Antibodies and Autoimmune diseases "OH MY" Please Help DR

[mshazzy]

In  2011 I started dating a man that I had known for several months , we started having protected sex but as things progressed it went to unprotected after he assured me that he was clean a couple more months later I caught him cheating and he confessed he had not been faithful during any of the time we had been dating  and he was going in to get an hiv and std test because he thought he had gotten something and told me I should do the same I went into a deep depression and drank a lot and many unprotected one night stands. I know how stupid and unsafe my actions were, First test  7/12  rapid finger prick ORAQUICK1/2 test negative  the woman was asking questions about my medical history and I told her I had two autoimmune diseases and she told me that there was a possibility that I was slow to produce antibodies because of this I needed to wait another 6 months to be sure that I had produced antibodies.
on 2/12 got a ORAQUICK oral swab negative
but the control line was very light i went to planned parenthood and took another rapid blood ORAQUICK negative. I started looking at delayed seroconversion and “Elite controllers” and what causes antibodies to not produce and I started to question my test results and fearing the worst.i took 2 more rapid tests done last month both were rapid blood UNIGOLD and ORAQUICK. im sorry if my questions seem ridiculous  I know if I can get them answered I can move on.

1.Is it at ALL possible for someone to be infected with HIV and not produce ANY antibodies, or not ENOUGH to be detectable on a rapid test beyond the 3 or even 6 month window period?

2. What WOULD  happen if someone was indeed infected with hiv and did not produce antibodies, could they remain healthy or would they become sick enough to be serious? im i an "elite controller?

3.Would my 2 autoimmune diseases affect my production of antibodies? Can i trust my 5 tests? THANK YOU FOR YOUR TIME.

[mshazzy]

Thank you Doc  have a great holiday :)

[Edward W Hook, MD]

Both celiac disease and Hasimoto's are problems of excessive antibody production, not a lack of antibodies and if you are not on therapy, your antibody production should certainly have produced antibodies to HIV if you had acquired infection.  There is no need to test specifically for the virus, you should believe you test results.  There is no need for further testing at all,  Currently available rapid tests for HIV have to perform at the same standard as laboratory-based tests for HIV antibodies.  EWH

[mshazzy]

Hay there thank you sorry i forgot to add celiac and hashimoto's but im not currently on any meds for hasimotos would those make any difference in production of antibodies? . Yes it has been 17 months since last exposure for some reason iv gotten into my head that i am infected but am not producing any antibodies or at least not enough to show on a rapid test. It looks like you said that if that was the case i would be very sick ? Im also guessing that some people with late stage AIDS could potentially stop making antibodies but i would know if i had full blown aids by now correct? As far as the rapid tests i had would you recommend a different test that doesn't look at antibodies but the virus itself?  Thank you again:)  

[Edward W Hook, MD]

Welcome to our Forum.  I'll be pleased to comment.  You do not say what autoimmune disease(s) you have however, in most autoimmune diseases the problem is not a lack of antibody production but too much antibody production.  In some instances, therapy for autoimmune diseases will delay development of antibodies but does not prevent antibody production.  

Also, I should point out that there is a big difference between elite controllers and the myth of delayed seroconversion.  Elite controllers are a scientifically very interesting (and rare) group of persons who become HIV infected and whose immune system keeps the level of virus in their bodies at very low but not undetectable levels.  Elite controllers however do produce antibodies to infection and are readily detectable with standard HIV antibody tests.  In fact, some of these antibodies may be part of what helps them to dramatically slow the progression of their infections.  

On the other hand, other than persons who are taking medications to delay their antibody response to infections or who have unsuccessfully taken anti-HIV medications in efforts to prevent infection, "delayed seroconversion" is a myth which is perpetuated by the internet.  Years ago, when tests were just beginning to be available for HIV diagnosis (i.e. about 20 years ago), the tests would sometimes fail to detect infections but that has not been the case in years.  

With respect to your specific questions:
1.Is it at ALL possible for someone to be infected with HIV and not produce ANY antibodies, or not ENOUGH to be detectable on a rapid test beyond the 3 or even 6 month window period?
Only in instances when persons are taking immunosuppressive drugs so strong that they are at risk for, and getting, other severe/life threatening infections.  If you are not getting severe infections this is not a concern.

2. What WOULD  happen if someone was indeed infected with hiv and did not produce antibodies, could they remain healthy or would they become sick enough to be serious? im i an "elite controller?
They would become very sick, very quickly.  As noted above, elite controllers produce antibodies and are readily detected by standard tests.  You are not an elite controller.

3.Would my 2 autoimmune diseases affect my production of antibodies? Can i trust my 5 tests? .
It appears that it has been at least a year since the last time you had an exposure which you feeel put you at risk for HIV.  If this is the case, your test results are to be believed.

I hope these comments clarify things.  EWH