Seroconversion - HIV Antibody Test Validity

[mozbayer]

If someone is symptomatic at the time of antibody testing for HIV will the test likely remain negative? I am now 8 weeks post-exposure and had an HIV1/2 DUO Ab/Ag test at 6 weeks post-exposure which was negative. At the time of testing I was symptomatic with sore throat and swollen and tender nodes. These symptoms have been there since 2 weeks post-exposure. At week 7 (i.e. 1 week after testing negative) I had the sudden onset of nausea (but have not vomited), which was also accompanied by a very obvious enhancement in the pain in the nodes under my arms and discrete muscle pains ("patches") around the backs of my upper arm, leg muscles and groin. Can my 6 week test be considered reliable or do I need to retest again after the symptoms have abated? I am thinking that the symptoms that started at week 7 are 'seroconversion' related. I understand from various posts in the forum that 6 weeks is generally considered conclusive by HHH; however I am unclear if this still applies when someone is still suffering symptoms at the time of testing. Thanks.

[united71]

Doctor I took an elisa test at the local clinic in august of this year due to a suspected exposure in march. It was negative, then I took one in september, October then two in November all negative. However I'm still concerned due to strange symptoms I have been having. I just know I have it. I'm not at all promiscuous but I think I have it. I only wonder is my body just not producing antibodies or am I needing to wait a year and retest. I was seriously thinking maybe testing with a different form of testing like p24 or RNA. What should I do doctor?

[Edward W Hook, MD]

I think your concnerns about HIV02 are overstated.  It is rare and as you have alrady stated, the antibody tests go a long way towards detecting HIV-2.  Worrying about HIV-2 has little "value added" in your situation.   As for your specfic questions

1.  You are correct that the DUO test antigen of interest is the p24.  As I suggested above however, one you have looked for antibodies and for HIV-1 p24 antigen, there are really very few, if any cases that are missed.
2.  The onset of symptoms you describe is long after the ARS, (which most people with HIV do not experience)
3.  I canot answer this question, sorry.  HIV-2 is extraordinarily rare in my practice
4.  As you imply, agian, there are few data on this.

Bottom line, you appear to be focused on nuances that have little impact on persons with and at risk for HIV but it is quite rare.  My advice is to try to move forward.  Take care.  EWH

[mozbayer]

Thanks Dr Hook

Your response has given me some re-assurance. I just wondered whether you can clarify a few final points for me as my main concern surrounds HIV-2.

1. I understand that p24 antigen is a core protein associated with HIV-1 and that it is not reactive with sera of HIV-2 infected patients, thereby nullifying the component of the DUO test for early detection of HIV-2 (ahead of antibody production). Antigen gp36 seems to be the relevant one for HIV-2 assays. I understand p24 is the antigen tested for in the DUO test because worldwide the vast majority of HIV cases relate to HIV-1.

2. You have indicated that " the negative DUO test would detect either the presence of antibodies ..... more than a week after the onset of symptoms" but I suppose my main concern surrounded the abrupt onset of persistent unexplained nausea (6 days now and counting) and myalgia which came on suddenly at week 7 i.e. they started after my 6 week test rather than before it and continue to persist.

3. In your experience,what is the best way to confirm HIV-2 ahead of antibody production. Is there a reliable PCR test that looks for HIV-2 RNA?

4. Does HIV-2 have a longer window period than HIV-1 because of its lower infectiousness/virility? i.e. does it take longer to initiate an antibody response because of a lower rate of viral multiplication in the acute phase after infection with HIV-2? I have read in the long term, the majority (85-90%) of HIV-2 + persons remain as non-progressors wheras with HIV-1 the minority (2-5%) fall into this category.

Thanks in antcipation

[Edward W Hook, MD]

Welcome to our Forum.  I would consider your results conclusive.  One of the origins of the ARS and its symptoms is because of the effects of antibodies as they mix with circulating virus at the time of seroconversion. Persons with the ARS typically will have antibodies and reactive tests a week after the beginning of their ARS symptoms. In your own case, with a negative DUO test which would detect either the presence of antibodies or circulating virus (this is the antigen that is detected by the test) more than a week after the onset of symptoms, you should be confident that the symptoms that you experienced were not due to HIV but some other cause.  while I know nothing about the reason that you are seeking testing, in general, I see no reason for repeat testing in the situation you describe.

Hope this comment is useful to you.  EWH