Heavy symptoms and testing time frame

[WorriedCanadian2010]

Dear Dr. Sean,

I would like to congratulate you for the great work you are doing. (Bringing peace to many worried over HIV).

Mid April, I  (Male 30) was drunk, and visited a brothel in Toronto, Canada.  The lady gave me oral (protected).
(I only paid for oral sex). but during the act, I was sleeping on top of her and then sleeping on her back...
When I got up from her, I saw the condom broke. Here far most, I remember is dipping the head of the penis in vagina twice for a quick 5-10 seconds each time. Since I was not drunk, my fear is that, there could have been penetration.

And I had all the classic symptoms but Fever/sore throat.
==
Day 7: Stomach upset, loss of appetite
Day 10- 15: Extreme fatigue
Day  20- 24: Swollen neck and under arms
Day 20- 27: Headache
Day 30: Rash
Day 49: Rash
Day 42: Mouth ulcer
From 7th day, I have been losing weight, My waist was 32 and now 28...

Weight loss really was my concern and I went out and took periodic tests.
==
23 day elisa  : Negative
23 day DNA PCR : Not Detected
25 Day Rapid test (INSTI)  : Negative
28 Day Elisa  : Negative
39 Day Elisa : Negative
39 Day DNA PCR : Not Detected
42 Day Rapid test (INSTI) : Negative
48 Day Rapid test (INSTI) : Negative

Question:
1.  Does DNA PCR cover all the subtypes?
2.  Is INSTI (3rd generation) as reliable as other tests?
3.  (assume the worst fear) If I really had penetrated her, (I am uncircumsized), with this risk,
     How reliable is my 7 week INSTI negative?
4.  Should I continue to test at 12 weeks, as I have experienced major symptoms
5.  How reliable is a HIV-1 Proviral DNA by PCR at the time frame I have taken (23 and 39 days)?
     can this test be false negative at the time I was tested?
6.  Stress can suppress immune system, do you think that would made my 7 week test less reliable?

Thanks in Advance. I really hope you have time to answer my post.

[Dr Sean Cummings]

Good Morning

You asked me the following question:-

4.  Should I continue to test at 12 weeks, as I have experienced major symptoms

My answer to this is yes because you are fixated with the idea of HIV. I have replied that I think you do not have HIV. As you have just pointed out you have had numerous tests already:

23 day elisa  : Negative
23 day DNA PCR : Not Detected
25 Day Rapid test (INSTI)  : Negative
28 Day Elisa  : Negative
39 Day Elisa : Negative
39 Day DNA PCR : Not Detected
42 Day Rapid test (INSTI) : Negative
48 Day Rapid test (INSTI) : Negative

You remain irrationally fixated with the idea of HIV somehow having escaped detection in which case a 12 week test is reasonable. Do you NEED a further test?? No of course not - you've been tested to hell and back and you are most certainly HIV negative.

best wishes, Sean

[WorriedCanadian2010]

Dear Dr Sean,

Could you please spare some time to answer my post?

[WorriedCanadian2010]

Dr. Sean,

Thank you very much for anwering my questions.

Your answers did help but also increased my anxiety, when you suggested 12 week test.

With all the negative test so far, what are my chances?  is there any test at 8 weeks that can give conclusive results? I can't wait for another month for 12 week INSTI.
I am really worried that, you have suggested a 12 week test for me (where I had 8 negative tests so far). I guess you suggested this because of the symptoms, which was my fear as well. In that case, do I have HIV?

Please help!

Thanks
-Kevin

[Dr Sean Cummings]

Good Morning

Thanks for the good wishes and I'm glad this is helpful!

You asked:-

Question:
1.  Does DNA PCR cover all the subtypes?

No it does not


2.  Is INSTI (3rd generation) as reliable as other tests?

yes - absolutely at the correct interval. We use a great many of these tests and find them exceptionally reliable. The ideal interval is at 12 weeks post exposure. However, we have found that in new HIV positive patients with symptoms the test will correctly identify the majority at about 3 weeks. At six weeks = 42 days then the test will correctly identify more than 99% of cases.

3.  (assume the worst fear) If I really had penetrated her, (I am uncircumsized), with this risk,
     How reliable is my 7 week INSTI negative?  

As above


4.  Should I continue to test at 12 weeks, as I have experienced major symptoms

Yes.

5.  How reliable is a HIV-1 Proviral DNA by PCR at the time frame I have taken (23 and 39 days)?

Certain

     can this test be false negative at the time I was tested?

Yes, all tests have false negative and false positive rates

6.  Stress can suppress immune system, do you think that would made my 7 week test less reliable?

No.

best wishes, Sean