[Question #833] Seronegative

89 months ago
Hello doctors,

My exposure (08/12/2015) was unprotected sex with a woman whom i later found out  is a SW.
The tests i had are the following:

7 weeks HIV combo - Negative
10 weeks HIV combo - Negative
12 weeks HIV rapid - Negative
13 weeks HEP C/HEP B/gonnorea/chlamydia - Negative
5 months HIV combo/HEP C/HEP B - Negative

Everything great so far! i know you are going to say i m in the clear but please bear with me for a little while.

Yesterday i came along this case in Journal of AIDS & Clinical Research :

From what i 've read here and in Medhelp with a 4th generation test either the p24 antigen or the antibodies are always present after 4 weeks. But in this case they performed a
4th generation and it was negative 2 times. The p24 was positive on a stand-alone assay! (or so i understand) How can that be possible? And the case is from 2010 with modern tests...
Now my anxiety is all over the roof again...

Are stand-alone p24 assays more sensitive than combos?

Further below though they mention only antibodies tests : "
The diagnosis of HIV infection by the detection of HIV- specific antibody is not possible if infected individuals do not produces HIV specific antibodies." They dont mention the antigen component in the 4th generation test that they used...

Damn, im so confused...
Please doctors, if you could spend 2 minutes from your precious time to read the case and clarify these points to me i'll be forever grateful.

H. Hunter Handsfield, MD
89 months ago
Welcome to the forum. Thanks for your question.

You correctly predicted my response:  "i know you are going to say i m in the clear...."  You are.

The case report you cite is irrelevant to your situation and your interpretations of the medical literature on testing are correct. The patient described had negative antibody tests only, but his P24 antigen test was positive. I'm wondering whether 6 years ago in India "4th generation" wasn't interprested in the same way we view it now. If the had been tested with the standard combo test, as you were, it would have been positive. Your negative combo test at 7 weeks showed conclusively that you did not catch HIV; all other tests after that were superfluous. And in any case, what if this report were true? What if extraordinarily rare patients have negative tests despite having HIV? It's like learning someone was struck by lightning and getting more worried it might happen to you.

That you even found this case report says a lot about your obsession with your test results. It is an obscure journal, rarely if ever read outside India. I would advise you to entirely stop searching the internet about these issues. You don't have HIV and shouldn't be looking into it. Like most anxious or obsessed persons, you're just going to keep finding statements that confirm your fears.

Best wishes--  HHH, MD

89 months ago
Thank you for your reply doctor.
You are again correct, I'm still anxious and a bit obsessive about this so maybe it's time i should pay a visit to a mental health consultant....

Thanks again for taking the time to reply.
H. Hunter Handsfield, MD
89 months ago
You're welcome. I'm glad to have helped.

89 months ago
Hello again doctor.

Sorry to bother you again  but my anxiety got the best of me again.

During the last 7 months i take a daily supplement of omega 3 fish oil. I read online that in some cases fish oils might have immunosuppresive properties...
This study in particular :

says that
"Dietary supplementation with  fish oil  caused a significant decrease (up to 65%) in T lymphocyte proliferation."

but also says

"None of the treatments affected the number or proportion of T or B lymphocytes, helper or cytotoxic T lymphocytes or memory helper T lymphocytes in the circulation."

I am no doctor (obviously!) so i am asking you. Would any of the above have any efect on the test i have taken...?
Or the immunosuppresive effects are on a level that they dont affect the production of antibodies or the presence of antigen...?

Thank you for your patience doctor.

89 months ago
Sorry forgot to paste another one

"Fish oil caused a significant reduction (mean decline: 48%) in NK cell activity that was fully reversed by 4 wk after supplementation had ceased."
H. Hunter Handsfield, MD
89 months ago
You are delving too deeply into the wrong scientific literature. You apparently have the idea that immune deficiencies can reduce the reliability of HIV testing. That simply is not true any more! It is theoretically possible that such things could delay or prevent positive results on antibody tests. However, these things would tend to make HIV antigen or DNA/RNA testing MORE likely to be positive, not less. The overall effect is to INCREASE the ease with which HIV is diagnosed.

And anyway, the papers you cite are referring to extremely mild kinds of immune system effects. I'll be nobody in the world ever had significant immune deficiency, or ANY kind of altered diagnostic tests, because they take fish oil. That you can find physiologicl effects on certain immune cells says absolutely nothing about actual effects in testing.

Re-read the last paragraph of my original reply above. There is no information you will ever find on the internet that would change my opinion or advice about your HIV tests and the chance you have HIV. So please don't ask.

That completes the two follow-up questions and replies included with each new question, and so closes this thread. Best wishes.