Preliminary positive antibody

[fliboi06]

Hello,

Thanks to the moderators and the other members of the community for the advice and words of encouragement you provide. 

Five weeks ago, I engaged in MSM sex (where I was the receptive bottom, no ejaculation) with someone of claimed negative status.  It was protected, however the first several times he tried to put a condom on, it broke and I'm still not sure whether the one we used maintained its integrity -though he assured me it did not break. 

I know symptoms are never indicative of transmission, but approximately two weeks post-exposure, I came down with severe symptoms that made me concerned...this coincided with receiving decidedly more ambiguous responses from the same sexual partner about his status (he was a bit more "shady" when we last spoke and told me he had received a call from the Dept of Health about previous sexual partner who had tested positive a year ago).  My 5 week antibody test was negative and my PCP (also ID doc) agreed to do a PCR RNA test at 4 weeks for my anxiety (which I will admit was/is significant) which also turned up negative. 

Questions for the community:

1.  I understand that the antibody test at 13weeks is the only approved method for diagnoses.  Nevertheless, should the unlikeliness of PCR-RNA tests to yield false negatives coupled with a 5-week negative antibody provide me any level of relief? 
2.  I understand that the virus is a fragile one, but could I have been infected through pre-cum and a leaky condom? 

Some silly questions, but I appreciate your feedback.  Thanks again for what you do!

[Andy Velez]

OK. If your recent partner's condom had broken it would have been very obvious. It's not a subtle thing with teensy little holes. When a condom breaks it looks like a fringed hula hoop on the dick. And it would have been very obvious to you.

So I would consider this to have been a protected intercourse incident. Condoms provide very effective protection.

Although the PCR is not a diagnostic test it IS very sensitive. A negative at 28 days or more is likely to be reliable. You should still re-test at 13 weeks to confirm those earlier negative results. The average time to seroconversion is 22 days and all but the smallest number of those who are going to seroconvert will do so within 4-6 weeks after an exposure to the HIV virus. With those two negatives in hand and having used a condom, I expect you will continue to test negative.

If your symptoms persist you should discuss them with your doctor.

It reads like you're not very experienced with having sex with another guy. If I'm correct about that, along with being exciting it can also stir up a lot of other feelings and anxiety. Just make sure that when it comes to intercourse whoever is the insertive partner is ALWAYS wearing a latex condom. No exceptions. Do that and you'll be ok as far as HIV is concerned in terms of sexual acitivity. And if you haven't already read our lesson on Transmission, please do so. There's a link to it in the Welcome thread which opens this section.

I expect you to come out of this incident ok.

Cheers,

[Ann]

fli,

I agree with everything Andy has told you and just want to add the following:

You need to be using condoms for anal or vaginal intercourse, every time, no exceptions until such time as you are in a securely monogamous relationship where you have both tested for ALL sexually transmitted infections together. To agree to have unprotected intercourse is to consent to the possibility of being infected with an STI. Sex with a condom lasts only a matter of minutes, but hiv is forever.

Have a look through all three condom and lube links in my signature line so you can use condoms with confidence. When you bottom, you can put the condom on your top so you can make sure he's wearing it correctly. You can do this as part of foreplay.

Anyone who is sexually active should be having a full sexual health care check-up, including but not limited to hiv testing, at least once a year and more often if unprotected intercourse occurs.

If you aren't already having regular, routine check-ups, now is the time to start. As long as you make sure condoms are being used for intercourse, you can fully expect your routine hiv tests to return with negative results. Don't forget to always get checked for all the other sexually transmitted infections as well, because they are MUCH easier to transmit than hiv.

Like Andy, I fully expect you to continue to test negative over this incident. Make sure you and/or your top is always using condoms and you will continue to avoid hiv infection.

Ann

[fliboi06]

Hi all,

I'm very worried right now and am reaching out to the community.  I posted here a while back about an incident that was decidedly low-risk.  I haven't had any sexual encounters since or for a few months prior to that incident:

I was the anal receptive partner of msm sex; it was protected (I had concerns about condom breakage but my partner says it didn't and I didn't notice it breaking) and no ejaculation.  I started feeling symptoms (severe hot flashes, dizziness) two weeks post-exposure which made me concerned. 

I had a 4 week pcr rna (viral load) that came back undetectable.  A six and nine-week oraquick came back negative. 

Today, at the 12-week mark, I had a preliminary positive result with the tester saying that it was a "faint" but "definitely reactive" bar on the device. 

I'm confused and angry and feeling a whole lot of other emotions...I'm confused as to how it could have happened.  I know there are few false positives with the Oraquick so I'm basically terrified.  I know that forum isn't meant for this, but I feel like I need to write or tell someone.  I feel adrift.

[Matty the Damned]

Boi,

Please keep all your additional thoughts, questions and comments in your original thread. This helps us to follow your story and give you the mos accurate advice.

If you can't find you original thread click on the red link I've provided above. Alternatively you can click on the "show own posts" link in the left hand column of any forums page. Your questions will not be answered until you return to your original thread.

MtD

[Ann]

fli,

I've merged your new thread into your original thread - where you should post all your additional thoughts or questions. It helps us to help you when you keep all your additional thoughts or questions in one thread.

If you need help finding your thread when you come here, click on the "Show own posts" link under your name in the left-hand column of any forum page.

Please also read through the Welcome Thread so you can familiarize yourself with our Forum Posting Guidelines. Thank you for your cooperation.

I've yet to see one of those "faint" lines on a three month test end up being definitely positive. You need to re-test and if that's also positive, it MUST be confirmed with a Western Blot.

I'm fully expecting this to turn out to be a false positive, especially in light of your previous testing along with not having a risk in the first place. Protected intercourse is just that - protected.

Ann

[fliboi06]

Hi Ann, MtD,

I apologize for the new post, but thank you for your advice; I'll follow the posting guidelines from here on.   

In a very strange confluence of events, my ID doc had me take another Oraquick today (yesterday's was reactive) and today the result was negative.  Both my doctor and I are confused; it will be the 12-week mark this week.  I'm not quite sure what is happening.  The doc ordered a viral load to be done and is also waiting on the Western Blot from yesterday's reactive, but I am as anxious as ever. 

Ann, thank you for your input.  You mentioned that a "faint" line may indicate a false positive.  In your experience, has anyone who had such a faint reactive line end up being a false positive?  It was low risk, or at least I thought it was, but my symptoms even today and the confusing test results are adding to my misery.  What could be the reason for the faint line, other than an actual positive result?  False negatives are rarer than false positives, I've read, especially twelve weeks out but my doc mentioned that I may just now be converting and the test yesterday was slightly more sensitive than today's test which would explain a positive yesterday and negative today.  Nor have I taken any medications or vaccinations recently that could lead to such a false positive.  Sorry I'm rambling...I'm just worried and confused.   

[Andy Velez]

You are understandably confused and very concerned.

I'm with Ann on this one. I expect you to ultimately test negative. With all of those earlier negatives at the points you received them it would be beyond unusual to test positive at this point.

Keep yourself productively busy for the next days until you can get the new results. It really will help much more than trying to quantify how many this and how many that. Which ultimately is only guesswork and answers nothing, leaving you with the same unanswered question.

Only that negative result will give you the answer you want. Given everything from the incident itself on I am expecting you to test negative.

Hang in there buddy and keep us posted.

Cheers,

[Ann]

fli,

Those faint line "positives" normally turn out to be FALSE positives, especially when they happen after six weeks.

Your doctor should NOT have done a viral load on you, as these are very prone to false positives. The standard procedure is to confirm with a Western Blot. I'm fully expecting your WB to be negative - after your negative ELISA today coupled with your no risk incident and all those other negative results you've already had.

With today's negative result, it's pretty much a foregone conclusion that you ARE hiv negative.

Ann

[fliboi06]

Hello community,

Thanks again for the words of support.  My ID doc just informed me that the PCR Viral Load he did following my preliminary reactive Oraquick (and then a negative Oraquick the day after) came back undetectable -12 week.  He assures me that this is conclusive and definitive and I was wondering what your advice was.  He says that I don't need to worry about the Western Blot (which won't return for another week) since I have an UD viral load.  Can I celebrate?

Thanks again for what you all do -I volunteer for an ASO and this experience has made me realize through a different lens how important it is to stay informed and be educated. 

[Ann]

Hi fli,

Considering your testing history, yes, it looks like you are in the clear. If I were you, I'd still collect the results of your WB, just to make absolutely certain.

Please make sure you always use condoms from here on out and you'll stay hiv negative. Have a look through the three condom and lube links in my signature line - think of it as a refresher course.

Ann

[fliboi06]

Ann, thank you for the input as always.  I'll follow up on the WB, and I have my fingers crossed.

Out of curiosity, I asked around a bit and I've been receiving different information about the conflicting Oraquicks.  Most seem to say that once the antibody is in your system, it's exactly that and should have also resulted in at least another faint line at the T mark on the test the next day.  Is that the case?  Or does the level of detectable antibody fluctuate in one's system?  Also, for whatever reason if I do test positive, the fact that I am seroconverting so very late -what are the implications?  Should I be worried about having a more serious disease that was suppressing my immune system for twelve weeks?

Sorry, I'm just really anxious about the WB.  The doc assured me that I was HIV- (quote, "No...final...HIV neg!!!!!") but I don't want to celebrate now only to have the WB confirm the reactive result; it would be devastating.

Again, thanks very much for the work you all do.  You are for me, and I'm sure for many others, the only avenue to turn to during a difficult time.   

[Ann]

fli,

It's highly unlikely that you're seroconverting late. The WB results are more a formality than anything else in your case. Expect a negative result; I am.

Antibody levels do not fluctuate as in up and down, they go up in number until a definite positive result is achieved.

Ann

[fliboi06]

Hello,

Just wanted to check back in with you all.  The WB for the reactive oraquick was negative -thank you all for the reassurances.  The past few weeks have been quite a roller coaster ride.  I have two questions for Ann/Andy, if you are willing:

1.  The counselor recommended that I re-test in three weeks since I had tested reactive on one of the tests.  Since I had tested at twelve weeks, is this still necessary?  The 12 week ultra VL had also returned ud.   

2.  I seem to have developed thrush or some sort of coated tongue at week 15/16.  Is there any way this could be linked to a late seroconversion, however unlikely?  I'm waiting to see my pcp before going to see my dentist. 

Thank you all for being such a supportive bunch!

[Andy Velez]

A negative at 12 weeks is acceptable in many countries. Our CDC just happens to prefer 13 weeks, but I would certainly consider that 12 week negative as sufficient and reliable.

You are HIV negative.

As for thrush, that is a very common occurrence and absolutely is not in any way an HIV specific occurrence. It can also be quite persistent so treating it successfully can take time. Also, what you are calling thrush may in fact not be such. Only a doctor or dentist can diagnose that for you so it's good that you're seeing a professional to have it evaluated.

In any case, this is not an HIV situation.

Cheers,

[fliboi06]

Hello all,

Still a little anxious, so I'm hoping you will be able to provide some insight...the preliminary positive Oraquick returned a negative Western Blot and the Viral Load Ultra that was drawn the next day after I received the positive also returned undetectable (at twelve weeks) in addition to another Oraquick that day which was non-reactive.  Though I'm sure you will all be convinced...for some reason, that positive result (and the genius counselor that told me it was a conclusive result) won't let me relax.  About the time I received all this testing (~12 weeks), I came down with a severe sore throat, continued dizziness and horrible migraines...my doctor (who's a certified hiv spec) assured me that it could not be b/c of hiv and after running several tests of his own, sent me to an ENT as well as a neurology practice for the headaches; none of these have been able to find the source of my various symptoms.  My fear, however unrealistic, is that I may be a case of severely belated seroconversion...though I have never been a chemo patient or have other known autoimmune conditions. 

After that false positive, I have honestly not been able to muster the courage to get tested again for hiv.  I was wondering...is it possible to have an undetectable viral load (<50) AND nonreactive antibody test at 12 weeks?  I know I did not test out to the recommended 13 weeks, but I've taken the word of the other kind members of the forums who assure me it's as reliable.  Could the preliminary positive Oraquick have caught the beginning of antibody production?  The good doc says you need at least 50k viral load to trigger antibody response, but there seem to be members who've experienced the contrary. 

I know some may consider these unrealistic concerns considering my situation, but after that initial positive result and the way the result was handled, I've found it mentally and emotionally difficult to move on -it was fairly traumatic!  Any help would, as always, be greatly appreciated...and thanks again for what you all do.   

[Matty the Damned]

Ja, you should consider complaining about the counselor in question here.

You are HIV negative, but I can appreciate your concerns given that a supposedly qualified health care worker told you a false positive result was conclusive when it patently was not. In my opinion positive ELISA results should not be revealed to a patient until that result has been confirmed or invalidated by a Western Blot result.

I don't see any need for further testing in your case.

MtD

[Andy Velez]

A false positive on the ELISA occurs from time to time for a number of reasons. Any positive is always checked by having a western blot done. And when the western blot is negative it ALWAYS trumps the previous ELISA result. ALWAYS.

So while your being rattled by this experience the bottom line is that you are HIV negative. Period.

There's no need for re-testing.

I agree with Matty about the counselor who sounds dangerously uninformed about basics of HIV testing.

Again, you are HIV negative.