIV PCR test how would one go through the trauma, though it was completely my fault to ask for a PCR test. I was going through the Internet and I saw that BASSH guidelines states that if someone has a high risk then that person should take two HIV combo test that is one after 4 weeks and the other after 8 weeks to exclude HIV. Therefore I did one more HIV combo test on the 56th day of exposure and it came Non Reactive. Sir I know I am bugging you with the same questions again and again. But my questions are:

1.  Does the 8 week HIV combo test overrule my PCR test? ( well I know u would say that my  4 week test was more than sufficient, but please answer this one).

2.  Dr I read on some websites that 12/13 week test whether combo or simple antibody is conclusive. Should I do one more test at 12/13 weeks? 

3.  Can a combo test at 8 weeks change later?

4. Am I conclusively HIV Negative? ( I know I am being repetitive).

I know you would tell me to get counseling to get over the anxiety but I hope u do understand my position and what I have gone through after receiving my PCR test result. 

Many thanks 

With best wishes and regards
W

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
1) That test plus all the others you had, taken together, overrule the PCR.

2) The combo test any time 8 weeks or more after exposures is 100% conclusive. All testing later than that was unnecessary. Many doctors would recommend still other tests, as yours did. But they're just being more careful than necessary.

3) After 4 weeks, the combo test results -- whether positive or negative -- remains unchnaged for the rest of the person's life.

4) Yes you are being repetative. And yes you are conclusively HIV negative. Did you think I might have changed my mind?

I do understand your psoition and the fears you have gone through. But that is not a valid reason to remain so fearful at this time. No matter the reasons (concern for your health or your partner's), it is not normal to have such doubts after all the repeated, reasoned, science-based advice you have had, both on this forum and from your own doctors. All this suggests you have unresolved anxieties over a sexual decision you regret. As you have predicted, if you find yourself still worried about all this, professional counseling is indeed your next logical step. But before that, go back and read my replies very carefully, concentrating on every word.

That completes the two follow-up comments and replies that come with each question, and so ends this thread. I hope this discussion helps you to move on. In the meantime, do not search the web any more about your risks, testing, etc, and don't seek any more professional advice except maybe professional counseling. Good luck!

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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
Point 2 above  should say the combo test is conclusive anytime 4 weeks or more after the last exposure, not 8.  And obviously, if it is reliable at four weeks, it also has to be 100% reliable at 8 weeks. ---