[Question #9010] Is it possible to miss some sort of HIV?
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37 months ago
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Dr Hook
I’m asking for help. I won’t bore you with details of past exposures. I’ve tested for 4 1/2 years(November 2017)since my last exposure but continue to have health issues. I’ve tested the last 4 years with many types of tests starting weeks after the exposure . There were many tests from 1/2018 up until now including. 4th, 3rd, rapid, pcr In the last 3 years (there were more done in between but I’ll give you the latest of each) I’ve tested with:
-Abbott architect 6/2020,alere 8/20,bioplex 5th 10/21,Abbott qual real-time hiv-1 10/21,cobas quant hiv1 10/21,roche hiv 1/2 qual 12/21,surecheck 1/22,cvs dbs 4th 4/22,mpxhiv 6/22,prism 6/22,Insti 7/22,oraquick 7/22. Like I mentioned, there were many duplicates of these tests since exposure I haven’t listed(example, I’ve had the bio plex 4 times since 2018(approx 1x/year)- never once in all tests was there ever a positive. All negative.
1)is there any way with 11-13 different types of tests over 4 1/2 years that ANY TYPE of hiv could be missed?
2)would any odd strain/subtype be able to be detected?
3)can I rely 100% on these tests that I don’t have hiv and stop testing regardless of my health issues?
4)should I bring this up any longer to any of my health care providers?
5)is there any different sort of hiv test that would trump what has already been done and be more conclusive?
6)would sending a sample somewhere better be advised?
I need to find out what’s going on with me and the daily abdominal pain I have after extensive work up.
7)is there anything left to do as I really don’t know what to do any longer from a health standpoint, spouse, father. The possibility of me having hiv and not being able to diagnose it is overwhelming
Thank you
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Edward W. Hook M.D.
37 months ago
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Welcome to our forum thanks as well for your implied confidence in our service. I’ll be glad to comment.
The myriad tests that you have had over the past 3 to 4 years absolutely rule out any possibility of HIV infection. You tested for antibodies to the virus, for viral antigen (proteins), and viral RNA as well. You have tested with different tests which target different HIV molecules. There is simply no realistic way that you could have HIV in the face of all these negative tests. With that general perspective, let me address your specific questions:
1. No it is simply not realistic that the testing you have a head missed an HIV infection.
2. Yes, even with unusual serotypes or HIV strains these tests wouls, at a minimum, give indeterminate results which would then be further investigated to provide a diagnosis.
3. Yes, there is simply no scientific, medical, or logical reason for further HIV testing related to your past encounters, irrespective of whatever signs and symptoms you may have been experiencing (please see my additional comment below). Further testing would be a waste of your time, of resources, and, I suspect, your emotional energy.
4. No, it is time to drop the topic of possible HIV infection in your interactors with health care providers.
5. No, the testing you have already had his state of the art and would not miss an HIV infection.
6. No.
7. You really need to move on. You are a parent inability to accept the test results you already have suggest that you are working under the bird of substantial anxiety or guilt. My sincere advice is that this is something you should speak to her trained counselor about.
Finally, you don’t describe your symptoms or signs other than frequent abdominal pain. In medicine the reason for testing is both to rule in and to exclude potential diagnoses. You have completely excluded the possibility of HIV with your testing. If you are continuing to be symptomatic or have signs of infection, it is time to look for other diagnoses. I would encourage you to start with a general internal medicine physician who may want to refer you to another specialist based on his or her findings. I would urge you to find a physician who you feel will listen carefully to your comments and concerns and whom you have faith and to do that listening.
I hope this perspective and comment is helpful to you. Take care. EWH
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37 months ago
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Thank you. It’s just that all this started after exposure. I’ll follow:
1)I’ve done different pcr test as you can see, some down to 20 copies, any better ones to do?
2)is there any way I could be a LTP?
3)from hiv point- ok to give blood?
4)I have over the last 4 1/2 years had multiple kinds of test ls from different manufacturers, is there any chance at all they could ALL give false negative?
5)if all these tests haven’t detected by now, does that mean they never would, even if I was indeed positive?
6)can one have such more advanced hiv that no hiv test can find?
7)should I consult another hiv doc? The last ID doc I saw just asked what I wanted done. Very lame
8)are there any cases/situations where hiv just can’t be found after this long
9)does hiv cause a fat belly(visceral fat) or the drugs that treat hiv?
10)how many tests (what kind) and and what timeframe does it take for you to know that ANY HIV (considering all subtypes we know of)possibility has been absolutely ruled out?
11)my exposure was a lady from China- does that change any of your thoughts?
12)would hiv 2 have been absolutely ruled out with all these tests?
13)am I any danger to my wife ?
14) have I beyond any shadow of a doubt excluded HIV 10,000% or is there anything more i need to consider medically?
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Edward W. Hook M.D.
37 months ago
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Straight to your follow-ups, then a comment:
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1. No, 20 copies are the limit of infection. Typically persons with HIV have PCRs which yield thousand or tens of thousands of copies.
2. No, long tern non-progressors still have positive tests, just low copy numbers (hundreds, or thousands) and no progression.
3. Yes
4. No chance whatsoever
5. Your hypothesis if off base. You've proven you don't have HIV.
6. No!!
7. See my comment below
8. None
9. The drugs and only certain. older drugs
10. After two 4th generation tests and perhaps a PCR, taken at appropriate times HIV is ruled out. You are long past that
11. No
12. Yes
13. No
14. Yes
Comment: As I said before, "Finally, you don’t describe your symptoms or signs other than frequent abdominal pain. In medicine the reason for testing is both to rule in and to exclude potential diagnoses. You have completely excluded the possibility of HIV with your testing. If you are continuing to be symptomatic or have signs of infection, it is time to look for other diagnoses. I would encourage you to start with a general internal medicine physician who may want to refer you to another specialist based on his or her findings. I would urge you to find a physician who you feel will listen carefully to your comments and concerns and whom you have faith in to do that listening."
You need to decide whether your symptoms warrant further evaluation or your concerns are a reflection of guilt/anxiety over a missstep. If the former, you need to put your HIV fears aside and work with a trusted doctor to establish the cause- it is not HIV, really." EWH
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36 months ago
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Good morning and thank you. The symptoms I have are nausea,muscle loss, tinnitus, involuntary muscle twitch, tiny painful sores on occasion on side of tongue that last a day or two and then just go away, ears itch, and chronic abdominal pain.
1)ID Doc even ordered a cd4/8. The number was 630 which was down from 2019 when it was around 1000. Seems like a big drop. My ratio has increased to 2.9(10/2021)when it was previously 2.1. What can you make of these numbers ?
2)is there any reason I should mention to my wife as she is having some health issues include nausea. She gave blood in October and then last week took an Insti rapid. All negative. I need to do what’s right, but if I don’t need to tell her I won’t.
3)is there no way that with all of these tests that hiv of whatever sort could evade detection because of mutation?
4)is there enough genetic similarities that most tests would pick up(even if not designed for)or at least cause further suspicion.
5)should I totally scrap the hiv notion and redistribute my focus elsewhere in finding out what’s wrong with me?
I really don’t want to be that case that ends if in NEJM.
If you have any other thoughts I’d love to hear. I know this is mr last reply.
Thank you and be well.
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36 months ago
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Oops. Forgot one line.
6)is there anyway either of us could have it, specifically her with normal antibody/pcr in October 21 and last weeks Insti?
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Edward W. Hook M.D.
36 months ago
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Final responses:
1. CD4 and CD4/CD8 Ratios are crude tools which vary on a daily basis. Early in the HIV epidemic these tools were used because there were not better tests but even then they were acknowledged as non-specific. Your multiple negative test results far outweigh any modest variation in the counts that you have reported.
2. There is no reason not to discuss your symptoms and concerns with your wife. However, if you choose to do so I would urge you to not suggest that you have HIV because you have proven again and again that you do not. Perhaps discussing this or even showing her this thread will help you accept that you do not have HIV
3. As I have said before, no way whatsoever. You do not have HIV!
4. The test that you have had have different targets and measure different manifestations of HIV infection. Taking together they provide incontrovertible results that you do not have HIV of any sort.
5. Yes, I have already urged to dis crap the notion that you have HIV and look for other causes of your symptoms. The way to do this is to work to address the symptoms with your own doctor.
6. Repetitive. As I’ve said before, there is no way that you can have HIV based on your test results.
As you have already noted, this completes this thread. I sincerely hope that you will be able to put aside your concerns over HIV and address what is really causing your symptoms. Take care. EWH
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