Scared to the bone

Hello Dr.

I am extremely worried and I hope you can help me.

I was reviewing posts and I saw one that worried me regarding subtypes and strains.

I wanted to know that if one had a duo test after 28 days after a potential exposure and it was negative is this all clear? I have had a couple of these tests and insti tests post 90 days all negative. You will probably tell me that I am 100% negative.

I was wondering if you could answer me this: I worried about getting another test from post days - NRA or something like that - and it was expensive. What I wanted to know was that if my negative tests and duo tests were negative, does that mean that the 10 day test would be negative.

PLease answer this: Have you ever had a patient or heard of a patient who has had a series of tests (all negative) yet had an NRA test that was positive? This worries me. as I was worried about strains that would not appear in a standard test.

Thank you in advance - you help so many people so I hope you will be able to answer my questions and sorry if I have badgered you with questions.

[Edward W Hook, MD]

Welcome to the Forum.  I know the posts regarding subtypes and rare strains of HIV and wish that the questions had not been raised because they cause so much unwarranted worry.  Concerns about rare HIV strains and subtypes are a waste of time and energy. The FACTS are that all strains of HIV have common and/or closely related molecular components which are shared between all HIV stains.   These components are the targets of the antibodies tested for in HIV antibody tests and are widely shared among p24 antigens from different HIV strains.  Thus there really is no meaningful risk of a person who has negative DUO tests at 4 weeks or beyond being infected with a hard to detect HIV strain. The concerns that you read about form our clients are paranoid thinking which are fueled by incorrect misstatements which are all too common on the internet.

I do not know of the NRA test.  Perhaps you are speaking of PCR tests for detection of HIV RNA.  If this is the case, we do not recommend them for testing.  While the PCR is likely to become positive more quickly than other antibody detection tests (i.e. usual blood tests), at the present time the blood tests are becoming more and more sensitive and detecting infection earlier and earlier so that the time difference in detection between PCR test and antibody detection tests is becoming smaller and smaller and at present is, in general only a week or two.  In addition the time course over which the PCR tests become positive is less well described than for the blood tests and, as a result, it is difficult to make a definitive statement on what a negative PCR test means at any time within a few weeks of exposure to a HIV infected or possibly infected partner.  PCR tests are also more expensive than regular antibody tests.  Finally and most importantly, the false positive rate for PCR tests (i.e. a positive result in persons who do not have HIV) is higher than for blood tests.  Each of this on this Forum have seen a number of people who were worried needlessly because of false positive tests. For all of these reasons, we rarely recommend testing for HIV diagnosis using PCR.  

I hope these comments are helpful. EWH

[nando77]

Thanks for this Dr.

I have had numerous DUO tests and INSTI (up to 6 months) tests and my DR said this means that I am 100% negative.

First do you agree?

Secondly, for peace of mind, although the worries with RNA (you were of course right, my mistake) are there i.e. more false positives - have you ever seen a patient with negative DUO tests have a genuinely positive RNA test?

Hoping you can answer the two questions.

[Edward W Hook, MD]

These are anxiety-driven questions.  I will answer them and then not repeat myself.

1.  Your doctor is correct. With multiple DUO and INSTI tests you can be confident that you do not have HIV.

2.  No, I have never seen a patient with a negative DUO test have a true postive RNA test (I have seen false positives).

It is time for this thread to end. your questions have been answered. EWH

[nando77]

thanks doctor. Your help is much appreciated!