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Author Topic: Clarity  (Read 956 times)

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Offline ClereR

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Clarity
« on: April 20, 2020, 09:54:43 am »
Please review the below and confirm if further testing is required or tests are conclusive
Had an indiscretion between Aug-October 2019 and want to know possible hiv risk.
Condom was used for both sexual encounters however gave unprotected  oral sex to male approximately 3 times. (I'm female) Not aware of any condom break.
Last day of exposure was somewhere Mid October ,not certain of the date. To put my mind at ease Im using the 17th November 2019 as that was the last day I saw the gentleman.
Tested for the below.
3 Jan - finger prick rapid test-Negative
6 Jan - 4th generation elisa - Non Reactive
9 Jan - Hiv viral load PCR quantitative - Undetectable
13 Jan - Hiv DNA RNA Qualitative - Negative
6 Feb - 4th Generation  elisa - Non Reactive
29 Feb - 4th generation test and quick rapid test- Non Reactive

Symptoms that probed testing in January was the following
Night sweats - over 3-4 nights
5 Jan - 2 mouth ulcers lasting a week
Knee/ knuckles / hand joint pain
Nausea
Linea alba in mouth- still present.
Loss of appetite
All symptoms lasted 1-2 weeks (ended around 17th Jan )Linea alba is still present.

Had unprotected sex with my boyfriend from a long term relationship during the period Aug-Jan. He complained of muscles aches and fatigue around 2nd week of January. He also tested month end February with a 4th generation test and was non reactive . He developed goosebump like rash on neck which is still present to date ( April ) rash is same as skin colour. Could this be a possible infection from my side. 

I Visited GP month end January recommended full blood count. B lymphocytes normal range 20-40%.Range was 42.6%. Doctor assured that this is normal and sees no concern.I currently feel a slightly swollen lymph node on left side of neck ,severe dry skin with brown patches underneath skin on arms. (Not itchy /looks like pigmentation ) I'm not sure when this patches started . They are usually more visible in the mornings after waking up.

Offline Jim Allen

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Re: Clarity
« Reply #1 on: April 20, 2020, 10:07:26 am »
Hiya,

Sorry to hear that you are feeling unwell, nothing you mentioned would be HIV specific so keep working with your doctor to treat whatever it is, I hope you feel better soon.

Quote
Had an indiscretion between Aug-October 2019 and want to know possible hiv risk.
Condom was used for both sexual encounters however gave unprotected  oral sex to male approximately 3 times. (I'm female) Not aware of any condom break.
Last day of exposure was somewhere Mid October ,not certain of the date. To put my mind at ease Im using the 17th November 2019 as that was the last day I saw the gentleman.
Tested for the below.
3 Jan - finger prick rapid test-Negative
6 Jan - 4th generation elisa - Non Reactive
9 Jan - Hiv viral load PCR quantitative - Undetectable
13 Jan - Hiv DNA RNA Qualitative - Negative
6 Feb - 4th Generation  elisa - Non Reactive
29 Feb - 4th generation test and quick rapid test- Non Reactive

HIV can't transmit through an intact latex or polyurethane condom. If a condom fails during the act of intercourse it's obvious. There is no reason to be stressing about intercourse as long as this obvious issue did not happen.

As giving a blowjob, the mouth simply lacks route (Cells to infect) for HIV, and even if there was damage to your mouth creating a possible route than saliva & air also act to neutralize HIV by damaging the receptors needed to infect human cells.

All in all, giving a blowjob is such a minute concern with regards to HIV that we don't even recommend specifically testing over it.

Anyhow, although testing outside of routine was not needed, you did and the result is HIV negative, you did not acquire HIV from these encounters in October 2019.

Quote
Had unprotected sex with my boyfriend from a long term relationship during the period Aug-Jan. He complained of muscles aches and fatigue around 2nd week of January. He also tested month end February with a 4th generation test and was non reactive .

So this would be an HIV risk, now I understand you last tested on the 29th of Feb so about 4 weeks post last possible exposure and the result was negative. It's now May, so presuming you have had no exposures since Jan, you could repeat testing for a conclusive negative HIV result if you are concerned.

Regarding your partner, it's not clear from your post if he current still is your partner but ill presume he is and give you the same advice I give anyone in a relationship.
If you engage in condomless sex with your partner it would meet all the biological conditions needed for you to acquire HIV.

Now I don't judge couples that decide to engage in condomless sex, it's often based on trust within a relationship or past test results. However, just note this trust or past results does not prevent HIV and any unprotected intercourse is simply accepting a possible risk towards you of acquiring HIV.

Test regularly for HIV and far easier to transmit STI's.

Here's what you need to know in order to avoid HIV infection:
Use condoms for anal or vaginal intercourse, correctly and consistently, every time, no exceptions.  Consider starting PrEP as an additional layer of HIV prevention going forward.

Keep in mind that some sexual practices which may be described as safe in terms of HIV might still pose a risk for transmission of other far easier to acquire STI's, so please do get fully tested regularly and at least yearly for all STI's including but not limited to HIV and test more frequently if unprotected intercourse occurs

Also, note that it is possible to have an STI and show no signs or symptoms and the only way of knowing is by testing.

More information on HIV Basics, PEP, TaSP and Transmission can be found through the links in my signature.

Kind regards

Jim

Please Note.
As a member of the AM, I Infected Forum you are required to only post in this one thread no matter how long between visits or the subject matter. You can find this thread by going to your profile and selecting show own post and it will take you here. It helps us to help you when you keep all your thoughts or questions in one thread and it helps other readers to follow the discussion. Any additional threads will be deleted.

 
« Last Edit: April 20, 2020, 10:09:39 am by Jim Allen »
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Offline ClereR

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Re: Clarity
« Reply #2 on: April 21, 2020, 11:46:16 am »
Thank you for reviewing my post.

Why is it that some  laboratories and clinics still advise to retest at six months ?

Is 3 months results not considered to be conclusive.Especially if a blood drawn test Ag/Ab was used

Offline Jim Allen

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Re: Clarity
« Reply #3 on: April 21, 2020, 11:49:39 am »
6 months is about 25/30 years outdated. I'm not sure who mentioned that to you but it's old news.

Most will not even recommend 3 months anymore as beyond 6 weeks results with a blood-drawn lab test a negative result would rarely change.

Unless you have had ongoing exposures or extremes like been undergoing cancer treatment/ a long time drug user, 3 months is considered to be a conclusive result. 



Generation 3 & 4

http://i-base.info/guides/testing/test-accuracy-results-and-further-testing

http://i-base.info/guides/testing/appendix-1-different-types-of-hiv-test

2015
Taylor, D., Durigon, M., Davis, H., Archibald, C., Konrad, B., Coombs, D., et al. (2015). Probability of a false-negative HIV antibody test result during the window period: a tool for pre- and post-test counselling. Int. J. STD AIDS 26, 215–224. doi: 10.1177/0956462414542987

Patients typically want accurate test results as soon as possible while clinicians prefer to wait until the probability of a false-negative is virtually nil. This review summarizes the median window periods for third-generation antibody and fourth-generation HIV tests and provides the probability of a false-negative result for various days post-exposure. Data were extracted from published seroconversion panels. The median (interquartile range) window period for third-generation tests was 22 days (19-25) and 18 days (16-24) for fourth-generation tests. The probability of a false-negative result is 0.01 at 80 days' post-exposure for third-generation tests and at 42 days for fourth-generation tests.

Generation 4

2012
Rosenberg NE, Kamanga G, Phiri S, et al. Detection of acute HIV infection: a field evaluation of the determine(R) HIV-1/2 Ag/Ab combo test. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3318673/

Results. Of the participants 838 were HIV negative, 163 had established HIV infection, and 8 had acute HIV infection. For detecting acute HIV infection, the antigen portion had a sensitivity of 0.000 and a specificity of 0.983. For detecting established HIV infection, the antibody portion had a sensitivity of 0.994 and a specificity of 0.992.

2011
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222669/
Conclusions. Combo RT displayed excellent performance for detecting established HIV infection and poor performance for detecting acute HIV infection. In this setting, Combo RT is no more useful than current algorithms.

In total, 953 people underwent HIV testing. HIV antibody (Ab) prevalence was 1.8% (17/953). Four false positive rapid tests were identified: two antibody and two p24 antigen (Ag) reactions. Of participants diagnosed as HIV Ab positive, 2/17 (12%) were recent seroconverters based on clinical history and HIV antibody avidity test results. However, none of these were detected by the p24 antigen component of the rapid test kit. There were no other true positive p24 Ag tests.

https://www.cdc.gov/hiv/testing/clinical/index.html
2018
CDC recently published research findings that estimate the window period for 20 U.S. Food and Drug Administration (FDA)-approved HIV tests. The study showed that laboratory testing using antigen/antibody tests detects HIV infection sooner than other available tests that detect only antibodies. If a person gets a laboratory-based antigen/antibody test on blood plasma less than 45 days after a possible HIV exposure and the result is negative, follow-up testing can begin 45 days after the possible HIV exposure. For all other tests, CDC recommends testing again at least 90 days after exposure to be sure that a negative test result is accurate.

Bentsen C Performance evaluation of the Bio-Rad Laboratories GS HIV Combo Ag/Ab EIA, a 4th generation HIV assay for the simultaneous detection of HIV p24 antigen and antibodies to HIV-1 (groups M and O) and HIV-2 in human serum or plasma. Journal of Clinical Virology, S57-S61, 2011

Nick S Sensitivities of CE-Marked HIV, HCV, and HBsAg Assays. Journal of Medical Virology, S59-S64, 2007

Eshelman S Detection of Individuals With Acute HIV-1 Infection Using the ARCHITECT HIV Ag/Ab Combo Assay. Journal of Acquired Immune Deficiency Syndromes, 121-4, 2009

Speers D et al. Combination assay detecting both Human Immunodeficiency Virus (HIV) p24 antigen and anti-HIV antibodies opens a second diagnostic window. J Clin Microbiol 43:5397-5399, 2005

Ly TD et al. Evaluation of the sensitivity and specificity of six HIV combined p24 antigen and antibody assays. J Virol Methods 122:185-94, 2004

2020 http://www.bhiva.org/ https://www.bhiva.org/file/5dfceab350819/HIV-Testing-Guidelines.pdf
Recommendations (Grade 1A)

• Clinic policies and patient information regarding the HIV test window period should be based on 99th percentile estimates; where a test is undertaken sooner than this time interval, window period data should be used to counsel patients as to the likelihood of a false-negative result.

• Fourth-generation laboratory tests reliably exclude HIV by 45 days post-exposure, and this should be the window period applied when utilising these tests.

• Third-generation laboratory tests reliably exclude HIV by 2 months post-exposure, and this should be the window period applied when utilising these tests.

• POCTs reliably exclude HIV by 90 days post-exposure, and this should be the window period applied when utilising these tests.

2015 WHO http://apps.who.int/iris/bitstream/handle/10665/179870/9789241508926_eng.pdf;jsessionid=1F192FECF734A0DE7E2520864984AE63?sequence=1
In many settings post-test counselling messages recommend that all people who have a
non-reactive (HIV-negative) test result should return for retesting to rule out acute
infection that is too early for the test to detect. However, retesting is needed only for HIV-negative individuals who report recent or ongoing risk of exposure. For most people who test HIV-negative, additional retesting to rule out being in the window period is not necessary and may waste resources.

Generation 1/2/3

Pilcher CD et al. Performance of Rapid Point-of-Care and Laboratory Tests for Acute and Established HIV Infection in San Francisco. PLOS ONE, 2013.

Branson BM State of the art for diagnosis of HIV infection. Clin Infect Dis 45:S221-225, 2007

Coombs RW Clinical laboratory diagnosis of HIV-1 and use of viral RNA to monitor infection. In Holmes KK (editor), Sexually Transmitted Diseases. New York: McGraw-Hill, 2008

Maldarelli F Diagnosis of Human Immunodeficiency Virus infection. In Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases (sixth edition). Philadelphia: Elsevier Churchill Livingstone, 2004

Parry JV et al. Towards error-free HIV diagnosis: guidelines on laboratory practice. Comm Dis Pub Health 6:334-350, 2003

3rd gen testing accuracy Perry KR et al. Improvement in the performance of HIV screening kits. Transfus Med 18:228-240, 2008
« Last Edit: April 21, 2020, 11:56:31 am by Jim Allen »
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You can read about HIV prevention here:
HIV prevention
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PEP and PrEP

Offline ClereR

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Re: Clarity
« Reply #4 on: April 21, 2020, 11:55:31 am »
Thanks Jim  :)

Offline Jim Allen

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Re: Clarity
« Reply #5 on: April 21, 2020, 11:57:28 am »
You're welcome.
HIV 101 - Everything you need to know
HIV 101
Read more about Testing here:
HIV Testing
Read about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read about HIV prevention here:
HIV prevention
Read about PEP and PrEP here
PEP and PrEP

Offline ClereR

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Re: Clarity
« Reply #6 on: October 13, 2020, 11:28:16 am »
Dearest Jim

After the below conversation with you  I've had one to many hiv tests. No further exposures occurred than what was mentioned in my initial post.

I did the following test
May - Rapid test
June- 4th generation combi
Aug - Rapid
Sep- Rapid t
Last test been Oct 5th- 4th generation combi

All these tests are non reactive however I have been working with my doctor and specialists tirelessly and it we can't get to bottom of my symptoms. 

I've read numerous posts that symptoms overule test results however I'm very much concerned with the deteriorating state of my health
I've had :
Numerous mouth ulcers
Red spots on inner cheeks that come and go
Blood filled pockets on inner cheek that rupture within a couple of seconds after developing
Debilitating leg cramps./thumb joint pains
Nausea /headaches
Pimples on face that suddenly leave visible blemishes
A rash had appeared out of nowhere
Currently blood like dots /rash on leg.  Looks like bruises
Palette irritation
Yellowing of teeth
Unexplainable swollen lymph nodes in neck /under chin and behind earts. This was confirmed by surgeon as we did scans .
Back and chest pains.
Im loosing so much muscle that im feeling like a deflating jelly fish . The fatigue I have is unbearable.


I'm finding myself here once again. I want to consider my test results as conclusive however I'm really finding it hard to considering all these recent challenges I'm finding myself it. One would think that it's psychological,but for someone who literally hasn't has a need to visit the doctor for almost 3 years prior to all this is very weird to me   

I'm living in a country where hiv is so prevalent and really my concern is what are the probabilities that all these tests would have missed an early infection.

Immune responses are different so by saying this at this stage what are the possibilities of a test coming up POSITIVE .

Ive been thinking about my suspected exposure, say there was a condom break and the insertive partner chose not to tell .

What makes me more suspicues is that I had seen a daily tablet case during the time I spent with him and there was one "big Blue pill for each day of the week . This concerns me even further. Should have probed a bit more.  Well don't know how this have helped,  irrelevant but just mentioning .

My fear really is that missing an opportunity to start treatment early if need be

For individuals infected with hepatitis how long does it take.for antibody to produce . I'm now thinking of all sorts of possibilities .

Offline Jim Allen

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Re: Clarity
« Reply #7 on: October 13, 2020, 12:24:16 pm »
Hiya.

The only real HIV risk was sas sex with your BF. You have since then tested 3 months post the last possible exposure and, the result was non-reactive (negative). This is a conclusive result unless you have had ongoing exposures not mentioned here.

Symptoms don't overrule test results and, the most common initial HIV symptoms is none whatsoever or nothing noticeable at least. Regardless, if you have or don't have symptoms a non-reactive approved HIV test result 3 months post last posible exposure is conclusive.

I wish you well, I hope you feel better soon however, please don't post about this again as it will lead to a temporary ban. Best. Jim

Quote
Anyone who continues to post excessively, questioning a conclusive negative result or no-risk situation, will be subject to a four week Time Out (a temporary ban from the Forums). If you continue to post excessively after one Time Out, you may be given a second Time Out which will last eight weeks. There is no third Time Out - it is a permanent ban. The purpose of a Time Out is to encourage you to seek the face-to-face help we cannot provide on this forum.

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