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Dr. Andrew Rynne

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Are frequent cold symptoms associated with HIV infection?

Answered by
Dr.
Dr. S. Murugan

HIV AIDS Specialist

Practicing since :1974

Answered : 2815 Questions

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Posted on Mon, 29 May 2017 in General Health
Question: Sir I am having cold for about 2 months now. It started off as pollen allergy and hasn't subsided yet. Could this be related to hiv? Do I have to get a viral load test done for this reason ?
Sir as you already know my case my high risk exposure was in Nov 2013 and my 1 st test( tridot 3 Rd generation)was in may 2015,2 nd test July 2016( 4 rth generation ag/ ab test) and 3 Rd test was in March 2017 by the same 4 rth generation test and all were non- reactive.And all along I was on several medications like ORGAMED/MEPRATE/PROVERA/DRONIS 30/METFORMIN/SYNTHROID/CLOMIPHENE CITRATE/ANTI- HISTAMINES /PRENATALS(folic acid and vit d supplements ( for conditions like PCOS,HYPOTHROIDISM,INFERTILITY AND POLLEN ALLERGY .I was on all these drugs ON AND OFF from XXXXXXX 2007 till MARCH 2017 (and my exposure was in Nov 2013)some at the time of testing and some inbetween tests.

I have taken flu shots in October 2016.     
doctor
Answered by Dr. S. Murugan 2 hours later
Brief Answer:
Your symptoms are not related to HIV.

Detailed Answer:
Hi XXXX,
Welcome once again to HCM.
Thanks for posting your query.

XXXX, I assure you that you are absolutely free from HIV. Please forget the incident happened during 2013. Just erase the same from your memory. This can be done by showing interest in your current activities..
Anybody can have allergy, cold and other illness at anytime in our life. All types of these diseases were existing even prior to HIV Era (that is only after 1980) for centuries. So these symptoms are entirely not related to HIV or your past activities. About the drugs those you had taken also, I already had assured that they would not have any interference with the outcome of your test results. So relax and forget the same.
Dr S.Murugan
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. S. Murugan 15 hours later
Thankyou for the reassurance sir as i mentioned already that i started to volunteer for a hiv helpline i want you to clarify one more doubt.This will be helpful to many who have concerns about hiv.This is what i read in the internet sir

"The accuracy of hiv tests has to be considered with the window period.

For example, 4th generation tests will pick up 95% of infections at 28 days after exposure.

A confirmatory test three months after the exposure is always recommended. This is because 5% of people take this long to show a positive result."

My doubt is the confirmatory test at 3 months after exposure is it with a viral load test or is it a retest with 4 rth generation ag/ab test?

Another scenario is screening test/rapid test - positive and RNA PCR quantitative test -negative.what would be the next step? how to interpret the results?
doctor
Answered by Dr. S. Murugan 1 hour later
Brief Answer:
Any rapid test after 3 months as a second test will become a confirmatory.

Detailed Answer:
Hi XXXX,
Welcome back.
Interesting questions!
1. Accuracy of HIV tests has to be considered with the window period.... Even though the window period of HIV is around 6-8 weeks after the exposure, this may be extended up to 12 weeks in certain individuals. So naturally after 12 weeks completion only these tests can be considered as conclusive.
2. 4th generation test (DUO or COMBO) consists of two parts. Antigen part will become conclusive by 4 weeks, but it can detect only HIV 1 infection only. HIV 1 is infection is common up to the extent of 99% throughout the world except few parts of XXXXXXX Second part can detect both HIV 1 and 2 But after the completion of 12 weeks (window period). So it is reliable up to the extent of 98% by 28 days, and more than 99% after 12 weeks.
3. That does not mean 5% takes longer time to reveal, but this test can not detect HIV 2 by 28 days after exposure.
4. Confirmatory test after 3 months period preferably be with another type of antibody detecting test (ELISA< TRIDOT or any other rapid test, Chemilumnescence or even western blot) or once again with another 4th generation test.
5. Rapid test positive, but RNA PCR negative means ------ whether it is qualitative or quantitative PCR? Qualitative will be useful as diagnostic one and quantitative will be prognostic one. Undetected virus with RNA PCR does not rule out HIV infection.Viral load is not able to be detected with this test capacity. That is all. Another possibility is HIV 2 infection... 4th generation test or any other antibody test can show positive but RNA PCR (HIV 1 Specific) will not be able to detect the infection. Moreover sometimes incompatibility of test could occur with some other reasons (depends on immune system functions).
Dr S.Murugan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S. Murugan 2 hours later
sir kindly answer the following questions in detail.
1. screening test/rapid test - positive and RNA PCR test(HIV-1 specific)-negative.still there is a possibility of HIV-2 infection so what will be the next step in diagnosing hiv?
2.Is there a HIV PCR test for both HIV-1 and HIV-2 seperately?
3.The new hiv testing algorithm says-if HIV1/2 Ag/Ab COMBINATION IMMUNOASSAY turns positive,then go for HIV-1/2 ANTIBODY DIFFERENTIATION IMMUNOASSAY-if this turns out negative for both hiv1 and 2,then go for HIV-1 NAT/HIV-1 RNA PCR for conclusive results.THIS ALGORITHM DOES NOT ACCOUNT FOR HIV-2 INFECTION.In this scenario WHAT WILL BE THE RECOMMENDATION GUIDELINES for diagnosing hiv? what will be the next step?
4.Two tests,Tridot and 4 rth gen ag/ab test turns out negative after 6 months of exposure-are those results conclusive or require any further tests?
your efforts will be much appreciated sir.Thank you.
doctor
Answered by Dr. S. Murugan 4 hours later
Brief Answer:
If two tests nonreactive 3 months after exposure no more test needed.

Detailed Answer:
Hi,
Welcome back.
1. Wait till completion of 12 weeks and repeat the 4th generation test once again to know whether the individual is infected with HIV 1 or 2. Otherwise take up qualitative HIV RNA PCR separately for HIV 1 and HIV 2 infections.
2. There is no common HIV PCR to test for both HIV 1 and 2.
3. Certain antibody tests (ELISA) will not be able to differentiate between HIV 1 ans 2. The result will be HIV 1 and 2 reactive. With such tests, we have to go for tests which can indicate separately for both infection as the treatment for both HIV 1 and 2 will vary.
4. If the infection is confirmed, it should once again to be confirmed with some other tests and you have to go for HIV viral load test (RNA PCR) and CD4 count before starting ART to know the baseline value. This will help to assess the prognosis of the disease, response to treatment and also acts as a more confirmatory test.
5.If two test nonreactive 6 months after the exposure, the individual does not need any more test for HIV, unless there is a fresh exposure.
Dr S.Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S. Murugan 2 hours later
sir can you be more clear on this part of the answer for the 3 rd question " Certain antibody tests (ELISA) will not be able to differentiate between HIV 1 ans 2. The result will be HIV 1 and 2 reactive. With such tests, we have to go for tests which can indicate separately for both infection as the treatment for both HIV 1 and 2 will vary.
If the infection is confirmed, it should once again to be confirmed with some other tests and you have to go for HIV viral load test (RNA PCR) and CD4 count before starting ART to know the baseline value. This will help to assess the prognosis of the disease, response to treatment and also acts as a more confirmatory test."
1.what are the tests which can indicate both the infections seperately?
2.what does " it should once again to be confirmed with some other test" mean? what are those some other tests?
3.does a HIV PCR test for HIV-1 and a HIV PCR test for HIV-2 EXIST?
doctor
Answered by Dr. S. Murugan 4 hours later
Brief Answer:
Rapid tests can differentiate HIV 1&2.

Detailed Answer:
Hi,
Welcome back.
1. Tridot , Triline, serum bioline, Western blot are certain tests which can differentiate HIV 1&2, and interpret the result.
2. When one test shows positive result, we should not reveal the status as a positive one, as a rare possibility of false positive result is there. Positive with two different tests like ELISA and Rapid test or a Western blot test leads a 100 % reliable result.
3. Separate qualitative RNA Park for HIV 1 and 2 are available separately with selective standard laboratories.
Dr S Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S. Murugan 7 hours later
1.so sir can western blot differentiate hiv1 and hiv 2 ?
Because this is what i found in the new testing algorithm article
"The big advance in moving from the 3rd to the 4th generation screening test was the addition of p24 antigen to the sensitive ELISA antibody. This shortens the window period from HIV acquisition to a positive screening test by about a week.

The second big change is that the confirmatory test is now a differentiation assay, an antibody test that tells us if the person has HIV-1 or HIV-2 — the Western blot couldn’t do that. If it’s negative, an HIV RNA (viral load or other nucleic acid test, NAT) is recommended, since the screening test (with its antigen component) is more sensitive early in disease than the differentiation assay. Importantly, the Western blot — may it R.I.P. — offers no advantage in sensitivity over the FDA-licensed differentiation assay (in fact, it’s a bit worse)."
i am attaching the link i saw it in as well sir

http://blogs.jwatch.org/hiv-id-observations/index.php/new-hiv-testing-algorithm-great-not-perfect-nothing/2016/09/04/

2.if western blot is confirmatory and can differentiate hiv1 and hiv 2 why would you consider PCR RNA quantitative(as it is specific for HIV-1) as confirmatory after a positive result with rapid test? AS POSSIBILITY OF HIV-2 INFECTION STILL EXISTS RIGHT?
As you said in a previous answer "I never go for Western blot tests in all cases. I rely on rapid tests and clinical examination and history. When it becomes positive I will confirm with RNA PCR quantitative test. This will be baseline test to start treatment as well as confirmatory test

3. IS 4 rth generation ag/ab test( COMBO/DUO test ) considered as an ELISA test? what is the difference when they say EIA and ELISA
4.what tests fall under ELISA tests and what tests come under RAPID TESTS can you name them please.it will clear a lot of confusion.thank you
doctor
Answered by Dr. S. Murugan 2 hours later
Brief Answer:
Microbiologist and laboratory specialists are more competent to answer

Detailed Answer:
Hi,
Welcome back to HCM.

1. Western blot can differentiate HIV 1 and 2.
2. If one wants to know their HIV status earlier, HIV qualitative RNA PCR is indicated. Quantitative RNA PCR is necessary to monitor the disease progress or response to treatment.
3. EIA and ELISA are almost worked on same principle.
4. Tests done with ELISA reader comes under ELISA test and Rapid test is just addition of serum , you can read the result within few minutes comparing with the control.
For more information consult a laboratory specialist like microbiologists and virologist. I am a clinician. You can direct your question, if you have more doubts in this regards to a microbiologist.
Dr S.Murugan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S. Murugan 24 hours later
sir i am having pollen allergy for about 2 months now.can this be related to hiv or acute hiv infection? i got tested with a 4 rth gen ag/ab test on april 26 2017 and that came back non-reactive.still have a doubt if pollen allergy is related to hiv???
doctor
Answered by Dr. S. Murugan 6 hours later
Brief Answer:
There is no possibility of HIV Acute infection with you.

Detailed Answer:
Hi,
Welcome back.
HIV is known to us for the past 37 years only whereas Pollen allergy was en entity known to human kind or healthcare providers for centuries.
HIV acute manifestations can occur within 4-6 weeks following the risky sexual activity, in the presence of infection.
Your exposure was well dated behind 2013. How could it be possible to relate acute HIV infection?
It is beyond any doubt as per your results that you are free from HIV.
Dr S.Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S. Murugan 18 hours later
sir one last question, can any sorts of HERBAL MEDICATIONS/PRESCRIPTIONS/SUPPLEMENTS(chineese,indian) interfere with hiv tests and ones body response to the hiv virus?? kindly answer this question and i will close the discussion.thank you so much.you have been a tremendous support throughout and i am very greatful for your responses and patience so far.
doctor
Answered by Dr. S. Murugan 6 hours later
Brief Answer:
Sero-conversion in HIV never delayed beyond 6 months after the exposure.

Detailed Answer:
Hi,
Welcome once again.
Even potent steroids and other immunosuppressive drugs could not delay the sero-conversion beyond 6 months as far as a HIV infection is concerned. Even though I have no idea about the pharmacodynamics of Herbal medications and supplements, I think it is not possible especially years after the exposure.
Dr S.Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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