Grateful for assessment

[Joseph787]

Hello,

I came across this statement from a medical practitioner on the web:

"In truth, none of these tests are ever likely to be 100% (EIA, RNA PCR). They have had cases of dormant STD infections that went tested and undetected for years, even up to 10 years has been documented. If your immune system is healthy enough to tuck the infection away and prevent it from spreading for a while, it will. This prevents anything from showing up on many tests until the immune system gets low for some reason and allows an outbreak or the virus. This is most common with HPV where women usually go several years without it showing up on tests. HIV is the same, and it is usually recommended to continue testing for years to be sure, if you think you could have been exposed."

1) How accurate is the above statement?

2) I had a brief possible exposure in the U.S. (vaginal intercourse/unknown status/condom broke) about 4.5 months ago. Had bad symptoms that began 1 week later and some still present today (1, possibly 2, small enlarged lymph nodes in my neck, white tongue (culture swab diagnosed heavy bacterial growth, not thrush), on-going folliculitis on arm pits and torso, fatigue, and very bad acid reflux/heartburn with strange sounds in my stomach and esophagus)  

Had several tests: 2,3,4,6,8,9,14 weeks EIA Negative. and 17.5 weeks EIA plus Western Blot for HIV 1/o/2, RNA PCR HIV 1, both Negative, and CD4 count of 718.

How reassured can I be with these results, especially since I'm still experiencing bothersome symptoms that no doctor can yet find a cause for?

3) How plausible/relevant is a possible rare strain/subgroup infection?

4) If I did contract a rare strain/subgroup would any of my tests not designed to detect rare strains/subgroups detect anything or indicate a possible problem, or would they just return a clean negative result?

Thank you Dr.!!!

[Joseph787]

Dr. Jose,

Thank you so much for your prompt and reassuring reply. It has helped me tremendously.

It's so difficult to know who to listen to when there is so much conflicting information on HIV out there.

I am definitely reassured by my test results and I'm very confident that HIV is not my problem. If it's ok, I just wanted to ask the following for general knowledge:

1) I have 1 palpable marble sized lymph node in my neck, left side above the clavical bone. I only noticed it 2 months ago since I was checking for possible ARS symptoms, therefore I don't know how long I had it for. Is it's size concerning at all? Should you be able to feel lymph nodes even if there is nothing wrong with you? With ARS, are concerning lymph nodes based on the size they swell to and/or the number of lymph nodes that become noticeable/present?

2) There is no way for an individual to sero convert 3 months after infection? Is it possible for the seroconversion process to take longer than 3 months?

3) If I had a suppressed immune system due to an illness that would delay seroconversion, would my CD4 count test come back abnormal?

4) I spoke with an HIV specialist/Doctor from San Diego USA, she told me she once had a case where an individual progressed to AIDS in 5 years post infection, and between infection and AIDS repeatedly tested negative on blood tests. Have you ever heard/seen cases like this? How plausible is this case? How could they determine the person had AIDS if he never tested positive?

I've had 4 general blood tests done over the course of the last 4 months and everything continues to come back normal! That's what's confusing me.

Thank you again so much for your valuable time and help Dr. Jose.

All the best to you Sir!

[Dr. Jose Gonzalez-Garcia, MD, MRCGP, PhD]

Hello Joseph,
Thank you very much for your post and welcome to our HIV forum.
Let me answer your questions here below:
1.) I find that general statements like that extremely vague and not useful or helpful at all.  One cannot generalise like that; therefore I would see that statement as totally innacurate for so many infections and for so many different ways of testing.  In Medicine, you can never have any statistical figure of 0% or 100%.  However you can have statistics close enough to those figures, that would render that particular test fully conclusive at the appropriate window period.  There are many different infections and there are many different ways of testing for these infections.  If that statemnt was to be accurate and PCR RNA or DNA tests cannot be relied upon because of the response of the immune system, all you would need to test for would be the specific antibodies produced by your own immune system against that particular infection.  Also different infections behave in different ways.  You cannot extrapolate what happens for example with HPV to all other viral infections, including HIV, as they are completely different.  Therefoer, if your main concern is HIV, that statement cannot be applied to it.  We know HIV infection very well now and we have highly sofisticated and sensitive test available nowadays that allow us to detect these infections very early on with total confidence.
2.) Completely.  You are definitley HIV negative.  There is no doubt about it at all whatsoever.  Symptoms have absolutely nothing to do with HIV.  They do not correlate with the timing or typical picture of acute sero-conversion.
3.) These rare subtypes are extremely rare and I do not believe that that is your case, and they would have been detected anyway in at least one of your tests.
4.) They would have been detected, as they all share similar characteristics.  I am completley sure that you are HIV negative.  Rather that wasting time and money worrying about HIV and these symptoms continue, you ought to look elsewhere and have a genral blood test to try identify the possible cause.
Best wishes,
Dr josé