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How To Rule Out HIV Infection?

Posted on Wed, 12 Mar 2014

Question: Hi, I asked this question on another board but would like a doctors opinion as your the experts in this stuff. I had unprotected sex with a CSW in September 2013. This was incredibly XXXXXXX as I know. My test results to date have been very encouraging but my concern was that I had symptoms that still seem to be lingering to this day. Most of the worry comes from the fever (101-102), headaches, sore throat, etc. that I got about 4 weeks after exposure and lasted about 4 days. In addition I have had tenseness in my neck and shoulders and an upset stomach that persists to this day. My test results have all come back negative which is what gives me hope. Testing to date is as follows. Antibody Test - blood draw at dr - 2 weeks negative Antibody Test - blood draw at dr - 4 weeks negative Antibody Test - blood draw at dr - 7 weeks negative PCR by RNA Qualitative - 14 weeks negative Antibody Test - Hiv-1 Home Access - 15 weeks negative Antibody Test - Oraquick swab - 16 weeks negative Antibody Test - labcorp blood draw - 19 weeks negative My questions are; 1. have I tested enough to rule out HIV? I know many say 13 weeks which I'm past but I've also seen a lot of people mention 6 months. It was the symptoms that made me most worried due to there timing. 2. Do antibodies form when a person has symptoms? Thanks for your help!! XXXX

Answered by Dr. Roopa Hiremath (1 hour later)

Brief Answer: HIV and HIV testing Detailed Answer: Hi, Thanks for choosing health care magic for your query. I have gone through your query and I understand your concern about HIV testing discrepancies. I would like to elaborate on the HIV pathogenesis and HIV testing to clear your doubts. Semen and vaginal fluids are very rich in HIV particles and HIV enters the body through small abrasions caused in the mucous membranes covering the genitalia during sexual intercourse. After entry, virus reaches the local lymph nodes and multiplies there. It takes 4-11 days to spill back into the blood and is then detectable in the blood. So technically there is no test to detect HIV immediately after exposure for at least 4 days. Tests of choice in early exposure is p24 antigen detection and PCR for HIV DNA/RNA. Antibodies against HIV develop from 3 weeks to 12 weeks after exposure (21 days to 3 months). This period varies in different individuals, so 100th day test for HIV antibodies is preferred. Answers to your queries: 1. Yes, you have tested enough for HIV and you are definitely HIV negative. 2. Many individuals who are HIV positive are asymptomatic. There there is no real correlation between symptoms and antibody formation. I would not be worried about HIV if tests are negative even you had symptoms similar to HIV. I hope I have cleared your doubts. Please get back if I cam assist you further. Thanks.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Roopa Hiremath (17 hours later)

Thanks Dr. XXXXXXX My understanding is that a PCR RNA test looks directly for the virus. Mine was negative after 90 days. Is this too late to take that type of test? Could my body effectively control HIV at an undetectable level making the PCR test negative at 90 days? Also what are your thoughts regarding HIV-2, does it have the same window period? The PCR test I took only was for HIV-1. The antibody tests I've taken were for both HIV 1&2. Is HIV-2 a concern in the United States?

Answered by Dr. Roopa Hiremath (6 hours later)

Brief Answer: HIV 1 and 2 Detailed Answer: Hi XXXX Welcome back. PCR can detect as less as 10 nanogram of HIV DNA/RNA so PCR should be able to detect it even after 90 days. It is preferred in early exposure and in window period because no other test is specific enough. Moreover, HIV virus multiplies at a faster rate after initial immune response of the body. HIV1 & HIV2 are two types of HIV viruses and are distinguished on the basis of their genome organization. Both appear to cause clinically indistinguishable AIDS. However the HIV II is less easily transmitted and the incubation period is much longer than HIV I. Worldwide the predominant virus is HIV I. The uncommon HIV II is concentrated in west Africa and rarely found elsewhere. As you have been tested for both HIV 1 and 2 antibodies, you do not have to worry about HIV 2 being missed. I hope I have cleared your doubts. Thanks.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar