[Question #889] Follow up to question #852

83 months ago
Hi Dr. Handsfield,
The incident I described in my post 852 was my last and only one.  I feel I have died inside so never again.

That said, I still have this anxiety that I may be infected and not know.

1. If I were to take another test now it would be 89 days.  Is there any use for a duo test or antibody only would be conclusive?

2.  I'm now scared I may get a false positive and my anxiety is high.  What are your thoughts?  I'm afraid that my 45 day 4th Gen Screening missed it.

3. Is it really you and Dr. Hook that personally answer all these posts?  If so, I'm honored.
H. Hunter Handsfield, MD
83 months ago
Welcome back. But your last comment in your previous thread was "I guess anxiety and guilt are powerful emotions. I have just one more question and I'll be done with this." I'm sorry that didn't stick. in addition to my replies below, I would first suggest you go back and re-read my replies in #852. They cover these questions.

1) Either a duo or a standalone antibody test would be conclusive at this time, but you've already had conclusive results. Any additional testing is purely for reassurance, not medical necessity.

2) False positive results can happen but are very rare. And I've never heard of it happening in someone who previously had the negative results you have had already.

3) Yes, it's really us. I'm glad you are honored by that. Now please do me the return honor of believing and acting on my advice.

But if you continue to worry, you should consider professional counseling. These questions and worries suggest an underlying conflict about sex and sexuality in general. You have had an experience that doesn't have nearly such emotional impact on the large majority of persons. In the meantime, be careful about making personal pledges about future sexual behaviors. Most such pledges fail, and when sex occurs again the guilt is even greater and a vicious cycle develops that can seriously interfere with sexual relations and satisfaction lifelong. This is another indication that professional counseling may be helpful. I suggest it from compassion, not criticism.

Best wishes--  HHH, MD
83 months ago
Thank you again, Dr.
I know I have anxiety and other issues.  I'll seek out help.  This whole event happened while I was dealing with the death of a family member and I was severely down.

To add to the anxiety I had a physical and my blood sugar and a1c were high.  When I googled it it said it could be a sign of an infection.  

I never had any of what people describe as ars symptoms and I never had a fever.  (I checked each day morning and eve; same cycle around 98.6 in the morning and low-mid 90 in the late afternoon). In fact I've been feeling quite healthy until I start to dwell on it.

Regarding the 4th generation test, is there any validity to a "second window" where antigen is too low to be detected and antibodies are also too low?  Don't they use these tests to screen the donor blood?  

H. Hunter Handsfield, MD
83 months ago
Almost any physiologic abnormality sometimes can be a sign of an infection. But that's very rare, especially for a1c hemoglobin. The logical and straightforward explanation usually is the right one. In your case, you have diabetes or at least incipient diabetes. It has nothing to do with HIV. And anyway, HIV test results ALWAYS overrule all other considerations. Your test results PROVE you do not have HIV.

There is no second window for the 4th gen test. It's an urban myth. In fact, it's impossible for that to happen. It's the antibody that makes p24 antigen disappear from the blood. Once, p24 is gone, antibody is present. So once the test is positive, whether from the antigen or antibody component, the test is positive for life. There are no known exception.

Please work to stop thinking of "what if", "yes but", or "could I be the exception" questions. Accept the straightforward, reasoned, science based reassurance you have had. And stop searching the internet about any of this. Like most anxious people, you're just being drawn to information (often unreliable) that serves to inflame your fears. It isn't worth it.

83 months ago
Thank you.

I'm starting to understand the 4th gen better.
From what I've read the p24 usually begins to drop ~ 20 days after infection.  The  only way for it to drop is the antibodies must rise.

What are the chances that the test wasn't able to see either because of antibodies masking p24?

I would suspect that by my 45 day test there would have been plenty of antibody if I were infected.

If I were to take another antibody now, would you expect it to be negative?
H. Hunter Handsfield, MD
83 months ago
OK, I give up. What exactly did you think I meant by "Please work to stop thinking of "what if", "yes but", or "could I be the exception" questions. Accept the straightforward, reasoned, science based reassurance you have had." These are exactly the sorts of questions I was talking about.

I suppose antibody could "mask" p24; I don't really know. But if that happened, the antibody portion of the test would still be positive.

Your 45 day test was conclusive. Any and all future HIV tests you may have, antibody, antigen, DNA or any combination of them, will always be negative until and unless you become infected from some future exposureds. Believe it and move on with your life.

Repeated anxiety driven questions are against forum policy. Do not start another question on this forum about this same exposure and testing; it would be deleted without reply and without refund of the posting fee.