[Question #873] Follow up

87 months ago
Hello again,

I'm following up on a previous question.I had a rapid Alere Determine at 44 days which was nonreactive. I felt uneasy because I kept seeing rapid tests have a lower sensitivity so I returned at day 53 and had another rapid (nonreactive) but also had a lab test. The lab test for day 53 also came back nonreactive or negative It was an Architect test and was 4th gen according to testing center. However, they said I should go back at 3 months for a conclusive result.

1. I'm having a hard time processing the conflicting information about window periods and conclusiveness. It just makes no sense that even given political pressures, experts would disagree and have such varying opinions. 

2. Also I was told I was in the clear and I let my partner perform brief oral (couple of minutes no ejaculation possible pre) on me and a week later my partner came down with hard flu like symptoms, including fever, which went away in a day or two. However, the sore throat fatigue and mouth ulcer persisted for a couple of weeks. Could I have infected her? I don't htink I have had symptoms I could notice. I got a rash this week that went away but it's week 10 right now, I did have a bit of  fever and night sweats that happened within a week (4-6 days) of the incident and lasted a day or two.

What does the 53 day 4th gen lab test indicate? Is there anyway it could be unreliable? I'm a bit of a heavy drinker, occasional drug (noninjected) user.
H. Hunter Handsfield, MD
87 months ago
Welcome back -- but there have been several posts by username David, probably not all yours, so I didn't try to figure out your previous question. (For this reason, we recommend people select more distinctive usernames.) In any case, I'm sorry you remain concerned after what was probably a definitive reply about your previous test results.

The rapid oral fluids test (Oraquick) is somewhat less sensitive and takes a bit longer than most standalone antibody tests to become positive. However, all blood tests, including the rapid ones, are conclusive, or very nearly so, by 6 weeks (44 days). But more important at this time, the Ag/Ab combination tests ("4th generation") are definitely conclusive any time 4 weeks or more after the last exposure. The test is not at all affectedd by alcohol or recreational drugs. In fact, there are no drugs or medical conditions known to have any effect on reliability or time to positive results with the 4th generation blood tests. You really don't need another test at 3 months, despite the advice you had. To your specific questions:

1) By chance, just yesterday I wrote a blog-like reply to exactly this question. See #868, username paul.

2) Your partner's symptoms cannot be due to HIV from performing oral sex on you. You don't have HIV, so cannot give it to anyone. Further, innumerable other garden variety viruses cause exactly the sorts of symptoms you had. HIV is simply one of many that can do things like this. See your doctor if you or your partner continues to have symptoms that concern you. In the meantime, you can be certain it's not HIV, assuming neither your nor your partner has had other exposures that you haven't mentioned.

I hope this has helped. Best wishes--  HHH, MD
87 months ago
Thank you for your reply. I hope you know how valuable the work you and Dr. Hook do is.  
My original post was #786 which was answered by Dr. Hook. I read your post, and he also discusses the overly conservative CDC position. Even if there is room for different scientific opinions (6 weeks vs 4 weeks for example) I still find the disagreement maddening, especially when there's a 3 month versus 4 week difference. I'm sure you won't be surprised that the majority of us think that if the CDC or the clinic in this case says 3 months it has to be for good reason. 

I never gave my symptoms a second thought, in fact I don't mention them in my previous post, And even though I was a little stubborn with Dr. Hook (my apologies), I did my best to move on, especially how it was apparently a low risk or even negligible risk (this is another point where I went crazy with the conflicting information) , but my partner's very suspicious symptoms brought everything roaring back. I questioned the ag/ab rapid test results, requested a lab test and later called the lab for verification of the result and an explanation even though they said if they didn't call me it meant a nonreactive result.  

Even though I suspect what the answers will be, i will ask: 1.)  Am I 100% not infected, including that rare HIv-2? 2.) I did not infect my partner? 3.) and can I resume unprotected sex with my partner? 

I am almost at 77 days, and I am considering going at 3 months just for closure. I am also seriously considering counseling because this anxiety and guilt have been overwhelming and a thing I've never experienced. I also apologize for what seems like trivial reassurance but you doctors provided two lifelines on two separate occasions. Thank you.   
H. Hunter Handsfield, MD
87 months ago
Thanks for these additional comments. But they do not change any of my opinions or advice. Most people aren't very worked up over the difference in testing advice from various agencies. As discussed in the other thread I cited (#868), such differences will always be with us, so people just have to live with it. I don't know who "the majority" of "us" refers to, but I can assure that in my experience, the vast majority of people being tested for HIV don't care (and often do not know) what CDC or other agencies say about window periods.

Your three new questions are the same as those you've asked before, in different words. So as you predicted, I'm sure you know the answers, which are yes, yes, and yes.

Thanks as well for your kind comments about our services.