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What do following HIV test results post unprotected sexual exposure indicate?

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Posted on Thu, 14 May 2015
Question: Please, I need your take on my situation;

Around 6 months ago I have a one time unprotected sex with a girl of unknown HIV status (one night stand). I did a routine health check and this results came out;

Last Unprotected sexual exposure Sept 9, 2014

1) Routine Screening HIV test ; Oct 7, 2014 (28 days after exposure) – ICMA HIV Test Repeatedly Reactive >1.45: then, they reflex to an HIV 1 and 2 Differentiation Test for confirmation (Results were HIV 1 Non-Reactive and HIV 2 Non-Reactive): The results were giving to me via phone since I was out of the USA at that time. The lab recommendation was for me to get an RNA test on a new specimen. Since I was out of the country I couldn’t find a place to do this RNA test, so I went to a private Lab in the country I was and they performed the following test;

2) Oct 15, 2014 (36 days after exposure): COBAS E-411 ECLIA: NEGATIVE (they performed the test twice with the same blood sample just to make sure). The Lady at the lab told me that this was a 4th Generation Test (test for Abs and Antigens), but I don’t have a way to confirmed since the results document only says “HIV COBAS E-411 ECLIA: NEGATIVE”

Then, back in the USA, I performed the following HIV tests;
3) Dec 09, 2014 (98 days after exposure): I went again and did the same original test (same lab but different state): HIV 1/O/2 Abs-ICMA; Non-Reactive

4) Dec 09, 2014 (98 days after exposure): With the Same blood Sample above I requested a 4th Generation HIV test: Non-Reactive

5) Feb 03, 2015 (160 days after exposure): I request a RT PCR RNA Test and the result was Negative <20copies/ml

6) Feb 24, 2015 (180 days after exposure): I went and bought an In Home Oraquick HIV Test and was Negative (only a C line visible)

7) Feb 25, 2015 (181 days after exposure): I went and bought an In Home Oraquick HIV Test and was Negative (only a C line visible)

8) Mar 01, 2015 (188 days after exposure): I went and bought another In Home Oraquick HIV Test and was Negative (only a C line visible)

My questions are the following;

1) Does my first test was a false positive?
2) Can I trust my later Negative Results?
3) I have being having painful lymph nodes under my neck, arm and one leg and weird sensations all over my body.
4) Should I take the last tests (after the first positive) as Conclusive Negative?
doctor
Answered by Dr. Chobufo Ditah (31 minutes later)
Brief Answer:
NO need for further testing. Sufficient evidence that you are HIV negative!

Detailed Answer:
Hi an thank you so much for this query.

I am so sorry to hear about the first testing results that seem to have made it very difficult for you to believe the series of negative results after this. The first test in itself was inconclusive and not positive because it was virtually impossible for them to confirm this on further testing using the same specimen. You have done a sufficiently large number of test already and the results have been consistent. I believe they have affirmed and reaffirmed on numerous occasions that you are HIV negative. I will not recommend any further testing and I would call on you to be convinced that you are for real negative.

With all these troubling thoughts, am not surprised you are having symptoms that might not really be real. I will like to know how often you look for lymph nodes under the neck as this might in fact be the reason for the swelling and pains as opposed to real symptoms. If there are any other symptoms, please report them to me.

I hope this addresses your query fully. I wish you well. Thanks for using our services and do feel free to ask for more information and clarifications if need be.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chobufo Ditah (41 minutes later)
Thanks for your answer Doctor.

Yes, it has being dificult to get over this. As far as symptoms, I didnt touch the lymph nodes a lot, I just feel pain and touch them, most of the time in my neck under the jaw bone area, they used to feel as the size of a small bean. The pain lasted for almost 3 months (started at 10 weeks) but it was intermitent (pain coming and going). Then (around 6 months after exposure) I have pain on my arm by the elbow and when I touched feels like a swollen lymph, this pain lasted for two weeks. The neck pain started around 10 weeks after the exposure. Also around the 18 weeks I felt like burning sensation behind my knees.
At this time I dont have any more pain. Now, I found out that I have like a dry skin white spot on the shaft of my pennis. In the begining I did felt very depressed which maked me feel tired and not focus. During the first 8 weeks after the exposure I didnt feel anything other than at the 3rd week after the exposure I went to vacation to Docimican Republic and eat something that gave me very bad diahrreas for 4 days.

I need you to answer these last questions please:

1) From your perspective, what tests do you think are the ones that confirmed me being NEGATIVE?
2) Do you know what Generation is the COBAS e-411 ECLIA Test (3rd or 4th)?
3) Do you think the RT-PCR-RNA (<20 copies/ml) is accurate at 160 days?
4) What is your opinion on the Oraquick Oral Home HIV Test? I heard a lot about false negatives. I did the test three times during the 6 months time period.
5) Can I move on and forget about this?

Many Thanks Doctor.

doctor
Answered by Dr. Chobufo Ditah (11 minutes later)
Brief Answer:
see below!

Detailed Answer:
Hi and see the responses below:

1) From your perspective, what tests do you think are the ones that confirmed me being NEGATIVE? You need no further testing. You have done all the possible tests to diagnose and confirm your status.. There is no need for further testing at this time.

2) Do you know what Generation is the COBAS e-411 ECLIA Test (3rd or 4th)?
It is a 4th generation test


3) Do you think the RT-PCR-RNA (<20 copies/ml) is accurate at 160 days?

It is very accurate and there is no better test than PCR to test for HIV.

4) What is your opinion on the Oraquick Oral Home HIV Test? I heard a lot about false negatives. I did the test three times during the 6 months time period.

These are reliable. Consistent negative results say it all. It could not be a mistake that has not been otherwise disproved on several occasions.

5) Can I move on and forget about this?

Yes, moving on is not the only the best thing to do but it is very justified.

I wish you well. And any further worries, am right here!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chobufo Ditah (8 minutes later)
Thanks a lot Doctor for your answers and good service.

Any comments on the symptoms or the white dry spots on the shaft of my pennis?

Do you have experience with HIV people during accute and established infections?

Many, Many Thanks for everything you are doing.
doctor
Answered by Dr. Chobufo Ditah (3 minutes later)
Brief Answer:
HIV is my daily bread.. I work in XXXXXXX ..Hope you understand!

Detailed Answer:
Hi,

HIV is my everyday affair. Unlike many others, I see HV patients daily.

I will like to have an image of the dry spots on the shaft of your penis for review. Providing information on rash without seeing is never a good idea and may not be very helpful.

I hope to hear from you and would provide more insights.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chobufo Ditah (21 minutes later)
Dr. I want to say thanks for your support and good services.

I forgot to ask about the window periods. According to the 3rd generation tests (ICMA) this one can detect IgM antibodies at 3 weeks and IgG Antibodies between 3 and 4 weeks. Now, the confirmatory test used was a Multispot which only test for IgG and that the window period is bwtween 4 and 6 weeks. So how they confirm my forst positive with a test that has longer window period?

Then, the ECLIA test was done one week after the first one with a new blood sample on a different lab and it was negative (4th Gen Test).

Then at 98 days or 10 weeks after the first positive I did the same ICMA 3rd Generation again which it was negative and with the same blood sample we ran a 4th Genration test which was also negative. What do you think about the window period?

I also heard that the RT-PCR-RNA at 160 days is not reliable. Have you seen patients that are NOT on treatment with a NEGATIVE RNA (<20 copies) test at 160 days?

Have you use the Oraquick oral fluid test (home test) at your practice?

Shall I be concerned about other STD's due to the symptoms? whish STDs?

Thanks
doctor
Answered by Dr. Chobufo Ditah (8 minutes later)
Brief Answer:
The problem at this time is your mindset and you need to get over this!

Detailed Answer:
Hi,

Please, do yourself some justice by looking for reasons to convince yourself that something is wrong of which that is not the case. You should rather look for reasons to understand you are clean and cleared of HIV and I have done just that. I have not provided any false assurance but assurance based on so much evidence that you have provided. be kind to yourself and stop being too worried.

For STD, it a rely presents with dry spots. I can't put it better but am concerned you are really hurting yourself by denying to accept that you are not HIV positive.

I wish you well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chobufo Ditah (11 minutes later)
You are absolubtly correct, but I just need these last questions answered for the last time, PLEASE doctor, PLEASE.

I forgot to ask about the window periods. According to the 3rd generation tests (ICMA) this one can detect IgM antibodies at 3 weeks and IgG Antibodies between 3 and 4 weeks. Now, the confirmatory test used was a Multispot which only test for IgG and that the window period is bwtween 4 and 6 weeks. So how they confirm my forst positive with a test that has longer window period?

Have you use the BIO-RAD Multispot HIV differiation test? How eraliest have you seen a positive with this test (3 weeks, 4 weeks, ....)

Then, the ECLIA test was done one week after the first one with a new blood sample on a different lab and it was negative (4th Gen Test).

Then at 98 days or 10 weeks after the first positive I did the same ICMA 3rd Generation again which it was negative and with the same blood sample we ran a 4th Genration test which was also negative. What do you think about the window period?

I also heard that the RT-PCR-RNA at 160 days is not reliable. Have you seen patients that are NOT on treatment with a NEGATIVE RNA (<20 copies) test at 160 days?

Have you use the Oraquick oral fluid test (home test) at your practice?
doctor
Answered by Dr. Chobufo Ditah (15 minutes later)
Brief Answer:
See below!

Detailed Answer:
I forgot to ask about the window periods. According to the 3rd generation tests (ICMA) this one can detect IgM antibodies at 3 weeks and IgG Antibodies between 3 and 4 weeks. Now, the confirmatory test used was a Multispot which only test for IgG and that the window period is bwtween 4 and 6 weeks. So how they confirm my forst positive with a test that has longer window period?

What test is used is really not the issue here. IgM is the first antibody to be produced and it is replaced with IgG. This testing is consistent and there is no reason to think this wasn't right.



Have you use the BIO-RAD Multispot HIV differiation test? How earliest have you seen a positive with this test (3 weeks, 4 weeks, ....).

I have never really checked on this. However, the manufacturers state that this test can detect positive cases as early as 21days after exposure.



Then, the ECLIA test was done one week after the first one with a new blood sample on a different lab and it was negative (4th Gen Test). Then at 98 days or 10 weeks after the first positive I did the same ICMA 3rd Generation again which it was negative and with the same blood sample we ran a 4th Genration test which was also negative. What do you think about the window period?

There is really no need stressing on a window period that has no further bearings at this time. It is beyond the scope of this platform to talk the technicalities of laboratory testing.



I also heard that the RT-PCR-RNA at 160 days is not reliable. Have you seen patients that are NOT on treatment with a NEGATIVE RNA (<20 copies) test at 160 days?

PCR is a very reliable test and whoever says it is not reliable is spreading false information and it is very wrong. This test is the gold standard for HIV testing.



Have you use the Oraquick oral fluid test (home test) at your practice?

I have used this test several times and also in mass HIV screening campaigns. It is a great test and there is no reason to question it quality.

I wish you well.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chobufo Ditah (3 days later)
Thanks for all your answers Doctor. I forgot to ask two last questions.

1) Is it true that people infected and NOT on tratment can have NEGATIVE RT-PCR-RNA Tests under <20copies/ml? Have you seen this happen to any of your patients at 160 days after infection?

2) What can caused a false NEgative on the Oral Oraquick Test? I took this test myself 3 times (the home test).

Thanks
doctor
Answered by Dr. Chobufo Ditah (54 minutes later)
Brief Answer:
See Below!

Detailed Answer:
Hi and find responses underneath.


1) Is it true that people infected and NOT on tratment can have NEGATIVE RT-PCR-RNA Tests under <20copies/ml? Have you seen this happen to any of your patients at 160 days after infection?

This is not true. In fact, less than 20copies is the threshold used to declare that you are negative in persons who have never been positive or to show that medications are fictive for those on drugs. In all, this is not possible and less than 20copnes simply confirms the negative status.



2) What can caused a false NEgative on the Oral Oraquick Test? I took this test myself 3 times (the home test).

I talk of false positive and not false negative. False negative is very rare. It can only occur when the test is done soon after the exposure and not long after the exposure.



Thanks
Thanks and wish you well. As I said before, you hold the keys to your treatment. Believe it is okay and all shall be well and if you fail to, am sorry you are making the wrong decision to think you are sick of which there is no information to support that at this time.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chobufo Ditah (15 days later)
Hello Doctor, is me again.....

Just want to let you know that I went yesterday and purchase another ORAQUICK HOME HIV Oral Test, and it was also NEGATIVE.

I was reading about people that dont produce antibodies to HIV any longer but they still infected and test NEGATIVE with ORAQUICK. When this happens? Could this be me?

I forgot to tell you that when I did the first HIV test that was repetedly reactive and confirmation NEGATIVE with the MULTISPOT differintiation test, that my CBC blood test was also abnormal. Here are the only values that were abnormal on the CBC. What do you think?

1) Eos (Absolute) 0.6 High - Normal Range is 0.0 - 0.4
2) BUN/Creatinine Ratio 22 High - Normal Range is 8 - 19
3) Lipase, Serum 66 High - Normal Range is 0 - 59

A week before I did the first repetedly reactive HIV test and CBC, I got food poisined and have very bad diahrreas for 3 days.

What do you think?

Thanks
doctor
Answered by Dr. Chobufo Ditah (12 hours later)
Brief Answer:
YOUR TESTS HAVE NEVER BEEN SUGGESTIVE OF HIV AND YOU ARE NOT HIV+!

Detailed Answer:
Hi and thanks for this follow up question.

I have reviewed your information fully. This is inline with persons who have no HIV and have nothing to worry about but to continue with preventive measures. That is all I can tell you at this time. To me, you want reasons to say your are HIV+. I have tried to look just for nay to convince myself that you could be HIV+, too. Unfortunately, I have found none and would maintain you are HIV-.

Have you ever heard of hypochondriacs? These are persons who have no disease, all tests have suggested so and experts have reassured them, yet they fail to accept that they are not having the disease condition. If you cannot get over this, I will refer you to a psychiatrist to figure this out.

So, let me know if you cannot get over it so that I can recommend a psychiatrist consult.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chobufo Ditah (58 minutes later)
What you have to say about the abnormal CBC report? Thanks.
doctor
Answered by Dr. Chobufo Ditah (16 minutes later)
Brief Answer:
See below!

Detailed Answer:
Hi,

Your CBC report following food poisoning is totally normal. With food poisoning, we expect the numbers of eosinophils to increase because this is a marker of allergies. The results are very much in line with this. Lipase and creatinine are all around that upper normal border and unless further testing shows consistence or that you have worrisome symptoms, I would not followup with this and would regard them as acceptable.

There is nothing like a patient not producing antibodies to HIV. This is not something I am familiar with and have never had patients with such characteristics.

I hope this helps. I wish you well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chobufo Ditah (2 hours later)
Thanks for the answer and clarification Doctor.

What symptoms will be related to the high Lipase and creatinine levels? I still have this intermitent pain under my jaw neck glands.

Does the high Lipase and creatinine has anything to do with HIV?

Thanks
doctor
Answered by Dr. Chobufo Ditah (32 hours later)
Brief Answer:
Lipase and creatinine has nothing to do with HIV!

Detailed Answer:
Hi and thanks for this follow up.

Increased lipase is suggestive of a problem with the pancreas. However, your levels are no where near values that are considered disturbing for a possible pancreas problem.

Creatinine is all about the kidneys, They both have nothing to do with the pancreas. Like I mentioned, there is nothing to be worried about at this time.

I wish you well and all the best in your daily undertakings!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Chobufo Ditah

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What do following HIV test results post unprotected sexual exposure indicate?

Brief Answer: NO need for further testing. Sufficient evidence that you are HIV negative! Detailed Answer: Hi an thank you so much for this query. I am so sorry to hear about the first testing results that seem to have made it very difficult for you to believe the series of negative results after this. The first test in itself was inconclusive and not positive because it was virtually impossible for them to confirm this on further testing using the same specimen. You have done a sufficiently large number of test already and the results have been consistent. I believe they have affirmed and reaffirmed on numerous occasions that you are HIV negative. I will not recommend any further testing and I would call on you to be convinced that you are for real negative. With all these troubling thoughts, am not surprised you are having symptoms that might not really be real. I will like to know how often you look for lymph nodes under the neck as this might in fact be the reason for the swelling and pains as opposed to real symptoms. If there are any other symptoms, please report them to me. I hope this addresses your query fully. I wish you well. Thanks for using our services and do feel free to ask for more information and clarifications if need be.