Conclusive?

[Dwashington]

Hello,  

Here is my story:  Had protected vaginal intercourse with csw in the caribbeans.  The condom did not broke, but it did slip, I don't believe it slipped entirely off because when I pulled out the condom was still on, though it was not snug over the head of the penis.  4 weeks later after this event I was diagnosed with shingles and given Valtrex. Having shingles at age 27 made me very concerned regarding HIV.  These are the following tests I've done:  

DNA PCR for hiv-1 by LabCorp at weeks 4 and 8 - negative
HIV 1/O/2 antibody test by LabCorp at weeks , 8, 12, 13, 24, 36 - all negative
HIV 1/2 EIA ab (3rd gen) by Quest Diagnostics at weeks 5 and 38 - negative (this test noted that it also tests for Group O)
I also had my overall IgA, IgM, IgG levels checked 4 months after exposure and all were normal (not sure if this was necessary or worthwhile).

I've recently entered into a new relationship with my now girlfriend and want to be 100% sure that I am HIV negative before I have sex with her.  My questions are as follows:

1.  Are my tests absolutely conclusive?
2.  Since my exposure was in the Caribbeans, is there a possibility that the modern day antibody tests that I had, could have missed a certain subtype?
3.  I know shingles typically has nothing to do with HIV.  But is shingles a symptom of primary (acute) HIV infection or is shingles a symptom of more longstanding HIV infection?
4.  Are the HIV 1/2 antibody tests as reliable as a standalone HIV-2 antibody EIA test for HIV-2 testing?
5.  I read online that the ratio of false negatives for 3rd generation antibody tests after 3 months is 3/1000, which I found to be quite high.  Would you agree with this ratio of false negatives?
6.  Would you recommend any additional testing at this point?

Thanks for your time.

[H. Hunter Handsfield, M.D.]

I would guess the DNA tests are getting less expensive just because that's the natural course of new technologies.  I'm sure the price has no bearing on test reliability.

I am unaware of any effect of HIV on IgM antibody levels.  I hope you didn't have such a test -- more money wasted!

Protected versus unprotected sex would make no difference in my reply.  As I said above, test results overrule all other factors.  You could have mainlined HIV infected blood and I would have reassured you just as I have.

Thanks for the thanks.  Best wishes.

[Dwashington]

One final question and that will be it from me.  If I were to have the exposure I described without wearing a condom, and had the same test results, there would be no change in your opinion that I am absolutely negative and no further testing is necessary?

Thanks in advance.

[Dwashington]

Thanks for your prompt reply, the reassurance is great.  I do have a couple of additional questions out of curiosity.  

I have read that DNA PCR tests are quite expensive (several hundred dollars), yet the test I got from LabCorp was quite a bit cheaper ($200).  Any idea on why such a large cost difference?  Also does the DNA PCR test check solely for subtype b only or all subtypes a-k?  Once again I trust your answer, these questions are more out of curiosity.  

From a science standpoint, would overall IgM levels be elevated post infection?

Thanks for the service you provide.

[H. Hunter Handsfield, M.D.]

Welcome to the forum and thanks for your question.

Shingles or not, you have been seriously overtested for HIV -- it's time to stop!  The combination of result of your first DNA test at 4 weeks and your first antibody test at 5 weeks proved conclusively that you did not catch HIV.  All test results after that time were superfluous.  Below is the link to a thread that explains how and why results are conclusive at much earlier times than the 3 month official window recommended by most test manufacturers and public health agencies.

http://www.medhelp.org/posts/show/1704700

On top of which, you had an essentially zero risk exposure anyway.  Condoms work!

To your specific questions:

1) Yes, absolutely conclusive.  See above.
2) No, that's not an issue.
3) To the best of my knowledge, shingles does not occur with increased frequency during primary HIV infection.  Even if it did, it would not affect my reassuring reply:  the test results always overrule exposure history, symptoms, etc.
4) These tests are equally reliable.
5) There are no truly accurate statistics on false negative rates; all such figures are estimates.  In any case, even if this figure is true, it applies ONLY to the antibody tests.  So this is an irrelevant concern:  it is not possible to have both a false negative antibody test and false negative DNA test at 4 weeks or more after infection.
6) I wouldn't have recommended any HIV testing at all after such an exposure -- and as I said above, all tests after your first two were unnecessary.  You certainly shouldn't spend anything more on any further tests.

Really, stop worrying about this and stop testing.  Believe the resutls you have had.  In regard to HIV, there is no reason for you to delay having sex with your new girlfriend.

Best wishes--  HHH, MD