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Delayed HIV Seroconversion
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This forum is limited to prevention of HIV and to safe sex in general. All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Delayed HIV Seroconversion

Delayed HIV seroconversion is something that many doctors or HIV experts dismiss as a rare occurrence or as an urban myth. But from what I researched it’s something that does exist and people should be made aware of it. The delayed seroconversion question is almost always met with a generic answer that is widely accepted by everyone in the field of HIV, e.g. it is a thing of the past, it is extremely rare, etc. but nothing more is given to really explain this occurrence. Google ‘Delayed Seroconversion’ and you’ll find numerous stories of people who seroconvert 6, 9, 30 months after exposure. And of course there are the CDC documented cases that confirm delay HIV seroconversion. Something that is never discussed maybe because it’s esoteric is the characteristics of HIV. It is a Lentivirus which is characterized as having a long incubation period that delays the immune response of the host, i.e. delayed seroconversion. And also HIV’s possible interaction with other viruses or bacteria such as HCV which has been documented to delay seroconversion up to 12 months. There are so many factors involved in delayed HIV seroconversion that to simply dismiss it as insignificant is doing a disservice to many.

This research was driven by my own possible exposure to HIV. I, too, experienced possible ARS symptoms early on and tested at 4, 6, 8, 11, 14.5, and recently at 20 weeks (~5 Months). I also took a RNA, Real Time PCR at 14.5 Weeks. Dr. Hook was very helpful during this period and gave me a clean bill of health in regards to HIV. But with some odd symptoms still lingering I’m doubtful of my tests, e.g. Mouth Sores, White Tongue, Folliculitis, Gastric Problems, etc.

What is your medical opinion on everything I’ve stated above? Your response will be greatly appreciated and may serve as reference for future inquiries on this same topic.
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239123_tn?1267651214
The premise of your question, as worded, is biased.  "Dismiss as rare or urban myth" implies that those who assert such things are off the mark.  It isn't true.

First, the whole concept applies only to the standalone antibody tests.  Nowadays, when there is uncertainty, other tests (p24 antigen, PCR for viral RNA/DNA can be tested to remove any doubt.  The combination of test results you had is incontrovertible evidence you don't have HIV and in my opinion you are spinning your wheels and wasting emotional energy and time to even be investigating this by online research.  

Second, much of the information about delayed seroconversion dates back to earlier tests, for the most part no longer in use.  With all antibody tests in regular use today, delayed seroconversion is exceedingly rare if it occurs at all.  Further, when you see statements that other infections (HCV or any other) can delay seroconversion by up to a year, or any other interval, almost always you are seeing opinion, not fact based on data.  There simply is no research to document such an effect by HCV or any other health problem.  Even the oft-stated problems that supposedly occur with terminal illnesses, potent chemotherapy, etc are based almost entirely on theory, with few if any actually documented cases of inaccurate HIV antibody testing.  And even if that could happen, the viral tests remain as a back-up.  In theory, such immune suppression would result in an elevated viral load, i.e. would make p24 and PCR testing more sensitive, not less so.

Third, tests always should be interpreted in the context of the likelihood of infection before testing is done.  If a patient has a truly high risk exposure, such as unprotected anal sex with a known infected or obviously high risk parnter, or if s/he as typical ARS symptoms (as determined by a health professional, not the patient's self-judgment which often is erroneous), then a negative antibody test should properly be viewed with skepticism.  But when someone has a virtually zero risk event, as you did, AND has negative antibody tests beyond 6 weeks, the test becomes 100% proof (for all practial purposes) against HIV.

Finally, the symptoms of ARS always are nonspecific.  It doesn't matter how classical they are.  Even when confirmed by an HIV-experienced clinician, the large majority of people with such symptoms do not have ARS.  Therefore, test results ALWAYS overrule symptoms in judging whether or not someone is infected.  Therefore, my opinion remains identical to Dr. Hook's:  your test results prove unequivocally that your symptoms are cause by something other than HIV.  You're just going to have to accept that apparently difficult truth.

There is no information you can provide that would change my opinions or advice, so let's forego any ongoing discussion.  

HHH, MD

19 Comments
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Avatar_m_tn
Regardless of what you think or believe about delayed seroconversion does not matter because you had an HIV RNA test which has nothing to do with seroconversion.  It looks directly for the virus so if you did have. "delayed seroconversion" then you would of had a significant viral load because technically you would not have antibodies to HIV which is what reduces the viral load after initial infection
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Avatar_m_tn
Thank you for your time, Doctor. I have no rebuttal. I'm going for my 6-month test in two weeks (Rapid Finger Prick). I'll post my results.

@Clueless Your're right. Thank you for your post.
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Avatar_m_tn
This is a very scary post showing that antinody test are not sufficient at all.
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Avatar_m_tn
I didn’t mean for this post to 'scare' anyone who is experiencing anxiety over a possible HIV exposure. It was a question I posed to the doctor to begin a dialogue on the seemingly polarizing topic of Late Seroconversion. I did some research online and this was a concern I had and the Doctor was kind enough to address it.

For anyone interested in reading some of the research I cited in my post, please copy and paste the link below in your browser:

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=2512827&dopt=Abstract
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Avatar_m_tn
My post was mysteriously deleted, but here it is again:

I didn’t mean for the above post to 'scare' anyone who is experiencing anxiety over a possible HIV exposure. It was a question I posed to the Doctor to begin a dialogue on the seemingly polarizing topic of Late Seroconversion. The Doctor was kind enough to address it and I thank him for his time.

For those interested in reading a study that I cited in my post, copy and paste the following link on your browser:

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=2512827&dopt=Abstract





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Avatar_m_tn
The post below is not addressed to anyone in specific. It is to add to my initial post (see above).

I didn’t mean for this post to 'scare' anyone who is experiencing anxiety over a possible HIV exposure. It was a question I posed to the doctor to begin a dialogue on the seemingly polarizing topic of Late Seroconversion.

If anyone who reads my posts have questions regarding my sources, below is one of the studies I cited. Copy and Paste the link in you browser:

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=2512827&dopt=Abstract



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239123_tn?1267651214
Your follow-up message was deleted (twice) because you attempted to cite a misleading research study -- 22 years old, based on the very earliest HIV antibody tests.  The results are irrelevant to modern HIV testing methods, and to the concerns expressed in your message.  I would also recommend you not post the link (or remove it if you have) on any of the community forums.  It is irrelevant today and unfairly misleading to anxious forum users.
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Avatar_m_tn
Last post on this forum...

According to you and other HIV experts the tests havent really changed much since the early models. Correct? So the study I cited isn’t a far stretch from being relevant.  

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239123_tn?1267651214
No, not correct.  You haven't heard that from Dr. Hook or me on this forum.

You need to suck it up, stop worrying about nonsensically low risk scenarios, and move on.  You don't have HIV.

This thread is over; any further comments will be deleted without reply, and continued argumentative comments and other sorts of abuse will jeopardize your MedHelp privileges.
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Avatar_f_tn
So antibody testing as a "stand alone test" is conclusive at 6+ months of someone did have unprotected sex with someone who is HIV positive, with ongoing symptoms that are indeed ars related?? No doctors can seem to answer this, it is or it isnt. Test again or conclusive ?
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239123_tn?1267651214
Three months is definitive, regardless of the exposure and regardless of symptoms.  As for "No doctors can seem to answer this", all you need to do is read this forum.  Dr. Hook and I have been stipulating 3 months for several years -- probably at least once a day, on average.

This reply doesn't imply an opportunity for ongoing discussion.  This thread is over.
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Avatar_f_tn
That's fine and I can see you have a lot going on and indeed are s very busy doctor on this forum. However you do not seem to be consistent on a few different post. You did indeed state that delayed serconversion has happened with ( stand Alone antibody test) but then you state 3 months is conclusive ?? I and many others do not understand this? There are many other sites besides this one that do state 6 months for known exposure. And some even say there are no guarantees as when someone will test positive for antibodys, if you have any unexplained symptoms talk to your health care provider and consider retesting for HIV. As a very worried soon to be mother I'm generally concerned and I apologize if I am trying to come to a doctor who specializes in this disease for help.
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239123_tn?1267651214
Sigh.  This has been explained so many times!  But here we go again.

There are no absolutes in biology or medicine.  If you want a 100% guarantee that there could not be somebody, somewhere who catches HIV and fails to have a positive antibody test after 3 months, you'll never have it.  Similarly, if you want to avoid HIV with 100% certainty, you'll just have to resign yourself to celibacy, or at least to non-penetrative sex.

But the notion of failing to have an positive antibody test beyond 3 months is similar to the risks associated with lightning strikes or being killed by a meteorite.  It could happen, but are you going to live your life in fear of it?  Or take special steps to avoid it?  Or go out of your way for additional testing or worry when the results of testing still leave a 1 in a billion chance you might have HIV?

And I will thank you to stop misquoting me or Dr. Hook.  Recently on the HIV community forum, you wrote "I just read a post from the dr. Forum that someone stated on dec 2 . Dr said there ARE known cases of late seroconversion with SINGLE antibody testing past 6 months!"  We said no such thing.  Perhaps it is theoretically possible this could happen, but I unwaware of any cases in which it did.

My advice to people with such worries is to suck it up and move on. And to trust their HIV test results -- which are infinitely more reliable than symptoms, for example, in judging whether or not someone has HIV.

Any apparent inconsistency in my responses on this issue, or Dr. Hook's, are strictly in the eye of the beholder.  Sometimes we say "no risk" and other times we might say "little or no risk for practical purposes".  It is irrational hair splitting to see a difference between them; sometimes we just dash of a response that makes sense in the context of the question asked.

That's definitel the end of this thread.  This isn't a debate and I'm through playing this game.  In any case, you are not welcom to continue irrational, unsupported statements that serve primarily to inflame anxious persons' fears and I'm asking you to stop doing it, either here or on the community forum.
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Avatar_m_tn
I'm posting my results as I promised in my post above. I went this past Saturday (12/17) for a Rapid (Finger Prick) test at a Planned Parenthood. The result was given to me in 20 minutes and it was Negative. This was 24 weeks (6 Months) post possible exposure. Thank you all for your time. I will no longer post to this thread.
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Avatar_m_tn
Please only read this thread - Do not post. Message me if you have any questions. Thank you, all.
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