Antibodie production or delay - for H. Hunter Handsfield M.D

Hi,

I will state my question explicitly and then I will explain a little more afterwards.

Q: How do experts such as yourself or scientists know that HPV (genital warts) cannot cause false negative hiv results or prolong the 3 month window period?

Everyone says that other dieseases such as HPV cannot delay the window period or cause unusual results in an hiv test.  However, they may have simply heard this from someone else and are simply repeating it.  I can imagine how hard it would be to find patients to perform tests on that were first exposed to HPV then exposed to HIV and to know how long they had hiv before they got tested.

WHY I AM WORRIED: I have genital warts and am paranoid that it may cause a false negative hiv result.  I am worried because my test results came back with a slightly low WBC of 3.7 and my urine came back with a trace of blood.  The hiv result was negative.  And the last time I had sex was 3 months ago.  Its actually the second test that came back with these results...the last time was back in April '08 (I also had a negative hiv result then).  I had ultrasound and x-rays performed on my abdominal and they found nothing as well - so what could this be?

Do I have any reason to be concerned that I have HIV????  I am paranoid and need to know if seroconversion (I think thats what they call it) can get delayed...and that my symptoms of low WBC and microhematuria are not pointing to hiv (because on the web the only thing they say a low WBC points towards is HIV)

[Edward W Hook, MD]

Dr. Handsfield and I share the forum.  You got me again and do not get to choose who your question goes to, sorry.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.

I have reviewed our past exchange, as well as your questions on the STD and HIV Prevention Communities.  You have nothing to worry about.

HPV does not delay HIV seroconversion.  There are no observations in the scientific literature to suggest this at all.  In addition, let me point out to you that over 85% of all adults have HPV and that if anything, the infection (HPV) is even more common in persons who get HIV than others since it is an STD and people who get a relatively uncommon STD such as HIV, have been shown to have other STDs prior to getting HIV, HPV being among the.

In addition, "late seroconversion" is an urban myth and does not occur except in persons who have taken anti_HIV medication in the interval between their exposure and having a positive test.

Bottom line, as I told you before, you have no reason whatsoever to be concerned about HIV - indeed, you are being paranoid.  A low WBC (and yours is not all that low) and microhematuria  is not due to HIV but something else.  What that might be is between you and your doctor.  You need to move on.  EWH

[obsessiveGeorge]

Thank you for answering my concerns...which I am feeling much better now- but hopefully can clear up all my fears as the stress of this is killing me.

I have read that a false negative is unlikely, but that Hiv-2, N or O type HIV can cause them.  What is the likeliness that I may have contracted one of those strains.  To be honest, I told you that I had sex with one women without a condom.  This women was israeli middle eastern and the last time we had sex was in Mar 08.  As explained before, only after about 2 weeks (after the last time having sex, 6 weeks after the first time having sex) I got the hiv test which was negative.  I did another test in late January '09 (about 9 months later), also negative.  The first test was in the window period but the second one was well after.  Could I have gottten one of those rare starins that can give a false negative?  Should I get another hiv test - maybe even just to assure myself ?

THANK YOU

[joggen]

Just an observation, but you seem to be working awfully hard trying to convince yourself you have HIV.

First, it was low WBC, then genital warts, and now 'rare strains'.

You identified your main health problem when you picked your Medhelp username. It's not normal to be so obsessive about HIV after a conclusive negative result.

[Edward W Hook, MD]

This will be your last answer.  Your anxiety is simply not justified by the facts.

The chance that you got a rare HIV type is close to zero and, just for the record. even the less common HIV sub-types are picked up by most tests.

If you choose to get tested again for your peace of mind, do so.  It is a waste of time.

There will be no more answers.  Further anxiety-driven questions will be deleted without comment.  eWH

[obsessiveGeorge]

My questions have logic and reason behind them and sure some anxiety, but so far all my questions have some possibilities associated with them (and I think this forum is meant to equate and explain these situations to people for future benefit) .  I have gained perspective and assessed my real situation.  In most people who are worried, you are correct that they are probably just that - worried and do not have hiv.  But rare cases do occurr.

Small parts of information can make a big difference in clinical diagnosis and that is why it is important that patients be open.

My symptoms (WBC changes, microhematuria and genital warts), all happened at the same time (which was after a stretch of promiscuity).  Furthermore, my WBC count on the first test was 3.9 then 9 months later was 3.7 - and as I have read at the inital phase of hiv, WBC counts go up and then fall later on.  Also, I can remember being sick for a long stretch in months prior to the first blood test where I was even coughing blood for about 3 weeks.

What I meant on the previous question was should I get tested for HIV-2?  Because as I understand HIV-1 are the only test performed in Canadian laboratories/clinics and for an HIV-2 I would need my doctors reference.

[obsessiveGeorge]

As well, since different regions have had different numbers of HIV-2 reported incidences (3 being in Canada), I was traveling last year and was with women from Europe, middle east and Massachusettes (which is one of the higher places of HIV-2 reported incidences in the us).  This is why a forum like this one is important, because it is very hard to share this kind of information with my general practioner.  Thank you

[Edward W Hook, MD]

You do not need to be tested for HIV-2.  It is a waste of time.  End of discussion. EWH

[obsessiveGeorge]

Hi,

So I decided and went yesterday just for peace of mind to get tested for Hiv-2.  I went to my doctor and asked to get tested, and unfortunately, he didn't even know there was such a strain.  He wrote up a requisition and simply wrote on it to test for Hiv1 and Hiv-2. I took the requisition to a labratory where they took 1 vial of blood and I think sent it to Ontario Public Health labelled HIV serology.  I don't know if my doctor ordered the correct test on the requisition.  Should he have been more specific as to which test to perform or given that my physician has written Hiv-2 on the requisiton will they do hiv-2 specific blood work?  given that he didn't know that Hiv-2 existed, I am worried that he may have sent me to the wrong place to get blood work...maybe he should have sent me to a local hospital (is it possible that Ontario Public Health will only test for Hiv-1 on receiving the vial of blood and leave me thinking that I was actually tested for Hiv-2- they don't really answer my questions over there at the provincial governernment).  Do you know what the proper procedure is in Canada?

Thank you

[Edward W Hook, MD]

Sorry, I know little about testing procedures in Canada.  I would suggest you discuss this with folks within your health department. At the very least they should know whom to ask.  EWH

[obsessiveGeorge]

I called the health department as you suggested, and they said they did a MEIA.  Microparticle Elisa.  Does this test for both Hiv1 and Hiv2?  

Could HTLV cause me to have the 3.7 WBC?  Is this something I need get tested for?
my doctor doesn't seem to know too much about this stuff and the public health department only gets into specifics with doctors not patients.

[H. Hunter Handsfield, M.D.]

Dr. Hook is away from the forum for a few days.  The clinic that did the test probably knows more about the specific test they use than he and I do, but almost all routine tests used in North America test for both HIV-1 and 2.  HTLV is not a likely cause of a WBC count of 3.7.  You'll need to follow up with your own doctor.  I'm sure Dr. Hook would agree wtih me that this forum has no more to offer you.  Take care.

[obsessiveGeorge]

Thanks for taking over Dr. Hooks posts.  I think this forum has more info than any other place I have tried looking.  If my doctor knew more, I don't think I would have found myself reading up so much and drowning in this stuff.

Well the clinic that did the test said it does test for HIV2 as well (actually all tests in Ontario are done at the same place), but that could mean that it primarily checks for Hiv-1 and secondarily to hiv-2.  They used an ABBOTT MEIA, and I don't kow that ABBOTT offers combinational EIA's which check both Hiv-1 and Hiv-2 primarily- I will ask my doctor again about this!

I could not find this out anywhere on the internet and most Canadian doctors do not know much about htlv from my experiences...but is it true that HTLV I/II would normally raise a persons WBC, as opposed to lower it?  I figured this because it can cause Leukemia.  Pretty much is there a point to get tested for HTLV?

[H. Hunter Handsfield, M.D.]

It isn't just Canadian doctors.  HTLV is an arcane, rare health problem.  Nobody ever does tests for it; as far as I know, no standard tests are available outside research labs.  A few cancer specialists might know something about HTLV, but no average doc does and that includes STD specialists, including Dr. Hook and I.  That is why I told you this forum has nothing more to offer you.  There is no point in further discussion and this thread has gone on long enough.  I will bring these final comments to Dr. Hook's attention when he returns. Unless and until he posts a comment that invites you to continue the dialog, any further comments will be deleted without reply.