8 Week Negative with Clearview HIV Stat Pak

Doctors,

I've had unprotected vaginal sex with a woman who claims to have been tested and HIV neg. I tested negative at 4 weeks(Clearview Stat Pak), 6 weeks(Uni-Gold) and 8 weeks (Clearview Stat Pak) . I've had several unusual symptoms from weeks 2 to 5 that I can now say  was due to anxiety, since I tested negative at 4 and 6 weeks. However the very next day after my 6 week test (42 days post exposure) I developed swollen lymph nodes under my jaw—that my GP has diagnosed as swollen “Submental” nodes (localized) . She believes its due to a scab that "seemed" infected that I had on my lower cheek, and prescribed Cephalexin. I waited an extra two weeks and got tested at my 8 weeks—exactly 56 days post exposure. At the testing clinic the nurse that administered the test told me that (verbatim): “The test we use at this clinic will only detect antibodies after 3 months of exposure. The test will tell you very little if you're under the 3-month mark. I suggest you return and re-test in a month when you reach 3-months.” The test she used was Clearview HIV 1 / 2 Stat Pak and it was NEGATIVE.  I have a few Questions:

1-- Is this nurse wrong? Its really bothering me and now I'm doubting the reliability of my 8 week negative. This is a pretty reputable clinic and now I'm wondering if she knows something I don't know about this particular test.

2-- My understanding is that acute HIV symptoms are due to the body's reaction not to the virus itself but the antibodies produced by our bodies. Does this include lymphadenopathy? According to this post  by Dr. HHH   http://www.medhelp.org/posts/STDs/Test-Results/show/246301    40% will show up positive after 2 weeks of onset of ARS, and 100% after 17 days??  But Dr. Hook says that a test will show positive after only a few days after the beginning of symptoms. (I realize that 6 weeks can be late for ars, but most sources put the time frame at 2-6 weeks post exposure, with 6 weeks being rare). Who is right? Would you say that my negative test 2 weeks after the onset of my swollen glands rules out HIV?  I'm worried since I've NEVER had swollen glands above my waist in my life.

3-- All my life I've had a white tongue in the mornings. But I've heard that it could be a sign of a weak immune system—however I rarely get sick and my CBC are normal. When you say people with weaken immune systems are late to develop antibodies do you mean folks with seriously compromised immune systems or ppl with a weaker-normal range as well?

4-- I've been very stressed since week 2. Can sleeplessness, prolonged stress, drugs like gabapentin, and  cephalexin delay production of antibodies?

5-- And finally,  if you were my doctor would you say that my 8 week test is conclusive? I've heard that in states like Massachusetts (not my state) the window period is 6 weeks using standard AB test. Can I move on?

Thanks for answering my question.

[Edward W Hook, MD]

Welcome to the Forum.  I'll be pleased to try to address your questions:

1-- Is this nurse wrong? Its really bothering me and now I'm doubting the reliability of my 8 week negative. This is a pretty reputable clinic and now I'm wondering if she knows something I don't know about this particular test.

Yes, she is incorrect.  She is quoting that standard recommendations from the manufacturer's package insert and the CDC which reflect old data and older studies. The manufacturers will not change their insert since to do so would require clinical trials costing millions of dollars- they have nothing to gain corporately from doing another study of an already approved test.  As for the other "official" recommendations, these recommendations for testing at 3 and even 6 months are the result of two factors- data from older tests no longer used (you really do not need to worry about which generation of tests you were tested with, at this time virtually all tests are far more sensitive that they were even 2-3 years ago when the 3 month recommendation was made) and secondly, the fact that some, mostly governmental agencies which have to provide recommendations for virtually everyone without the sort of interactions such as those you get with your doctor or on personalized sites such as this one, feel they cannot "afford" to be wrong and therefore make recommendations and guidelines which leave most people unnecessarily nervous for 4-6 weeks longer than the 6-8 weeks it takes virtually everyone to develop HIV antibodies.  

2-- My understanding is that acute HIV symptoms are due to the body's reaction not to the virus itself but the antibodies produced by our bodies. Does this include lymphadenopathy? According to this post  by Dr. HHH   http://www.medhelp.org/posts/STDs/Test-Results/show/246301    40% will show up positive after 2 weeks of onset of ARS, and 100% after 17 days??  But Dr. Hook says that a test will show positive after only a few days after the beginning of symptoms. (I realize that 6 weeks can be late for ars, but most sources put the time frame at 2-6 weeks post exposure, with 6 weeks being rare). Who is right? Would you say that my negative test 2 weeks after the onset of my swollen glands rules out HIV?  I'm worried since I've NEVER had swollen glands above my waist in my life.

I cannot comment on Dr. Handsfield’s figures although I would point out that the data he quoted were from studies performed more than 7 years ago.  I can however confirm you that the symptoms of the ARS are due to the reaction of HIV antibodies with the virus and that soon after the symptoms start, antibodies are detectable.  Whether this is one week or, occasionally two is less clear and the data vary from study to study.

Your negative test 2 weeks after the onset of symptoms does rule out HIV as the cause of your swollen glands. (and I would challenge the idea that you have never had swollen glands above the waste- if you have had a sore throat, I am confident you  had swollen glands).

3-- All my life I've had a white tongue in the mornings. But I've heard that it could be a sign of a weak immune system—however I rarely get sick and my CBC are normal. When you say people with weaken immune systems are late to develop antibodies do you mean folks with seriously compromised immune systems or ppl with a weaker-normal range as well?

This talk of a "weak" immune system indicated by a white tongue is a lot of mythology.  There are many causes of discoloration of the tongue.  Our statements about delayed antibody responses in persons with weakened immune systems refers to people with profoundly weakened immune systems such as persons receiving cancer chemotherapy.  

4-- I've been very stressed since week 2. Can sleeplessness, prolonged stress, drugs like gabapentin, and  cephalexin delay production of antibodies?

No!!

5-- And finally,  if you were my doctor would you say that my 8 week test is conclusive? I've heard that in states like Massachusetts (not my state) the window period is 6 weeks using standard AB test. Can I move on?

I urge you to move on.  I would tell you (and am, that your tests prove that you did not get HIV form the encounter you have described.  EWH

[BernardMarx]

Hello doctor,
Thank you for your fast response. I'm trying hard to move on. Today I woke up with red dots on my penis head, similar to a faint rash. It's very alarming especially since I'm in the HIV window period. I think it could be a yeast infection. I just finished a 2 week treatment of cephalexin. Does this sound like a rash associated with HIV seeing how it's an immune system dieseas. I haven't had sex with anyone in over 2 months and was treated for gonorrhea and chlamydia back then.

Again tested negative for HIV last Friday at exactly 8 weeks. This is conclusive right?

Thank you once again

[BernardMarx]

And I don't have diabetes.

[Edward W Hook, MD]

Your test is conclusive.  The rash you noted is not a sign of HIV.  Without examining you I cannot be sure but yeast infections can be a result of recent antibiotic use and present as the sort of rash you appear to be descrbing.  Perhaps that is what is going on.  You can ask the opinion of your doctor without worrying about HIV.  EWH

[BernardMarx]

Thanks again Doctor Hook.

I have a few last questions and then I'm done.

1. I forgot to mention that yesterday I noticed a black (superficial) spot on my gum, between my lower and upper right molars. I was able to scrap it off with my fingernail and realized it was blood. It must've been a scab. (1 mm in size). No open sore under that. Does this sound like anything HIV-related/need to worry about?

2. I've read a lot of post by yourself and Dr. HHH where you claim that "virtually" everyone seroconverts by week 8. Would you say that the 8 week limit is like a safety net/ conservative limit? i.e. would it be realistic for someone to seroconvert at 8 weeks, 3days, etc/  very close to the 8 week limit?

3. Is it ok to resume having unprotected sex with my spouse ?

THATS IT. Thank you very much for your time doctor!

[Edward W Hook, MD]

1.  Believe your tests.  When symptoms and tests do not agre, the tests wqare what hsould be believed.  

2.  For statistical reasons, all studies can provide only estimate, not defintive results.  The 8 week time frame is very reliable.  When Dr. Handsfield or I say that something is virtually zero, very close to no risk, or of minimal risk, or use any other term to indicate a very small risk, that means "close to zero" in a world where zero cannot be attained.

3.  Yes

Take care.  EWH