HIV - Prevention Expert Forum
HIV Multiplex & Duo Reliability
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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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HIV Multiplex & Duo Reliability

Dear Dr HHH & Dr Hook,

I hope this finds you well and I would like to commend you on an excellent forum and fantastic reassurance you provide everyone. My Situation and Questions are as follows:

On the 1st of August 2011 I had sex with a prostitute (Oriental) – unprotected sex twice, kissing and rimming. The following 9 weeks I have had pain in my lymph nodes behind ears, groin & armpits, very very dry mouth, burning lips, oral ulcers and diagnosed fungal rash on back and arms.
I am also a type 1 diabetic. This has normally been very well controlled until the incident in question.

After 13 days I went to a London clinic and had the HIV RNA PCR Multiplex & HIV DUO – both negative and non reactive.

After 31 days I had the HIV duo which again was negative.

After 6 weeks I had the HIV Multiplex & HIV Duo again with another clinic.

After 9 weeks I had the Multiplex & HIV Duo with another clinic again which was negative.

After 11 weeks I had an insti - negative.

After 13 weeks I had a HIV Duo negative.


I am particularly worries in leu of the fact that I am a diabetic (type 1) which is an autoimmune condition and I feel that I might be a late seroconverter, having also been drinking and smoking heavily? I know there are people who take up to 3 months to test positive...

I am in particular pinning my hopes on the HIV RNA PCR Multiplex.

Many up to date websites say that there is a window period of 6 months + due to those who seroconvert late? I am worried that the P24 antigen part of the test is unreliable & I have not seroconverted yet due to my diabetes mellitus - which is an autoimmune condition.


Please advise and once again thank you Dr's.
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Welcome to our Forum.  You do not have HIV. I say this with absolute confidence.  The idea of "late seroconversion" is an urban myth that is promulgated on the internet but is simply not a realistic concern.  Further even if such a thing existed, you have not only been tested for HIV antibodies but the virus itself with PCR, further ruling out the theoretical possibility of late seroconversion.  Diabetes does not change the time course of seroconversion.

As for the other websites you have been visiting- they are overly conservative.  The 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.  

You do not have HIV from your August exposure.  There is no need for concern or for further testing. EWH
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Thank you for your answer Dr Hook,

Am I right in thinking that the p24 antigen part of the combi test is unreliable due to low sensitivity?

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H. Hunter Handsfield, M.D.Blank
University of Washington
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