Can the tests be missing it?

Dear Dr., I don't know how much you look at previous posts but I will give you brief summary.  I am a young Korean male and am petrified that i may have acquired HIV.  All of my exposures have been here in the US, but with girls from Asian Massage Parlors.  From what I gather, they come and go quickly-meaning travel between cities.  I have had numerous exposures in the past few years.  ALL of these exposures were either a handjob or prostrate massage or combination of the two.  When they "fingered" me they never wore a shield on their finger.  I have been told that it was not a risk, but what if they had bleeding cuticle/cut that they were unaware of?   Wouldn't that be a risk?  You may laugh at this but, I have tested numerous times after the 13 week window.  4 times by Labcorp ICMA method(last 31 weeks), 7 times by Quest EIA method (last 34 weeks(nearly 8 months)), 7 rapid oraquick advance between 16 and 30 weeks(last).  I also had two PCR DNA done.  One at 4 weeks and the other at 6 months.  All of my tests have been negative.  What worries me is lingering symptoms that bother me.  How unlikely is it that with all of my testing, that if I indeed was positive, that none of these tests would pick it up?  I have done a lot of reading on the subject of different strains/subtypes/CRF's.  Could it be that since the girls I was with were from another country, that the tests that I had would be unable to pick it up?   I think that is what freaks me out the most, and that if I continue to test with these tests and keep getting negatives but I really could be positive but they are unable to recognize it.  Please give me your thoughts on this scary ordeal.

[H. Hunter Handsfield, M.D.]

This is my second reply; I deleted the first one because you're right (in your follow-up comment below).  I confused you with another user.  My fault and my apology!

As has been discussed innumerable times on the forum, safe sex means not having unprotected vaginal, anal or oral sex.  No bare penis in another person's vagina,rectum, or (rarely) mouth means no risk of HIV.  The virus is not transmitted by fingering, hand-genital (or anal) contact, kissing, or skin-skin contact.  Second, the odds a particular sexually active woman in the US or other industrialized country has HIV -- even among commercial sex workers -- generally is under 1 in 1,000, so it is very unlikely any of your massage partners had HIV.  From a medical or risk assessment standpoint, you did not need to be HIV tested.

Further, with standard HIV tests in use today, a negative result 6+ weeks after the last possible exposure is virtually 100% reliable; some experts continue to advise waiting 3 months, but it's never necessary to test later than that. Your negative result is proof you weren't infected.  The negative PCR is icing on the cake, further proving you don't have HIV.  There no HIV types that are missed by both antibody and PCR tests.  And test results always outweigh symptoms in judging whether someone has HIV.  I'm inclined to doubt you have "chronic esophagitis", which woud be extremely rare at age 23  -- but even if you do, it does not change my advice.

Finally, some of my remarks in my original (deleted) reply remain pertinent.  You are far more woked up about this than warranted.  Most likely you have been repeatedly reassured by others, probably including your own doctor(s) and perhaps on the HIV community forum -- which I have not looked but will do after this comment is done -- that you were not at risk and that you are not infected.  It is not normal to be so resistant to such overwhelming evidence.  If you cannot shake your fear of having HIV despite this additional reassurance, professional counseling may be helpful.  I suggest it out of compassion, not criticism.

Really, let it go.  Stop testing.  You  don't have it.

Good luck--  HHH, MD

[iscrewedupbig]

I believe that you may have me confused with another user.  Only reason I say that is because this is my first post on the professionally moderated forums.  Although when I signed up there was a similar name.  1) But how confident are you in a nearly 8 month antibody test?  2) how about PCR DNA?  3) When can I stop testing? 4) Would a 6 month chronic esophagitis change your mind at atll?  Also, I tried to find it somewhere but could not, how do they actually find/label new strains of HIV.  Meaning if current tests dont pick up, but someone infected, how do they finally ever get to that diagnosis.  Thanks

[iscrewedupbig]

Thank you for taking the time to reply to my post, sorry about the confusion.  As far as testing goes, you feel that they would pick up any infection no matter what part of the world it may come from?   Also, I tried to find it somewhere but could not, how do they actually find/label new strains of HIV.  Meaning if current tests dont pick up, but someone infected, how do they finally ever get to that diagnosis.  Thanks again, and have a good week.

[H. Hunter Handsfield, M.D.]

That's a good question, but not a realistic concern.  My understanding is that the scenario of having HIV/AIDS and "never getting to the diagnosis" never happens with the currently available tests.

I'm not a virologist, so these comments undoubtedly are incomplete.  But the various HIV types and subtypes are much more similar than different.  Evolutionary changes in the virus are incremental, not likely to ever involve such a giant shift that current tests would suddenly miss a new variant, especially for tests that detect the virus directly, like PCR or p24 antigen.  I can't say a major genetic shift could not occur sometime in the future, with the first few infected people therefore having delayed diagnosis.  But the chance it has happened to you are too low to be a legitimate cause for worry.  You may as well worry about getting hit by a meteorite someday; the odds probably are higher.

[iscrewedupbig]

Dear Doctor Hansfield, I thank you for your prompt reply. I wanted to
update you on some labs my doctor ordered.  He is out of town but the
PA signed off and they faxed them to me.  Normal ranges listed besides
%cd3--79%. (57-85)
abs. Cd3--1441 (840-3060)
%cd4--54% (30-61)
abs. Cd4--974 (490-1740)
%cd8--24% (12-42)
abs. Cd8--438 (180-1170)
Cd4/cd8 ratio 2.22
%cd 19--8% (6-29)
abs. Cd19--142 (110-660)
Abs. Lymphocytes--1817 (850-3900)

All of my #'s are in range but tend to gravitate to the low side.
Particuarly cd19%. 1) how does my immune system appear to you?  Is the
cd4/cd8 ratio good/healthy along with %?  2) is there one thing you
look at more than others in this report?  3). Should I disregard all
of this as to pointing to HIV and look elsewhere, and should I be concerned at all about
these numbers, including the low ones?  4) I want to close this
chapter in my life, is there any test (viral load, bDNA, etc.) that
could help me close the book, and if so, when should I have it done?
I am just tired of this chronic sore throat(culture,ent visit all
normal) and there HAS to be something causing it, we just cannot find
it.  Also, I DO NOT want to infect my wife if I could possibly have HIV and have it still not detected with ALL of the tests that I have done.
I thank you in advance for your time and I look forward to hearing your reply.

[H. Hunter Handsfield, M.D.]

Sorry, this goes beyond this forum's service.  We are not direct health care providers.  I haven't looked at these numbers as there is no need:  you already provided enough information to be 100% certain you do not have HIV.

Please re-read the closing paragraph of my original reply above.  This thread is over, and you may not start a new one on this topic; it would be deleted without reply or refund.

[iscrewedupbig]

Thank you for your time

[iscrewedupbig]

FINAL comment please--With my tests/timeframe, as a medical professional, would you say 100% if you weren't 100% confident in that statement?  And are you saying whatever symptoms I have, they are not HIV?  Thank you, and that will be all.

[H. Hunter Handsfield, M.D.]

You're repeatiing the same questions with different words.  Read my replies above.  Any more of this and the entire thread will be immediately deleted.