[Question #865] Hiv rna, hiv 4th gen, hiv antibody eia

53 months ago
On April 28th, had unprotected sex with Asian girl about age 21. Oral and vaginal sex unprotected. As soon as I ejaculated I pulled out and it was blood. My blood. On may 11th, 12-13 days after exposure Went and got hiv rna and hiv 4th gen plus 10 panel test from stdcheck.com. test came back negative. Also went to family Dr next day may 12th, test came back positive for hep b. Very devastated of my false negative hep b, can my hiv test be false also? How accurate is hiv rna and 4th gen on 12 days post? On June 2, approx 32-33 days after exposure took hiv antibody eia test.  Test came back negative. Can I go by my 2nd hiv test and be more comfortable?  Will go back and test again at 3 and 6 months to confirm. It's about 6 weeks now, been feeling fatigue but no rashes or fever. Slight sore throat. Also had unprotected sex with my gf on may 7th can I have infected her?l
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Welcome to the forum. Thanks for your question.

Your HIV test results (negative RNA and 4th gen test at 12 days, plus negative antibody at 1 month) prove you didn't catch HIV, regardless of your hepatitis B test results. I could also go into the low risk of the exposure itself, despite the blood contact:  protected sex with a partner who is statistically unlikely to have HIV (probably less than 1 chance in a thousand she has it). But the level of risk at the time doesn't matter:  the test results overrule all other considerations, including exposure history and symptoms. And that includes the possibility of a false negative hep B test. (I'm skeptical about that part of your story -- discussed below.) If you would like additional reassurance, have another 4th generation (antigen-antibody) test now. You don't need to wait until 2-3 months for conclusive testing; that's old news. The 4th gen test is conclusive any time 4 weeks or more after exposure.

Hepatitis B testing is somewhat complex. Knowing whether you have hepatitis B, and when you caught it, depends on the results of three different tests -- but you don't say which tests were done. If you would like to tell me exactly what tests were done both at 12-13 days and again later, and the results of each, we can probably sort this out. Look for results for HBsAg (hep B surface antigen), antibody to HBsAg (which will be listed either as HBsAb or as anti-HBs), and antibody to hep B core antigen (which will be listed as HBcAb or anti-HBc). My guess is that you did not catch hepatitis B during the exposure April 28, and you might not be infected at all. And by the way, were you ever vaccinated against hep B?

So no worries about HIV at all. You do not have it and therefore could not have infected your girlfriend. And your symptoms are NOT suggestive of either HIV or hep B. I look forward to more details about your hep B test results if you would like me to help sort it out. In the meantime, I hope this information has been helpful.

Best regards--  HHH, MD
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53 months ago
Thank you for such a quick response. If this is truly Dr handsfield I'm honored to be assess by you. 
May 11th test hep b core Ab, igm. Test from stdcheck.com.  test came back neg. Hiv rna n hiv 4th taken same day both negative.
May 12th hep b core Ab >8.00. HBsAG reactive. 
HBs  AB Quant  <3.00. Test taken from family Dr sent to cmblabs.com. 
Also went hospital they confirmed I have hep b. Not sure what test they took.
1. Can hep b delay my detection of hiv?  I'm not on any meds.
2. How accurate is stdcheck.com and cmblabs.com? How can 2 test taken so close be off?
3. I've shown symptoms of hep b with pain in right side near and around liver. And also pain would be on my mid upper left at times.  Don't think I've gotten a vaccine for hep b cause I am a foreign person migrated here from Vietnam. Born in Malaysia and came here as a baby. 31 yrs old now.
Slight sore throat feels different, with a minor ache not sure but haven't really felt it before. Can it be hiv related? Still very nervous and scared about all this. The blood ejaculation was just too much as I've never ejaculated blood before and it happen first time with a new person that I had unprotected sex with.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
I agree the results appear to show have a hepatitis B virus (HBV) infection, apparently a recent one. They also confirm you were not vaccinated against HBV. I've never had a patient who acquired hepatitis B from a heterosexual exposure as you describe, but it probably explains your infection, unless there is some other exposure that could be responsible. Most likely your doctor has also done liver function tests (hepatic enzymes, bilirubin, etc) and will recommend follow-up testing in hopes your immune system will clear the infection, as happens in most people, and you will not become a carrier or have ongoing chronic hepatitis. You'll also need to avoid sex in the next few weeks or months, or assure that your partner(s) have been vaccinated or previously infected. And your girlfriend for sure needs testing -- you may not have been infectious only a week after catching HBV, but you shouldn't take the chance unless you know she received a complete HBV vaccine series herself. Finally, you should inform the sex worker; she also needs testing and should begin informing her other clients about her apparent HBV infection. Your local or state health department may take this responsibility; you or your doctor should contact them and follow their advice.

Those commetns all address question no. 3. Now back to HIV and questions 1 and 2:

1) HBV infection, whether new or longstanding, is not known to have any effect on HIV testing.

2) Online STD testing services generally do not have their own labs, but contract with the same labs used by physicians in the same geographic area. For the most part, all such commercial labs are highly reliable and use standard test procedures used by all other labs. That said, I have no explanation for the different HBcAb results from the two laboratories. Maybe it has to do with IgM testing vs IgG? Your own doctor may be able to help sort this out; I cannot.

Your symptoms are not typical for a new HIV infection, and in any case your test results prove you don't have HIV.

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53 months ago
Thanks Dr handsfield. Back to the ejaculating blood. Can std transfer so fast that it made me ejaculate blood? Penis was in vaginal for breif 3-4 mins. And the hiv antibody eia test that I took is only for antibody correct? I'm very worried of a coinfection and it's scary me to death as I know it can be fatal. Because of my false hep b test I'm so worried of my hiv test results both hiv rna and 4th gen. My hiv antibody done at 32-33 days reassuring?  As I know you told me to get a 4th gen test now to calm my nerves but what's the possibility of it going positive?
 Another question, I haven't had sex with my gf but I did masturbate and I would see some red spots on top of my penis after orgasm. It's not bumpy or painful, like Lil freckles on my penis top and it does go away in a few hrs or the next day. Can this be hiv related also?
I been trying to stay healthy,  eat clean and workout on a daily basis as I do understand that hep b can go away in 6 months if body fights it off. But I can't get the thought of possible hiv out of my mind. As it is about to be 7 weeks, every little sign is making so stress. Please help and thx for everything.  
53 months ago
I also read that early signs and symptoms of hep b, like my inflammation of my liver right now can be a sign that my body is fighting the hep b. People with weaker immune system will not show signs til later. Is this correct? Do you have any explanation about that too? And also my left upper mid abdominal aches more towards the mid day to night time. Do you have any explanation for that also? Please and thank you for answering. I've gotten some very encouraging advice from you but I still have my worries. Will take my 4th gen test also soon. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
No STD can start to cause symptoms in less than 1-2 days, and bloody ejaculate is not usually due to STDs. The most common cause is trauma to the perineum (the area between scrotum and anus), of the type that is common from horseback riding, bicycling (especially off road), etc. See your doctor if it continues, but it's not an STD.

It is unlikely your CSW partner had HIV, and your negative HIV antibody test at about 5-6 weeks is over 95% conclusive. You can expect your 4th generation blood test to also be negative. When it is, it will prove conclusively you did not catch HIV. There are no medical conditions that make the 4th gen tests falsely negative.

I can't say what might be causing the "red spots" or your penis, but it doesn't sound serious or like any STD. Show your doctor if they continue or you remain concerned.

Whether or not you have symptoms from hepatitis does not indicate either increased or decreased chance that your immune system will clear the infection. It is good that you are working to steay healthy to maintain a strong immune system.

Thanks for the thanks. But really, you can stop worrying about HIV, especially after your upcoming 4th gen test. Do that test ASAP:  you don't need to wait any longer for it to be conclusive.

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