Testing Question / Cvid

Dr

I come to you in a state of confussion.  In feb 2010 i was assaulted.  I was baseline tested for HIV via pcr and also antibody.  The results were negative.  I then took pep.  After the pep i was tested via antibody test at 3 and 6 months post last dose of pep.  The results were negative.

Since that time i have had two concerns:

September 2011 received protected oral.  I wore a condom but still developed a burning when urinating.  I was given antibiotics which cured this problem.
(my partner tested negative three months after this via antibody test)

Feb 2012 fingered girl with cut(partner tested negative 6 weeks after risk) I tested negative for hiv at 8 weeks after this

Here is my concern starting in December 2012 i have been treated multiple times with antibiotics for chronic sinusitis.  This has been a problem for me for over 20 years.  I see an ent and allergist.  I get shots and have had multiple sinus / nose surgeries.  I am still taking antibiotics today.

My allergist tested me for IGG, IGA and IGM deficiencies via blood tests.  All my results fell in the normal ranges. He did not check the subclasses of each.  He said he did this bloodwork to check my immune system.  He said people with chronic sinus problems may have deficiencies.

1. I heard if you have cvid antibody tests arent accurate.  Does the fact he didnt check subclasses NOT eliminate a cvid diagnosis.

2. Does the fact he did not check my responses to immunizations NOT rule out cvid?

3. If i take more hiv antibody tests will they be accurate?

4. Do I need more or different hiv screening tests?

** nj does not have duo tests

Thanks

[Dr. Jose Gonzalez-Garcia, MD, MRCGP, PhD]

Hello,
Thank you for your post and welcome to our forum.  I will try to answer your questions here below:

1. I heard if you have cvid antibody tests arent accurate.  Does the fact he didnt check subclasses NOT eliminate a cvid diagnosis.
IT IS INDEED THE CASE THAT IT MIGHT TAKE SOME MORE TIME FOR PEOPLE WITH COMMON VARIABLE IMMUNE DEFFICIENCY OR ACQUIRED HYPOGAMMAGLOBULINAEMIA TO DEVELOP SPECIFIC ANTIBOIDES TO INFECTIONS AND HENCE RENDERING ANTIBODY TESTS NOT AS RELIABLE, USUALLY REQUIRING LONGER WINDOW PERIODS.  HOWEVER THIS CONDITION HAS BEEN RULED OUT IN YOUR CASE AS YOUR TOTAL LEVELS OF IgG, IgA AND IgM ARE NORMAL.  THERE IS NO NEED TO TEST THE DIFFERENT Ig SUBCLASSES TO EXCLUDE IT.  ALSO YOU ONLY SUFFER FROM RECURRENT SINUS INFECTION, A VERY COMMON CONDITION; YOU DO NOT HAVE ANY OTHER PROBLEMS WITH YOUR HEALTH AND THAT WOULD BE THE CASE WITH CVID.


2. Does the fact he did not check my responses to immunizations NOT rule out cvid?
NOT NECESSARILY.  IT IS ANOTHER WAY TO TEST FOR THIS CONDITION.  HOWEVER TESTING THE LEVELS OF IMMUNOGLOBULINS IS THE MAIN INDICATED TEST.


3. If i take more hiv antibody tests will they be accurate?
I BELEIVE THAT ALL THE NEGATIVE TESTS THAT YOU HAVE HAD SO FAR HAVE BEEN ACCURATE AND FULLY RELIABLE.  YOU ARE HIV NEGATIVE


4. Do I need more or different hiv screening tests? I DO NOT BELIEVE SO.  THE ONLY WAY TO REMOVE THE DOUBT FORM YOUR HEAD WOULD BE TO DO A TEST WITH THE P24 ANTIGEN OR A PCR RNA TEST, AS THEY WOULD BE TOTALLY INDEPENDENT OF YOUR IMMUNE RESPONSE.  HOWEVER I DO NOT THINK THIS TO BE NECESSARY AS YOUR TESTS ARE CONCLUSIVE.

5. I had one additional question is fingering with a very small nick (that wasnt bleeding during insertion) a risk? NO RISK OF HIV INFECTION.

Best wishes,

Dr José

[keith965]

I had one additional question is fingering with a very small nick (that wasnt bleeding during insertion) a risk?

[keith965]

Which of the two tests you suggested above would be a better choice?  I thought i read somewhere that overtime the p24 antigens lesson and eventually dissappear as antibodies develop.  Wouldnt this be an issue if i have an immune deficiency and my antibody development is slowed and the antigens dissappear?

Would an Aptima HIV RNA qualitative assay suffice?

Or

Would an abBott architect hiv ag / ab combo assay work?

I dont have insurance so i must pay and i want to get the rigjt

[keith965]

I want to get the right test?  Please help.
Thanks

[Dr. Jose Gonzalez-Garcia, MD, MRCGP, PhD]

If someone has an immunoglobinopathy, not producing antibodies as their immune response to a specific infection, in the case of HIV, the p24 antigen will always be detectable.  The reason why the p24 becomes undetectabel after several months is due to the production of antibodies.  Therefore if the test is negative for both: antibdoies and antigen, you would be able to conclude that you do not have HIV, regardless of the possibility of CVID.  Both tests, the HIV Ag/Ab Combo and the HIV RNA qualitative would be suitable.  I would recommend the former one as it is cheaper.
Best wishes,
Dr José

[keith965]

I saw my DR and at your suggestion he ordered an HIV Ag /Ab combo.  (which includes the p24 test).  Quest is the Lab doing the test.  One thing my DR mentioned is flu shots can trigger false positives on the p24 test.

Is that true?

I havnt had a flu shot this season and i dont think i did last year either.


Thanks for the advice

[keith965]

Quest did not have the p24 test.  They do I have;

HIV 1 DNA Qualitative

HIV 1 RNA Quantitative

HIV 1 RNA Qualitative TMA

Is one better then the other?

Thanks