[Question #8278] HIV 1/2 reassurance

46 months ago

Hello Doctors,

I think I understand through this forum the physiology of HIV (but please correct gaps based on my questions below!) and how the 4th generation tests work and am grateful to you for helping me trust them.

I am in a solid, committed relationship but feel some anxiety about how I navigated sexuality (I wouldn’t say that I took many big risks, just had some experiences I rather would not have had) as a teenage/early twenties woman in the years 2010-2017.

Can I relax and trust that my negative 4th generation tests from 2017-2020 prove that I did not acquire HIV of any type or strain during my earlier years of sexual activity?

I understand that HIV 1 antibody clears p24 antigen from the blood and that if, somehow, HIV 1 antibody was not produced or waned, the p24 antigen portion would be detectable again.

I also understand that HIV 2 is exceedingly rare.

With HIV 2, if antibodies were somehow not produced or waned after some time, and with no HIV 2 antigen component to the test, how would HIV 2 be detectable on the 4th generation test?

Thank you so much for your humanity and compassionate practice of medicine.

H. Hunter Handsfield, MD

46 months ago

Welcome to the forum. And thanks for researching your question by reviewing other questions like your own, and perhaps from other sources as well. It seems you've learned most of what I am ableto say about your situation.

I'll start with some perhaps reassuring comments about your sexual lifestyle when younger. It doesn't sound at all unusual, and exceedingly few persons with such backgrounds have acquired HIV. Th/is is especially so if none of your partners were men who also have sex with men, known injection drug users, or otherwise at especially high risk. ANother factor you don't mention is their current health. While I don't expect you've kept touch with all or even most of those men, don't you think you would have heard through the grapevine (past mutual friends etc) if someone had AIDS? After several years, any infected partners probably would be overly ill. This isn't any guarantee, of course, but you might think about it.

Question 1: Indeed you can rely 100% on your negative tests, for both HIV1 and 2. There are few known cases of the AgAb (4th generation) tests becoming negative, or remaining falsely negative, during the life of the infected person. (To my knowledge, none at all.)

Question 2: I certainly can confirm the rarity of HIV2 in North America. To date there have only been a couple hundred cases in the US, and most or all of those were in immigrants who acquired it in Africa, or their immediate contacts. Also, I think the premise of your question has an error: the AgAb tests do detect most HIV2 infections. And as implied above, I'm guessing none of your past partners was from equatorial east Africa, right?

Finally, remember that if you had acquired HIV several years ago, you probably would have been quite ill by now, and your infection would have been suspected and diagnosed. Assuming you are outwardly healthy, that too is reassuring.

Thank you for your kind words about our services. I hope these comments are helpful. You really needn't be worried about having HIV. Let me know if anything isn't clear.

HHH, MD

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46 months ago

Thank you so much, Dr. Handsfield.

I am very healthy and would expect that past partners are as well. Just some anxiety when looking at the past. I did have a bisexual partner at one time but knew their status. No partners who would be more likely to have HIV 2 either.

Just to clarify on the antibody component of the 4th gen tests, which I think is the heart of any doubt/fear I feel:

I am familiar with the concept of waning antibodies (from COVID-19 as well as Hep B vaccination and other examples) but in the case of type 1 or 2 HIV infection, would the infected person be positive for antibodies for life?

In other words, would antibodies to HIV 1 and especially HIV 2 where there is no antigen involved in the test, wane over time and cause a false negative?

I think you pretty much answered this already. Thank you for your patience with me.

Take care and thank you again

H. Hunter Handsfield, MD

46 months ago

That antibody levels decline in some infections doesn't mean it happens in all others. For HIV, antibody production and detection definitely are lifelong, no exceptions. The basic reasons is that infection itself is permenent -- the virus persists and remains active --and the immune response to it therefore never stops. (That p24 antigen become negative doesn't mean the infeciton is gone -- only that the immune system is keeping it in check sufficiently that the virus and antigen are not present at detctable levels in the blood. But they're still there, insice various cells.)

With few or no exceptions -- none to my knowledge -- antibody to HIV (either type) persists in infected persons and is detectable for life. Which is among the important reasons you can be entirely confident you do not have HIV.

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46 months ago

Thank you so much Dr. Handsfield.

That makes perfect sense and was exactly the reassurance and science I needed to go forward without any worry (& forgive younger me for not being as careful as I would be today.)

I value this service and your work.

H. Hunter Handsfield, MD

46 months ago

Thanks for the thanks -- I'm glad to have helped. Your conversation with your younger self is your business, but I see nothing that needs forgiveness. There's nothing unusual in your past lifestyle, it seems to me.

That concludes this thread. Best wishes and stay safe.

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