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Are Negative HIV Test Results After 60 Days Of Possible Exposure Conclusive?
Posted on
Mon, 31 Aug 2015
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Mon, 31 Aug 2015
Answered on
Fri, 18 Sep 2015
Last reviewed on
Question : Hi ,
Had protected vaginal sex with a woman of unknown status. However i was under the influence of alcohol and i slept with the condom inside my underwear. Next morning I found the condom and it was intact(checked twice). Then irrational fears gripped me and I started worrying about the possible exposure of my uthera to the fluids on the condom and the inner side of underwear (when it popped out). I questioned the woman but she seems to be unaware of her status (she had multiple one-night stand partners in the past). Later I couldn't reach out to her , seems she left the city. This grew my concern.
Now after researching insanely on internet , I came to the conclusion that world wide most HIV specialist were talking about 4th Generation test (p24 + antibody ) test . Most are of the opinion that this test is conclusive after 4 weeks. Most countries like australia ,canada and france have accepted 6 weeks test norm.
Thus below are the test that I have conducted.
- 9 days – Ag/ab Combo CMIA
- 16 day- Serology (hiv1/Hiv2)
- 18th day - Ag/ab Combo CMIA
- 25th Day- Ag/ab Combo CMIA
- 29th Day- Ag/ab Combo CMIA
- 32nd Day- Ag/ab Combo CMIA
- 40th Day - Ag/ab Combo CMIA
- 42nd Day- HIV-2 RNA PCR ( Just for precaution measure)
- 60th Day- Serology Antibody Test (HIv1 /HIv2)
All of the above test have been NEGATIVE.
Still I would like to have your personal opinion.
q.1) Is it possible for Ag/ab Combo CMIA test to yield false negatives. Even though when the test's covers the entire window period of antigen detectable part ( as per CDC 1-7 weeks)
q.2 ) Do I still need to repeat test at 3 months mark even though most specialist are stating that CDC's guidelines are conservative and pertains to the data which are not relevant as per the newer generation test.
q.3) have you ever seen a 6 week negative( on duo test) or 8 week negative on antibody test turn positive later.
q.4 ) I never seroconverted/ had any ARS in the past 10 weeks . But still I am very very worried. The last Serology Antibody test which I took looks for : HEP B/C , VDRL , Syphillis and HIV-1/2 . Except for the HIV segment ,the test report showed ELISA Kit is being used. For HIV segment it was written done by Immuno Concentration Test . When I enquired they told me they have blood testing kit.
What I know is except 1st generation test all the other generations of tests look for both the antibodies. So either Immuno Concentration test was a 2nd generation test or 3rd Generation Test. So what is this Immuno Concentration Test. Is it reliable too ?
q.5) All the eminent professionals of your field ( Dr H.H.Hansfield, Dr EWHook, Dr XXXXXXX Cummings , Dr XXXXXXX , dr XXXXXXX Garcia , dr XXXXXXX dr S XXXXXXX etc) were of the opinion that :: Any Combo test done after 4 + weeks = 'IT is impossible to have HIV. Either the antigen or antibody or sometimes both will show positive' . However if only the patient is displaying severe seroconversion symptoms along with a previous negative duo after 4 weeks, test can be repeated after 7-10 days. Is this the extremely rare case you are talking about (FYI I never any symptoms , though research led me to a fact that only 80 % have symptoms ). So can You be ABSOLUTELY sure that I can never ever .. ever..ever.. catch it because of this Episode. (It has been 2 more weeks( 10th week) , I am still not able to concentrate on Real life) thus I would like your assurance that my test are final and conclusive ?
q.6) Why Do all doctors say there is a a rare chance of missing diagnosis ? Say taking into consideration my situation wouldn't it be unbelievably impossible for medical science to explain this.
a) Virus was never found not in it's intial detectable stage(CDC : 4-7 days), peak time ( 16th Day-18th Day ), generalised last stage before being undetetable for some time (4th- 6th Week ) : The only explanation would be virus was replicating slowly (which should not be the case because the virus would die- dr HOOK).
So that's why I took a HIV 2 RNA PCR Test (after 6 weeks) as I heard that this virus replicates very slowly( viral load is 28 folds lower than hiV-1) and also followed up with an serology antibody test after 2 weeks ( as recomended by CDC: PCR test followed by an antibody test ).
b) Late seroconverters are generally those who are/have either terminal illness or regular IV drug user or On chemotherapy or have used PEP or already have HIV. I am none of the above how can a normal body not produce antibodies ? And If Antibodies are the problem the Viral load should be exceptionally high correct.
I have done everything to remove any doubt that the testing 'procedure' I conducted was full proof. That By no means , I should live my life without updating my status.
Hence dear Doctor , Please let me know any loophole that You have seen in my testing procedure. Please let me know If I can completely , in full faith of God and You ( and all those Doctors) can conclusively rule out the infection, forget about the incident and move on in My Life ?
Thanks
Worried Soul
Had protected vaginal sex with a woman of unknown status. However i was under the influence of alcohol and i slept with the condom inside my underwear. Next morning I found the condom and it was intact(checked twice). Then irrational fears gripped me and I started worrying about the possible exposure of my uthera to the fluids on the condom and the inner side of underwear (when it popped out). I questioned the woman but she seems to be unaware of her status (she had multiple one-night stand partners in the past). Later I couldn't reach out to her , seems she left the city. This grew my concern.
Now after researching insanely on internet , I came to the conclusion that world wide most HIV specialist were talking about 4th Generation test (p24 + antibody ) test . Most are of the opinion that this test is conclusive after 4 weeks. Most countries like australia ,canada and france have accepted 6 weeks test norm.
Thus below are the test that I have conducted.
- 9 days – Ag/ab Combo CMIA
- 16 day- Serology (hiv1/Hiv2)
- 18th day - Ag/ab Combo CMIA
- 25th Day- Ag/ab Combo CMIA
- 29th Day- Ag/ab Combo CMIA
- 32nd Day- Ag/ab Combo CMIA
- 40th Day - Ag/ab Combo CMIA
- 42nd Day- HIV-2 RNA PCR ( Just for precaution measure)
- 60th Day- Serology Antibody Test (HIv1 /HIv2)
All of the above test have been NEGATIVE.
Still I would like to have your personal opinion.
q.1) Is it possible for Ag/ab Combo CMIA test to yield false negatives. Even though when the test's covers the entire window period of antigen detectable part ( as per CDC 1-7 weeks)
q.2 ) Do I still need to repeat test at 3 months mark even though most specialist are stating that CDC's guidelines are conservative and pertains to the data which are not relevant as per the newer generation test.
q.3) have you ever seen a 6 week negative( on duo test) or 8 week negative on antibody test turn positive later.
q.4 ) I never seroconverted/ had any ARS in the past 10 weeks . But still I am very very worried. The last Serology Antibody test which I took looks for : HEP B/C , VDRL , Syphillis and HIV-1/2 . Except for the HIV segment ,the test report showed ELISA Kit is being used. For HIV segment it was written done by Immuno Concentration Test . When I enquired they told me they have blood testing kit.
What I know is except 1st generation test all the other generations of tests look for both the antibodies. So either Immuno Concentration test was a 2nd generation test or 3rd Generation Test. So what is this Immuno Concentration Test. Is it reliable too ?
q.5) All the eminent professionals of your field ( Dr H.H.Hansfield, Dr EWHook, Dr XXXXXXX Cummings , Dr XXXXXXX , dr XXXXXXX Garcia , dr XXXXXXX dr S XXXXXXX etc) were of the opinion that :: Any Combo test done after 4 + weeks = 'IT is impossible to have HIV. Either the antigen or antibody or sometimes both will show positive' . However if only the patient is displaying severe seroconversion symptoms along with a previous negative duo after 4 weeks, test can be repeated after 7-10 days. Is this the extremely rare case you are talking about (FYI I never any symptoms , though research led me to a fact that only 80 % have symptoms ). So can You be ABSOLUTELY sure that I can never ever .. ever..ever.. catch it because of this Episode. (It has been 2 more weeks( 10th week) , I am still not able to concentrate on Real life) thus I would like your assurance that my test are final and conclusive ?
q.6) Why Do all doctors say there is a a rare chance of missing diagnosis ? Say taking into consideration my situation wouldn't it be unbelievably impossible for medical science to explain this.
a) Virus was never found not in it's intial detectable stage(CDC : 4-7 days), peak time ( 16th Day-18th Day ), generalised last stage before being undetetable for some time (4th- 6th Week ) : The only explanation would be virus was replicating slowly (which should not be the case because the virus would die- dr HOOK).
So that's why I took a HIV 2 RNA PCR Test (after 6 weeks) as I heard that this virus replicates very slowly( viral load is 28 folds lower than hiV-1) and also followed up with an serology antibody test after 2 weeks ( as recomended by CDC: PCR test followed by an antibody test ).
b) Late seroconverters are generally those who are/have either terminal illness or regular IV drug user or On chemotherapy or have used PEP or already have HIV. I am none of the above how can a normal body not produce antibodies ? And If Antibodies are the problem the Viral load should be exceptionally high correct.
I have done everything to remove any doubt that the testing 'procedure' I conducted was full proof. That By no means , I should live my life without updating my status.
Hence dear Doctor , Please let me know any loophole that You have seen in my testing procedure. Please let me know If I can completely , in full faith of God and You ( and all those Doctors) can conclusively rule out the infection, forget about the incident and move on in My Life ?
Thanks
Worried Soul
Brief Answer:
Yo are free from both HIV and 2. No need for further test
Detailed Answer:
Hi,
Welcome to HCM.
Thanks for posting your query.
You are disturbed much mentally. Don't try to surf any more on line web sites on HIV. Those will definitely confuse you.
Even though you had unprotected sex and left the condom un-removed overnight, fortunately you are free from both HIV 1 and 2. It is sure and confirmatory.
1.Ag/Ab Combo test for HIV is highly specific and sensitive 4 weeks after the risky sexual exposure. You had this test more than two times after 4 weeks and they came negative. False negative results are less than 1% when done once. When it had been done more than once the sensitivity becomes 100%. So there is no doubt that you are free from HIV 1. Combo test Antigen part is sensitive by 4 weeks not the antibody part as it fell well within the window period for antibody formation. So a negative test by 4 weeks ruled out the possibility HIV1.
2.You also had HIV 2 RNA PCR Qualitative Test on 42nd day after sexual exposure and it was negative. It is also a highly specific test. So the possibility of both HIV and HIV 2 had been eliminated from you.
3.You need no further test for HIV after 3 months.
4.As the COMBO 4th generation tests had been introduced recently (within a year or two), I have yet to see a case to become HIV positive who remained negative up to six weeks after an exposure.
5. HIV 2 is less transmissible both vertically and horizontally. Replication virus there is not much difference between the two.
6. Absence of sero-conversion illness once again is a confirmatory and contributory factor for your test result.
7. Medicine is not like a mathematics to have a constant answer. It would likely be to get variety of response from each individual.
8. Those who are on immuno suppressive drugs like steroids or anti cancer drugs or already taken PEP might get delay in appearance of antibodies not the antigen detection where we had tested for both.
Your tests are confirmatory beyond any doubts. You can relax and can have a normal routine life with your family.
Dr S.Murugan
Yo are free from both HIV and 2. No need for further test
Detailed Answer:
Hi,
Welcome to HCM.
Thanks for posting your query.
You are disturbed much mentally. Don't try to surf any more on line web sites on HIV. Those will definitely confuse you.
Even though you had unprotected sex and left the condom un-removed overnight, fortunately you are free from both HIV 1 and 2. It is sure and confirmatory.
1.Ag/Ab Combo test for HIV is highly specific and sensitive 4 weeks after the risky sexual exposure. You had this test more than two times after 4 weeks and they came negative. False negative results are less than 1% when done once. When it had been done more than once the sensitivity becomes 100%. So there is no doubt that you are free from HIV 1. Combo test Antigen part is sensitive by 4 weeks not the antibody part as it fell well within the window period for antibody formation. So a negative test by 4 weeks ruled out the possibility HIV1.
2.You also had HIV 2 RNA PCR Qualitative Test on 42nd day after sexual exposure and it was negative. It is also a highly specific test. So the possibility of both HIV and HIV 2 had been eliminated from you.
3.You need no further test for HIV after 3 months.
4.As the COMBO 4th generation tests had been introduced recently (within a year or two), I have yet to see a case to become HIV positive who remained negative up to six weeks after an exposure.
5. HIV 2 is less transmissible both vertically and horizontally. Replication virus there is not much difference between the two.
6. Absence of sero-conversion illness once again is a confirmatory and contributory factor for your test result.
7. Medicine is not like a mathematics to have a constant answer. It would likely be to get variety of response from each individual.
8. Those who are on immuno suppressive drugs like steroids or anti cancer drugs or already taken PEP might get delay in appearance of antibodies not the antigen detection where we had tested for both.
Your tests are confirmatory beyond any doubts. You can relax and can have a normal routine life with your family.
Dr S.Murugan
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor,
Thanks for clearing me of the Virus. It has been 70 days of feeling and living the disease. Checking the symptoms every now and then. Though it will take some time but in some days I will accept the facts and your suggestion.
Anyhow ,
q.1) Whilst going through these comment chain I realised that Combo Test are being used in XXXXXXX only for a year and two , whereas the test has been in use for more than decade in western countries (at least the dates of questions regarding duo test on webmd sites are suggestive of that) !! Why is XXXXXXX so behind in using these technological advances even though we are currently ranking 3rd in the list of HIV prevalence ?
q.2) You mentioned delayed seroconversion has no affect on p24 . That is great news for me. I just wanted to clarify that only those "specific people" + People with genetic issue develop antibodies as late as 12 weeks or do normal healthy people can seroconvert as late as that ?
q.3) Though it may not interest you but can you tell me what is serology test for HIv1/2. They performed a Immuno concentration test ( 2nd or 3rd Generation) it was done by some lab called Spandan Diagnostics. They said they made use of a kit. I guess a rapid test kit ?
q.4) The other tests were conducted at Dr Lal Path Labs (ab/ag CMIA Test), Metropolis (RNA PCR) , SRL ranbaxy (ab/ag CMIA Test) to cross check. Are these labs reliable ?
q.5) sorry to bug you again, This will be the last time but I should not have any reasons to doubt my test and move on confidently?
Sorry few more Questions before I can close this thread and event from my life.
q.6) You mentioned un-removed condom. I was under the impression that it needs a large volume of vaginal fluids INSIDE the person body to get affected. Some experts are also of the opinion that Virus is very difficult to transmit and fragile, becomes INACTIVE to replicate within seconds (in exposure to change in PH and temperature) and DIEs within 10-15 minutes . Is that true ? In that case I was at NO risk Exposure ??
q.7) All of the test I have conducted are well within the ADVISED window time frame . No discrepancies in that Regard I hope ?
q.8) How should I deal with This post traumatic experience. MY hands are shaking inconsistently , In the morning I get panic attacks with heart palpitation going up, Body starts shaking and gives weird movements whenever I am in horizontal sleeping position (this happens generally when I am sleeping). All of these because of thinking about this disease for 24 X7. Plus I don't feel like eating , only thing I do is take stress.
Again Thanks a lot for any help that you can render.
Thanks for your patience and Time
Thanks for clearing me of the Virus. It has been 70 days of feeling and living the disease. Checking the symptoms every now and then. Though it will take some time but in some days I will accept the facts and your suggestion.
Anyhow ,
q.1) Whilst going through these comment chain I realised that Combo Test are being used in XXXXXXX only for a year and two , whereas the test has been in use for more than decade in western countries (at least the dates of questions regarding duo test on webmd sites are suggestive of that) !! Why is XXXXXXX so behind in using these technological advances even though we are currently ranking 3rd in the list of HIV prevalence ?
q.2) You mentioned delayed seroconversion has no affect on p24 . That is great news for me. I just wanted to clarify that only those "specific people" + People with genetic issue develop antibodies as late as 12 weeks or do normal healthy people can seroconvert as late as that ?
q.3) Though it may not interest you but can you tell me what is serology test for HIv1/2. They performed a Immuno concentration test ( 2nd or 3rd Generation) it was done by some lab called Spandan Diagnostics. They said they made use of a kit. I guess a rapid test kit ?
q.4) The other tests were conducted at Dr Lal Path Labs (ab/ag CMIA Test), Metropolis (RNA PCR) , SRL ranbaxy (ab/ag CMIA Test) to cross check. Are these labs reliable ?
q.5) sorry to bug you again, This will be the last time but I should not have any reasons to doubt my test and move on confidently?
Sorry few more Questions before I can close this thread and event from my life.
q.6) You mentioned un-removed condom. I was under the impression that it needs a large volume of vaginal fluids INSIDE the person body to get affected. Some experts are also of the opinion that Virus is very difficult to transmit and fragile, becomes INACTIVE to replicate within seconds (in exposure to change in PH and temperature) and DIEs within 10-15 minutes . Is that true ? In that case I was at NO risk Exposure ??
q.7) All of the test I have conducted are well within the ADVISED window time frame . No discrepancies in that Regard I hope ?
q.8) How should I deal with This post traumatic experience. MY hands are shaking inconsistently , In the morning I get panic attacks with heart palpitation going up, Body starts shaking and gives weird movements whenever I am in horizontal sleeping position (this happens generally when I am sleeping). All of these because of thinking about this disease for 24 X7. Plus I don't feel like eating , only thing I do is take stress.
Again Thanks a lot for any help that you can render.
Thanks for your patience and Time
Brief Answer:
Your results are confirmatory.Better have counselling from a psychiatrist
Detailed Answer:
Hi,
Welcome back.
1.Why the there is a delay in technology? As antigen test and antibody tests were available separately and due to price factor there could be a delay.
2. P24 antigen test detects only the antigen of the HIV virus and not the antibodies produced by the body. So the immunological status of the individual has no role in the detection of the antigen.
3. I am a clinician and not a microbiologist or lab specialist. Certain thins can better be answered by a microbiologist than me.
4.All these labs are equally good and reliable.
5. Your test results are very clear and you need to have no doubts about the same and you are free from HIV 1 and 2.
6. Yes, of course virus can not live outside the body fluids not more than few seconds. Once it gets dried it is no longer viable.
7.Once again I affirm you that the antigen part of the tests done after 12 weeks are in stipulated time and highly reliable.
8. You have to get a counselling from a good psychiatrist and if necessary you have to take certain drugs on his/her advice to get relieved from your anxiety and tension.
I Wish you to get out of your stress earlier.
Dr S.Murugan
Your results are confirmatory.Better have counselling from a psychiatrist
Detailed Answer:
Hi,
Welcome back.
1.Why the there is a delay in technology? As antigen test and antibody tests were available separately and due to price factor there could be a delay.
2. P24 antigen test detects only the antigen of the HIV virus and not the antibodies produced by the body. So the immunological status of the individual has no role in the detection of the antigen.
3. I am a clinician and not a microbiologist or lab specialist. Certain thins can better be answered by a microbiologist than me.
4.All these labs are equally good and reliable.
5. Your test results are very clear and you need to have no doubts about the same and you are free from HIV 1 and 2.
6. Yes, of course virus can not live outside the body fluids not more than few seconds. Once it gets dried it is no longer viable.
7.Once again I affirm you that the antigen part of the tests done after 12 weeks are in stipulated time and highly reliable.
8. You have to get a counselling from a good psychiatrist and if necessary you have to take certain drugs on his/her advice to get relieved from your anxiety and tension.
I Wish you to get out of your stress earlier.
Dr S.Murugan
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank You Dr S XXXXXXX
Your assurance means a lot to me. I am already pretty relieved now.
I decided to finally have some quality time with friends tonight .
Just for clarifications in point 7 you mentioned " Once again I affirm you that the antigen part of the tests done after 12 weeks are in stipulated time and highly reliable." Was it a Typo or did you actually mean 4-6 weeks or Antibody part ?
Your assurance means a lot to me. I am already pretty relieved now.
I decided to finally have some quality time with friends tonight .
Just for clarifications in point 7 you mentioned " Once again I affirm you that the antigen part of the tests done after 12 weeks are in stipulated time and highly reliable." Was it a Typo or did you actually mean 4-6 weeks or Antibody part ?
Brief Answer:
Negative antigen test done after 4 weeks are confirmatory
Detailed Answer:
Hi,
Welcome back.
It is a type error. I am extremely sorry for that gave you a wrong expression. I mean that negative antigen test done after 4 weeks are very much conclusive.
Dr S.Murugan
Negative antigen test done after 4 weeks are confirmatory
Detailed Answer:
Hi,
Welcome back.
It is a type error. I am extremely sorry for that gave you a wrong expression. I mean that negative antigen test done after 4 weeks are very much conclusive.
Dr S.Murugan
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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