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Dr. Andrew Rynne

Family Physician

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Is HIV combo test result conclusive?

Answered by
Dr.
Dr. Roopa Hiremath

Infectious Diseases Specialist

Practicing since :2002

Answered : 877 Questions

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Posted on Thu, 21 Aug 2014 in Sexually Transmitted Diseases
Question: Hello Doctor,

I had protected vaginal sex with a lady (dont know if condom croke), and a unprotected oral sex (receptive). I live in Eastern Europe (Hungary). Since then I have got this fear whether i have caught any STI's. So I have done some tests, the results and tests are as follows:

1. HIV Combo Test (HIV-1,2 Antibody, HIV-1 Antigen/ECLIA) - Week 6,11,18 - Negative ( Test Values - 0.9,0.9,0.11 resp)
2. HCV Antibody Test (IgG) - Week 12 Negative (Test Value - 0,0)
3. HBV (HBsAg, HBs, HBC) - Week 12 Negative (Test Value - 0.47, 3.6IU/L, 1.820 resp.)
4. Syphilis (Treponema Pallidium IgG/IgM) - Week 18 Negative ( Test Value - 0.6)

Can I be sure that all these results are conclusive?

I am planning to repeat the same tests tomorrow for HIV, HCV & HBV (it will be 20 Weeks tomorrow after the exposure). As i have heard that if I am infected with HCV during that exposure it will prolong the window period of HIV.

Please advise. I am very much tensed. Can i sleep over this situaton if my tomorrow's results are also negative.

Thanks & Regards,
XXXXXXX
doctor
Answered by Dr. Roopa Hiremath 50 minutes later
Brief Answer:
No need of concern if test results are negative

Detailed Answer:
Hi Mr. XXXXXXX

Welcome to health care magic.

I have gone through your query and I understand your concern regarding exposure to HIV and other STDs.

Based on the details provided in your query, there is no need of concern if the test results are negative.

There are studies showing interaction between hepatitis C and HIV but antibodies against HIV must be detected by 100th day after exposure.

Also, you are negative for Hepatitis B and C antibodies which should be detectable by 6 weeks.

Please do not worry unnecessarily and relax, you are definitely HIV negative.

I would also suggest taking necessary precautions in the future with a partner whose sexual history is unknown to avoid unnecessary stress and worry.

I hope I have cleared your doubts.

Please get back if any more clarifications.

Thanks.




Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Roopa Hiremath 32 minutes later
Dear Dr. XXXXXXX

Thanks for your response.
However I would still have a doubt regarding the Anti HCV (Anti Body) Test already conducted in 12 Weeks.

What are the chances that this test result which is Negative in 12 weeks be changed to positive in 20 Weeks?

Also is 12 Weeks (to be precise 11 Week & 5 Days), is this period enough for getting cocnlusive result for Hep B & C?

lso I made a short mistake in my initial question. The test values for HIV tests done
7th Week - 0.09
11th Week - 0.09
18th Week - 0.11

Why have the value increased with 0.02. Does this have any impact.

Also another question which has come to my mind, all these tests have been done in same laboratory.
Does this influence my result lets say False Negative or something?

Also are these tests the best antibody tests availble right now around the globe?

Thanking you in advance.

Best Regards,
XXXXXXX
doctor
Answered by Dr. Roopa Hiremath 55 minutes later
Brief Answer:
No need of concern if test results are negative

Detailed Answer:
Hi Mr. XXXXXXX

Welcome back.

I understand your anxiety regarding getting false negative results but let me assure you that test kits used for HIV and Hepatitis undergo a vigorous testing for quality control and then only released in the market for use.

There are many legal and moral issues involved with HIV result reporting and labs have to very careful which test kits, they are using.

So, I would not doubt the accuracy of the test results if they are done in an authentic lab.

Coming to your other queries, anti HCV antibodies should be detectable by 6 weeks and there is very negligible chance of negative results turning positive.

Next, there are cutoff values mentioned for every test kit used to detect HIV antibodies.

If the antibodies titre is more than the cut off value then the result is given as positive, and if the result is less than cut off value, it is taken as negative.

Value changes do not matter as long as they are below cut off value.

Test kits used around the globe have to be FDA approved to be declared as authentic and you can find out the brand of test kit used in the lab you have gone to and then check whether it is FDA approved or not on the weblink given below:

http://www.fda.gov/forconsumers/byaudience/forpatientadvocates/hivandaidsactivities/ucm117922.htm

I hope I have cleared your doubts.

Please let me know if I can assist you further.

Thanks.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Roopa Hiremath 36 minutes later
Hi Doctor,

I really appreciate you quick responses. very thanks for that.

I just checked my test reports. For HIV it shows ECLIA Roche
For HCV also ECLIA Roche
For Syphilis also ECLIA Roche
For HBV it shows HBc (ECLIA Roche), HBs (ELISA Siemens), HBsAg(ECLIA Roche)

Are these FDA Approved. In your link i can see CLIA is it same as ECLIA?

Also one more question. After tomorrow result if negative, do i need to repeat any more test?
And shall i be worried for any other STI's?
And if yes are their any symptoms for those STi's? If you can advise me, I can do those tests as well tomorrow?Also have you ever heard or seen a Negative HCV & HBV result at 12 Weeks seroconverting to Positive at 20th Week?
Also the same for HIV - 18th Week negative sero-converting to positive at 20th week?
As i am planning to do HIV test again with HCV & HBV tomorrow?

Thanks,

Best Regards,
XXXXXXX
doctor
Answered by Dr. Roopa Hiremath 54 minutes later
Brief Answer:
No more testing required

Detailed Answer:
Hi Mr. XXXXXXX

Roche brand is definitely FDA approved, so quit worrying about that.

Siemens brand is also FDA approved.

CLIA is chemiluminescent immunoassay and ECLIA is electrochemiluminescent immunoassay.

Both these techniques are based on chemiluminescence and ECLIA is the newest and more reliable technique.

If the results of tomorrow's tests are negative, no more testing is required.

There is negligible chances of negative HCV, HBV and HIV turning positive after 20 weeks.

The tests you are undergoing tomorrow will confirm your infection negative status and no more testing is required.

I would like to stress here to be more careful in the future.

I hope I have helped to relieve your anxiety, please get back if any more doubts.

Wishing you good luck.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Roopa Hiremath 13 minutes later
have you seen any one seroconverting later when taken into account my testing history?
doctor
Answered by Dr. Roopa Hiremath 1 hour later
Brief Answer:
False negative results very rare

Detailed Answer:
Hi Mr. XXXXXXX

There have been instances where false negative results have been reported, but they are very rare.

The common causes of false negative results for HIV antibodies include:
1. Window period
2. Immunosuppression therapy
3. Bone marrow transplantation
4. B cell dysfunction
5. Late stage of the disease or full blown AIDS
6. Replacement transfusion
7. Technical error/ glove starch powder

These causes can be definitely ruled out before testing.

Technical errors can occur very very rarely in an authentic lab.

So please quit worrying unnecessarily, and accept the results as definitive.

I hope I have cleared your doubts.

Thanks.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Roopa Hiremath 15 minutes later
but are their ways to know whether i am immunocompromised or not?
doctor
Answered by Dr. Roopa Hiremath 54 minutes later
Brief Answer:
Low immunity ruled out clinically & by lab tests

Detailed Answer:
Hi Mr. XXXXXXX

Welcome back.

Testing for an immunocompromised state is based on the two part approach of physically examining a patient and getting a series of "immunological" blood tests done. The simplest of which is the CBC which will tell me (among other things) the number of White Blood Cells in your blood.

Immunocompromised state is when your normal immune mechanisms fail to function and predispose you to opportunistic infections.

Opportunistic infections are infections caused by microorganisms that normally do not cause infection in normal individuals.

Such patients usually present with repeated infections which do not respond easily to treatment.

I will need more details about your symptoms to suspect immunocompromised state in your case.

Unnecessary stress and worry also lowers your immunity.

Please get back with more details about your symptoms and I can assist you based on them.

Thanks.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Roopa Hiremath 34 minutes later
i dont have any such symptoms...touchwood...i dont remember last time when i got fever...this has always given me worries that whats wrong with me..because i have heard fever once a month is good for health but dont know how genuine is this statement...is it because i have low immunity?
other than that i have no idea what symptoms i shall tell you..may be if u can state few common symptoms which are happening to immunocompromised patients?

ah and i had gas trouble in these recent times for past few months...but i beleive that might be because of anxiety and stress for past months. but when i did my tests in 12th week i was feeling relieved from ancxiety for a week or so that time this got better. but recently it started again but not on a big scale...is this a symptom of low immunity?

shall i do a LFT and blood count test for checking immunity?
also other than hbv hcv hiv and syphilis shall i do any other test for std?i dont have any such symptoms...touchwood...i dont remember last time when i got fever...this has always given me worries that whats wrong with me..because i have heard fever once a month is good for health but dont know how genuine is this statement...is it because i have low immunity?
other than that i have no idea what symptoms i shall tell you..may be if u can state few common symptoms which are happening to immunocompromised patients?

ah and i had gas trouble in these recent times for past few months...but i beleive that might be because of anxiety and stress for past months. but when i did my tests in 12th week i was feeling relieved from ancxiety for a week or so that time this got better. but recently it started again but not on a big scale...is this a symptom of low immunity?

shall i do a LFT and blood count test for checking immunity?
also other than hbv hcv hiv and syphilis shall i do any other test for std?

thanking u in advance.

thanking u in advance.
doctor
Answered by Dr. Roopa Hiremath 10 hours later
Brief Answer:
No other tests required

Detailed Answer:
Hi Mr. XXXXXXX

I can understand the anxiety and stress you have been through for the past few months to rule out exposure to HIV and other STDs.

Based on the details in your query, I do not suspect any kind of immunocompromise in your case.

If you have been well and have not suffered from fever, it indicates a good immune system and there is no need of any concern in that aspect.

Patients with weak immune systems may not show the classic signs of infection, the only symptom of an infection may be fever.

Infection may rapidly progress from fever alone to sepsis and complications in such patients.

They may take longer to clear infections compared to a person with a healthy immune system, for example, a common cold may take longer to clear in such patients when compared to normal individuals.

For now, you do not require any more tests.

Wishing you good luck.

Please let me know if I can assist you further.

Thanks.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Roopa Hiremath 3 hours later
ok understood. one more question...viruses attack which immune system faster, weak or strong?
doctor
Answered by Dr. Roopa Hiremath 33 minutes later
Brief Answer:
Cell mediated immunity protects against viruses

Detailed Answer:
Hi Mr. XXXXXXX

Welcome back.

Weak immune system predisposes to all kind of infections, bacterial, viral, fungal and parasitic.

Our acquired immune system has two modes of protection called humoral immunity and cell mediated immunity.

Humoral immunity is defense provided by antibodies which are produced against the microorganisms to kill them.

Cell mediated immunity is protection provided by defense cells which usually act against viruses because viruses multiply intracellularly.

I have tried to simplify the answer as much as possible and I hope I have cleared your doubts.

Thanks.
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Roopa Hiremath 1 hour later
ok so is 20 weeks enough for these viruses to show up in the blood even if the person have a weak immune system with the kind of testing system i am going through?

i have gone today morning to the lab and given my blood for testing and will get my results today evening. however there is still one question which u have not answered yet. i asked you have u seen any 12 week hepb & c negative result changing to positive by 20 week and similarly 18 week HIV test changing to positive at 20 week? what is the probability for this?

somehow i could not convince myself so i did LFT tests and blood platelet count test like WBC & RBC.
results awaited.

i did a test for HPV PCR also at 18th week which i forgot to mention earlier. and it also came out negative. do you think this also conclusive and accurate?

i know i am asking too much of questions. but to be honest i am trying to gain some courage for the evening results. but really sorry for asking so many follow up questions.

Thanks,

Regards,
XXXXXXX
doctor
Answered by Dr. Roopa Hiremath 1 hour later
Brief Answer:
Do not worry, expect normal results

Detailed Answer:
Hi Mr. XXXXXXX

I can understand your concern and you do not have to apologize for your follow up queries.

Doctors at this forum are always willing to assist you efficiently.

Different groups of viruses take different amount of time to set up an infection and stimulate the immune system and this period is called incubation period.

Incubation periods of viruses you have tested for are as follows:
Hepatitis B - 1 to 6 months
Hepatitis C - 6 to 8 weeks
HIV - 2 to 4 weeks
HPV - viral nucleic acid is detected by PCR

A person with a weak immune system is more susceptible to infection.

I have answered your query about HepB and HepC negative results later turning positive and such instances are very rare.

Such results are called false negative results and I have listed the causes for the same in my previous answers.

HPV is detected by PCR and the genotype of the virus is relevant, if result is positive.

As you are HPV negative, no need to worry. This result is accurate and conclusive as PCR is considered as one of the most sensitive and specific tests for HPV.

I wish you all the luck for your test results.

Please do not worry, I am expecting normal results.

Feel free to get back if any more queries.

Thanks.
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Roopa Hiremath 1 hour later
Thank you doc.
What i still dont understand about the Immunity power is, do a person with strong immunity power shows up a positive result faster or a person with weak immunity power shows up a positive result faster?

For Hep B, the incubation period is 6 months XXXXXXX as you said. Does that mean 1 20 Week result (approx 5 Months) is still not conclusive?
And are the incubation period mentioned by you are for PCR tests or do they apply for Anti Body test as well?

Thanks & Regards,
XXXXXXX
doctor
Answered by Dr. Roopa Hiremath 4 hours later
Brief Answer:
Incubation period is a range and average is taken

Detailed Answer:
Hi Mr. XXXXXXX

I cannot explain the intricacies of our immune system in few lines, it would be enough to say that our body tries very hard to combat any infection.

A person with a healthy immune system will be able to control the infection faster when compared to a person with a weak immune system.

The initial response of seroconversion is not very different in both.

Both produce antibodies to be detectable but the healthier immune system will produce effective antibodies which aid in killing the microorganisms causing infection.

I hope I have cleared your confusion about this aspect.

Coming to incubation period of Hepatitis B, it is usually a range of 1-6 months, but an average is taken which is 60-90 days.

20th week result for Hep B is conclusive in your case, please quit worrying unnecessarily.

PCR is a test which detects nucleic acid of the relevant microorganism and is usually more sensitive in the initial period of infection.

As antibodies develop, they kill the organisms causing infection and PCR becomes less sensitive.

I hope I have answered your query satisfactorily.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Roopa Hiremath 16 hours later
Hello Doc,

I have got my results as follows:

1. HIV Combo Test (HIV-1,2 Antibody, HIV-1 Antigen/ECLIA) - Week 20 - 0.14 - Negative
2. HCV Antibody Test (IgG) - Week 20 - 0.0 - Negative
3. HBV (HBsAg, HBC) - Week 20 Negative (Test Value - 0.47, 1.820 resp.)

I have not got the results for LFT & Blood Test results yet. Expected by tomorrow I guess.

But finally i think i can be relieved from all these tensions. What do you think?

Thank you very much for your kind support throughout this useless questions which I was asking, though some gave me good knowledge about many aspects which I never knew :). Thank you very much really from my deep heart. Because a mental support is really important in these type of situations. And there are few people who have suported me all through these months. And you are one of them. Thank you very much once again.

One final question, do i really need to worry about my Immune System now?

Thanks,

Best Regards,
XXXXXXX
doctor
Answered by Dr. Roopa Hiremath 30 minutes later
Brief Answer:
Healthy diet, regular exercise regime recommended

Detailed Answer:
Hi Mr. XXXXXXX

Welcome back.

I am glad that I could be of help.

A healthy immune system can be maintained if you eat healthy and have a regular exercise regime.

Regular exercise releases endorphins which boosts your immune system and also keeps your mood positive.

Wishing you good health.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Roopa Hiremath 8 minutes later
for last 5 months i have stopped eating non veg and reduced my diet. sometime even have skipped meals also due to anxiety. does this effect the immune system and liver function?
doctor
Answered by Dr. Roopa Hiremath 44 minutes later
Brief Answer:
Irregular diet and stress affects immune system

Detailed Answer:
Hi Mr. XXXXXXX

Irregular diet and stress does affect the immune system and might cause temporary fall in the immune mechanisms, but this can be easily corrected by eating healthy regular meals and doing regular exercise.

I suggest you login to the weblink below and calculate the number of calories required for you per day based on your height and weight.

http://www.calculator.net/calorie-calculator.html

Try meditation and yoga to reduce the stress levels and elevate your mood.

Regular exercise will boost your appetite and also make you fit.

Liver function tests are affected only when there is prolonged starvation and when there is any liver disease.

I hope I have cleared your doubts.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Roopa Hiremath 7 minutes later
Dear Doc,

I have just received my LFT & Blood tests results. I have uploaded it. Can you please review it and provide your comments.

I can see that MT RBC count is outside the range. Also Lymphocyta & MCH is out of the range. Is this too harmful. Do I need to worry. How can bring this back in tolerence levels.

This report is Hungarian, so I have tramslated the words in English by writing near to the words for your easy understanding.

Thanks & Regards,
XXXXXXX
doctor
Answered by Dr. Roopa Hiremath 30 minutes later
Brief Answer:
Normal results, no need of any concern

Detailed Answer:
Hi Mr. XXXXXXX


I have gone through the reports you have uploaded and thanks for translating few words in english.

Your reports are normal and there is not a very big deviation from the normal range.

The reference ranges mentioned in the lab reports vary for every lab and this variation is due to the different populations visiting the lab and the equipment used in the lab.

Your RBC count, lymphocytes and MCH are all within the normal range and there is no need of any concern.

Please follow the suggestions I have given in my previous answers and that would suffice for now.

Wishing you good health and good luck for the future.

Thanks.




Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Roopa Hiremath 34 minutes later
Dear Doc,

Does givng blood for testing these parameters. Because I do not remember how many times I have given my blodd for tests in past 20 weeks.

Approximately 10 Times.And I also realized now that Lymphocytes low count means more prone or exposure to infection. Now this is giving me another stress to be honest.

Is the value for Lymphocyte really in the normal range as per you. And you are 100% sure that I dont have to worry?

Thanks & Regards,
XXXXXXX
doctor
Answered by Dr. Roopa Hiremath 5 hours later
Brief Answer:
Normal range of lymphocytes, no need to worry

Detailed Answer:
Hi Mr. XXXXXXX

Blood taken for testing is minimal and that blood is easily replenished by the body.

Coming to your lymphocytes count, it is within the normal range but more towards the lower range.

Please do not worry, our body produces lymphocytes as when required.

Whenever, our body tries to combat any infection, there is increase in the WBCs, lymphocytes to counteract and kill the microorganisms causing infection.

I am 100% sure you do not have to worry.

Please quit stressing about trivial issues and follow a healthy lifestyle now onwards.

Thanks



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Roopa Hiremath 21 hours later
Hello Doc,

Thank you very much for your assuring words.
I am pretty much releived now. And trying to get back on tracks. Hope I can manage myself to a stress free life again without worrying about all these things.

And get over this incident and this is filling me out with hell of guilt.

So once again thanks for your support all through these 3 days.

Best Wishes for you as well.
XXXXXXX
doctor
Answered by Dr. Roopa Hiremath 15 hours later
Brief Answer:
Thanks and all the best

Detailed Answer:
Thanks Mr. XXXXXXX

Wishing you good health,

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