HIV testing.

[david112]

Dear Doctor HHH ,

I had my last exposure 8 months back , I tested negative 4 times using antibody tests and 2 of those were duo tests for p24 antigen and antibodies to HIV 1/2.I also had a proviral PCR DNA test at 8 months post exposure , about a week back , it came out negative too.
I have the following questions to ask -
1)Suppose I am still in my window period (rarest of cases) where antibodies have not developed would my p24 antigen be detected hence the duo test come out positive ? (I HAD THE DUO TESTS AT 6 MONTHS POST EXPOSURE BOTH OF THEM.)

2)How reliable is a PCR proviral DNA test at 8 months post exposure , And if I was infected 8 months back and had no treatment etc , would my viral load be below 100 copies therefore undetectable ?

3)I have a swelling on the right side of my neck , just a minor one cannot see it just feel it , does HIV cause swollen nodes allover the body or just one place ?.I dont have any swelling elsewhere.

4)Is the HIV related rash Itchy ? I had a rash at 7 months post exposure and the dermatologist said it was heat rash , it went away within a week of applying oinment.

5)The CDC refers to a 6 months window period , for what kind of people is this true ? As some sites say 3 months is conclusive.

6)What does a combination of PCR testing and antibody testing suggest ? Had my viral load been lower than 100 copies would antibodies still be produced ? And is it possible for viral load to be below 100 copies at 8 months post exposure without any treatment ?

7)And what does a negative combination of a pcr proviral dna test and hiv antibody indicate ? Have you ever come across anybody who tested negative on both theses tests at 8 months post exposure then positive later ?

Thanks
David

5)

[Edward W Hook, MD]

You are correct.  And this ends this this thread. EWH

[david112]

Thank you Doctor , But there have been cases of late seroconversion . But is for me the combination of a dna pcr and antibody clears it all out right ?
Am i correct
thanks

[Edward W Hook, MD]

Dr. Handsfield and I share the forum.  You got me.  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'll go to your questions in a moment but, before I do, let me tell you that even without reading your questions, you do not have HIV from an exposure which occurred 8 months earlier.  Now, on to your questions:

1.  The idea of a "window period" that occurs any time beyond a few weeks following exposure is an urban myth.  Your DUO tests prove you do not have HIV.

2.  Reliable.  When people have untreated HIV they have viral loads measured in the thousands, not in the hundreds or below for the duration of the infection.

3.  The lymph node swelling of HIV occurs over the entire body, not in isolated areas.

4.  Believe your dermatologist.  The rash of early HIV occurs at 2-4 weeks following exposure, not at 7 months

5.  The only persons who may take that long to have a positive test are those who have taken anti-HIV therapy in an effort to prevent infection.  The recommendations for testing at 3 and even 6 months are the result of two factors- data from older tests no longer used (you really do not need to worry about which generation of tests you were tested with, at this time virtually all tests are far more sensitive that they were even 2-3 years ago when the 3 month recommendation was made) and secondly, the fact that some, mostly governmental agencies which have to provide recommendations for virtually everyone without the sort of interactions such as those you get with your doctor or on personalized sites such as this one, feel the cannot "afford" to be wrong and therefore make recommendations and guidelines which leave most people unnecessarily nervous for 4-6 weeks longer than the 6-8 weeks it takes virtually everyone to develop HIV antibodies.  

6 and 7. Your combination of tests indicates that, without a doubt, you do not have HIV.

Bottom line, you do not have HIV.  To continue to worry is a waste of time and energy.  To continue to test is a waste of money.  You do not have HIV. There is little more to say.  EWH