[Question #9280] Can all my tests miss a sort of hiv infection?

34 months ago

Hello. I will keep it brief for all. Had exposures years 2009-2010, and December of 2017. Have had numerous health issues more so since 2017 exposure. I tested multiple times between 2009 and 2017. All negative. Since my 2017 exposure with a lady from China, I have tested a lot and I will give you the dates of the most recent tests that I’ve done although they were repeats of these earlier. ALL TESTS resulted NEGATIVE or NOT DETECTED

Abbott Architect- 5/2020

Hiv-1 proviral dna 5/2020

Hiv-2 proviral dna 5/2020

Prism antibody 6/2022

Mpx PCR hiv/hcv/hcb 6/2022

Surecheck 1/2022

Insti 7/2022

Alere 8/2020

Oraquick 10/2022

Cvs 4th dbs 9/2022

Bioplex 4th 9/2022

Roche NAT hiv 1/2 qual 8/2022

Advia 8/2022

Roche quant PCR 9/2022

Abbott RT quant 9/2022

Abbott RT qual 10/2021

Hiv-2 eia 8/2018

Geenius 8/2018

Aptima 2/2018

What puzzles me is the odd symptoms and things that doctors have been unable to diagnose, but are puzzled by. My main concern is that somehow some sort of HIV is evading detection. I know the internet is full of BS, but there are multiple reports (peer reviewed)of missing infection because of odd/strange subtypes where the tests performed were not primed for. As I said, the lady was from a different country(China) but the exposure was in the states. I worry about some of some type or recombinant form other than subtype B, that may be more difficult to detect because we are here in the US where subtype B is predominant and current tests may not be as sensitive for and therefore possibly miss. Last exposure was the December 2017

1)Could ALL those tests miss Hiv of any sort given my exposure from a non-National?
2)Would a more specialized genotyping test be any better to rule out or confirm a hiv diagnosis?
3)If indeed positive, would at least one of the multiple tests show something?
4)could a weird subtype other than b, n,o, p, crf, be missed by all of these?
5)Anything other to do?

Thank You

34 months ago

Let me please add, that after my 2017 exposure I tested multiple times in 2018 starting at 1 month with 4th generation as well as PCR, and tested extensively in all of 2018. All subsequent tests after 2018 were/are because of persistent health issues.

Edward W. Hook M.D.

34 months ago

Welcome to the forum and thanks for your questions. Bottom line, there is simply no way that you could have HIV which has gone undetected since 2017 ( or before). You do not know that your partners had HIV, most women do not have HIV, and most exposures to untreated infected partners do not result in infection. Further, the tests for HIV are among the most sensitive tests in all of medicine. The multiple tests you describe have looked for the virus itself ( both in testing for the DNA and antigen [ viral protein]) and your body’s response to infection ( the antibodies). Different tests look for different varieties of antibodies, antigen, and DNA fragments. An infection would not have been missed.

I am not discounting that you have symptoms but would urge you to accept that you don’t have HIV. Further testing for HIV would be a waste of time and resources. Rather I would urge you to work with a trusted clinician to look for other causes. In some instances it is necessary to repeatedly examine persons in your situation, looking for subtle changes in the physical examination or lab tests to guide us to the diagnosis. EWH

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34 months ago

Thank you for your reply. It’s just these symptoms/anemia/etc, that are unexplainable that worry me. My doctors are concerned, but have no really idea where to turn at this point. All of my tests have been normal or negative, but it worries me that even though it would be extremely rare, that we could be missing some sort of HIV that the test are not sensitive enough to pick up.

If you wouldn’t mind going through my prior questions in answering them each, I would be really grateful

Is there any value in a proviral dna resistance from quest (94807) OR the Genosure archive from labcorp (552020 or 551776)? This might possibly detect any odd subtypes? Would that make things any clearer? What do you know about these tests? They were mentioned as a possible additional test to rule out or confirm although it would be offlabel.

I’m wordiness about the non-b subtype only because she was Asian and non-b is more prevalent in Asian geography.

How can one detect and be sure non-b types are detected? Type O, Crf, etc?

Also, I’ve been going through this long enough that if it would be feasible, it would be nice to hear what your colleague (Dr Handsfield)says as well in this post,. always nice to have a second perspective or opinion. If I need to pay another posting fee, that is quite acceptable and fair.

I am really trying to accept the tests but the possibility of not proving a negative worries me.

I very much respect your time and hope you will consider all my questions above with an open mind .

Thank you

Edward W. Hook M.D.

34 months ago

As I said earlier, your symptoms are non=specific and you have PROVEN that they are not due to HIV. When symptoms are present, tests are always positive as the symptoms are due to the virus or the host response to infection. It saddens me that your guilt and/or anxiety do not let you accept this. Brief answer to your repeat questions:

Is there any value in a proviral dna resistance from quest (94807) OR the Genosure archive from labcorp (552020 or 551776)?

This might possibly detect any odd subtypes? Would that make things any clearer? What do you know about these tests?

Again, no. The internet based, sometimes quasi-peer reviewed reports of "missed" subtypes typically refer to infections missed by one type of test or another, not multiple tests testing for different evidence of HIV.

They were mentioned as a possible additional test to rule out or confirm although it would be offlabel.

See above

How can one detect and be sure non-b types are detected? Type O, Crf, etc?

The tests you have had would have detected non-B subtypes. In cases where detection is challenging, they may give equivocal or indeterminant results but they are not stone-cold normal as your tests have apparently been.

Dr. Handsfield and I share the Forum because while our verbal styles differ, we have not differed in our scientific assessment in over 30 years of working together. Clients are not permitted to choose who responds to their questions and if they ask repetitive questions, those questions may not be answered but simply closed without return of the posting fee.

I hope these explanations will be helpful. I fear that you are looking at the internet for clues to the possibility of HIV and would discourage this. The internet is not filtered and much of what is there is take our of context, misinterpreted, out of date or just plain wring. EWH

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34 months ago

Thank you. I’m just worried that over the last number of years or even longer that something has been missed because of some oddity with my body or the testing itself

1)Any reason to test anymore with any sort of test?

2)As far as testing goes, can I have extreme confidence that it has been totally ruled out and not give it another ounce of energy?

3)If symptomatic, hiv ab test and rna, would both be positive (when you have an established infection, and you’re symptomatic, would your RNA be typically high from what I’ve read)?

4)Regardless of ANY symptoms(no matter how Classic), ANY sort of hiv as a cause has been totally eliminated?

5)Are the tests I’ve had, as good as they get or any other recommendations?

6)Is my testing more than adequate in terms of number of tests as well as times tested to definitively exclude ANY type of hiv?

7)With modern testing, even though a test may not have specific primers for that sub type, Is it designed to pick up other data in the test to give some sort of abnormal result?(dual target, conserved regions)?

8)Even weird subtypes would give abnormal results?

9)The reason I say this is it seems that otherwise, we would have a lot more HIV infection in America if the test weren’t sensitive enough to pick up subtypes other than what the test says in the package insert Is this correct?

10)Any medical reason/condition that could give all false negatives in setting of actual infection?

11)Any possibility that i could have advanced hiv disease that you could have loss of antibodies/antigen as well as give false PCR negative on all test that I’ve taken regardless of subtype?

I worry about because I am

In medical field and have seen the “strange”.

If I am TOTALLY OUT OF THE WOODS(am I?), I will do my best with my physicians to ascertain an etiology to my health issues. Sorry for the questions and worry, but I want to completely cross off the list without looking back.

Thank you

Edward W. Hook M.D.

34 months ago

Final responses:

1)Any reason to test anymore with any sort of test?

2)As far as testing goes, can I have extreme confidence that it has been totally ruled out and not give it another ounce of energy

Repetitive. Repeating the questions will not change the answer. Yes, you vcan have complete confidence you have ruled out HIV.

3)If symptomatic, hiv ab test and rna, would both be positive (when you have an established infection, and you’re symptomatic, would your RNA be typically high from what I’ve read)?

Again, repetitive. Correct on both counts.

4)Regardless of ANY symptoms(no matter how Classic), ANY sort of hiv as a cause has been totally eliminated?

More repetition. Yes!

5)Are the tests I’ve had, as good as they get or any other recommendations?

More repetition. There are no other tests that will provide more information .

6)Is my testing more than adequate in terms of number of tests as well as times tested to definitively exclude ANY type of hiv?

Yes.

Correct

8)Even weird subtypes would give abnormal results?

Same answer

Correct

10)Any medical reason/condition that could give all false negatives in setting of actual infection?

11)Any possibility that i could have advanced hiv disease that you could have loss of antibodies/antigen as well as give false PCR negative on all test that I’ve taken regardless of subtype?

None

This completes this thread which will be closed shortly. Should you return with further, anxiety-driven questions your thread may be closed with out a response and without return of your posting fee. You need to move forward. EWG

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34 months ago

I appreciate all your time.

One last thing,

— NO CHANCE AT ALL that I could be that medical case(that actually has hiv)that a poster is made out of at an aids/hiv conference ?

Thank you

34 months ago

That’s all. Thank you again and take care and thank you for all you do here for people.