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I'm a 26 yrs old female, I had this encounter with this guy…

Hi, I'm a 26 yrs...
Hi, I'm a 26 yrs old female, I had this encounter with this guy who I know from a while now and we had always been involve and we see each other some times when we both are alone and single just to chill and etc, everything was ok till the last time I had sex with him. 1 month ago the health department called me saying I need it to go and get tested for hiv cuz 1 partner I had sex with has tested positive. It wasn't difficult for me to find out who was that person cuz Im not a promiscuous woman or anything like that and I knew it was him so I called him and he say I'm sorry that he didn't know and that he let the health dep. contact me cuz he just didn't know how to tell me, My world stopped at that moment, then I started thinking cuz I been feeling unwell for the past 3 months, I had this rash on my torso along with loss of appetite and nauseas for about a week at 1st like 3 weeks after the exposure with this guy, I also noticed my period was coming really irregular, I used to have a 5 days period and since 2 months back I been having a 1 day period, I also been having a lot of tingling on my hands and feets, really cold hands and feets all time, I also been having this like flu symptoms for over a month now with sore throats. And all this symptoms I been noticed them before I founded out he was + but know I know where all this is coming from , there is not way I don't have this, we had vaginal & anal sex and he finished inside with the anal sex, and I had blood on my anus at the end which it means his semen got in contact with my blood what IT means I'm + too. so I went to get tested, I did 3 tests at exactly 3 months post-exp. , I did a PCR RANA which was undetectable or under 20copies/ ml, I did a RNA QUALITATIVE which came back negative, and I did and antibodies Multispot test who came back neg. as well, so I have some questions:
1- I have understood viral load is high at the beginning and then goes down, it is possible that viral load is down till less than 20 copies/ml at 3 months post-exposure? I had also understood that when it goes down is because antibodies fight the infection, so why then antibodies are not detected on my test?
2- RNA QUAL TEST is supposed to look for the virus itself and not for the antibodies and is accurate after 3 weeks post exposure and ahead, what is the possibility that at 3 months this test can't detect the virus, does the virus hide to this point that it can't be detected?
3-how accurate is the Multispot antibodies test? I never heard about this test before, but I heard is used as confirmatory test and that is even more accurate than Western blot test , its that true?
4-Why if new guidelines is 3 months conclusive and 6 month is old guidelines, why people in high risk are recommended to re-test at 6 months? I think we all are in high risk when it comes to having sex without protection. I know I have this but obviously it's not showing at my 3 months post-exposure, so what's the point on saying it is conclusive when is not?
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Answered in 39 minutes by:
8/26/2017
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19,748
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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Hello from JustAnswer. This is Dr. Love.

Symptoms are never an accurate method for diagnosis of an HIV infection. Every symptom that occurs in an early HIV infection can occur from a variety of other conditions. So, your statement that "there is not way I don't have this" is not accurate. It can be said that symptoms are worrisome, but they defintiely cannot be used to make the diagnosis. Testing is the only accurate method for making a diagnosis of HIV.

As for your specific questions.

1. Yes, viral load is higher initially and then drops, but once it is detectable, it does not drop to an undetectable level spontaneously. There are many people on medicines for HIV in whom the viral load can become undetectable, but it does no happen spontaneously.

There also are some people that do not manifest a detectable a viral load initially, called long-term non-progressors. Actually some long-term non-progressors have an undetectable viral load and some have a minimal viral load. But the people that are undetectable do not have a detectable viral load and then become undetectable. They are undetectable throughout the early disease. The only way to determine that these people are infected is a positive antibody test. However, the long-term non-progressors also do not have any of the symptoms associated with an HIV infection, because the virus is not growing, so this possibility is not a concern in someone with worrisome symptoms.

2. Both the viral load test and the RNA qualitative test can miss the virus only in the long-term non-progressors that I noted above. These cases are rare, occurring in only one in 200-500 cases of HIV infection. But this rate is also the possibility that these tests will miss the virus. It is not that the virus "hides." In long-term non-progressors, the virus is truly not replicating, and that is why the tests do not detect it.

3. The Multispot test is extremely accurate. It is not that it is more accurate than the Western Blot, as the Western Blot test is extremely accurate. The advantage of the Multispot test is the differentiation of antibodies of HIV-1 vs HIV-2.

4. The reason that the new guidelines is that 3 months is conclusive is that there is no conversions after 3 months using sensitive antibody tests at 3 months. The old tests were not as accurate at 3 months, which is why repeat testing at 6 months was recommended. Even after the new sensitive test was developed, the guidelines continued to recommend testing at 6 months, because a long time of experience with the new test was necessary before the recommendations were changed. Although there are multiple guidelines available, most of the guidelines do not recommend testing at 6 months, even for high risk individuals.

For example, look at http://www.hivguidelines.org/pep-for-hiv-prevention/non-occupational/#tab_6. About 2/3 down the page, the guideline explains that HIV testing at 6 months is no longer recommended. It also notes that seroconversion after 3 months has not been described since 1990.

It is possible that there is a conservative guidelines out there that still recommends testing at 6 months based on the historical experience from decades ago. But not only are most guidelines no longer recommending testing at 6 months, there are some guidelines that are no longer recommending testing at 3 months (or 12 weeks). For example, the UK guideline no longer recommends testing at 3 months.

So, in your case, a negative viral load test, a negative RNA qualitative test, and a negative antibody test at 3 months is conclusive evidence that you do not have HIV, regardless of what symptoms you are having.

If I can provide any clarification, please let me know.

Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19,748
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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Customer reply replied 10 months ago
Thank you Dr. D. Love for your response, I just can't see in my mind that I'm - when I had all kind of high risk exposure with a HIV + person I don't know if you understand my point, but my symptoms are so extremely telling me I have it and I know my body, and its not anxiety or anything similar cuz as I had explained before knowing this person status I wasn't even thinking it could be hiv, one more evidence is this one, before I had that with him I had a boyfriend for over 1 year and at the time I had that with this guy my boyfriend and I were separated for over a month, so after the risk encounter with this guy t my boyfriend and I talked and we came back together, well he started having ulcers on his penis while I was having my rash but like I said I never through it could be hiv, then when all this happened I talked to my boyfriend at the time and told him what was going on, cuz it was about a health issue and he need it to know, since then he us been having headaches and etc, I really think I also gave hiv to him as well. And besides that I have a friend who tested neg. at 3 months and tested positive at 5 months?? and he lives in NJ and he doesn't have any health condition that could it delay his hiv results at 3 months, so as you can imagine my concern is accurate , pls doctor be honest with me , I don't feel my body the same I'm tired all time, I have this flu that I been taking a lot of medicines for it and its not going away, so Pls doctor as per my high risk with and hiv positive person I have it right? I have to check again at 6 months to confirm that? which I would do anyways but I would like your most sincere recommendation like if I were your daughter, I'm only daughter, and I'm really scared and concern pls help me , there is other test I could take? what about the DNA, would the DNA be more accurate than the RNA? also the rash I had I went to the doctor for it 3 times, and all creams they gave me wasn't taking the rash away which when I read the rash per hiv acute infection its really difficult to treat, I took my diagnosis since then to be honest, I have this bad feeling that all my symptoms is cuz I have it and my test will be positive in couple of months.
Customer reply replied 10 months ago
about the viral load, if my symptoms like the rash it was cuz of the acute infection, that means my viral load was high by then, which it means that it couldn't go down till less than 20 copies at 3 month right. The way I was thinking it was like maybe the virus hides inside of the cells cd4 of something like that, like maybe the virus its not spread in my whole body just yet and maybe its working inside my white blood cells or something and then maybe will spread on all my body and then my antibodies will react to it? obviously I don't really know anything about it but that's some option I been thinking on, and how long seroconversion takes? can I be seroconverting for 2 months now?? cuz my symptoms are been following one following another, like the rash 1st with loss of appetite and etc, then sore throats for over a week, then period changes, then this flu that is taking forever, its that normal? it could be that my seroconversion is going really slow cuz my viral load is really low and that's why antibodies hasn't show yet cuz the virus it's not attacking agresively and is taking my body longer to response?
Customer reply replied 10 months ago
1 more thing if I had symptoms it was cuz my viral load was high at the time, or could a person go thought seroconversion having symptoms with an undetectable viral load?
Customer reply replied 10 months ago
the acute and early stage of HIV infection (first 6 months) --this I tooked from the site you sent me, which it means that seroconversion could take up to 6 months, which could explain my symptoms this long?

I understand your position, but many poeople have regular sex with an HIV positive partner and do not get infected. When we follow discordant heterosexual couples, about 5% of teh uninfected partners get infected each year, even if condoms are not used and there are no HIV medicines being taken. But that also means that 95% do not get infected. In these studies, the couples were having regulqar penile-vaginal sex, and obviously anal sex would increase the risk, but even with anal sex, many do not get infected over the course of a year.

There is no test that is more accurate.

Seroconversion is different than having symptoms. Seroconversion is changing from being HIV antibody negative to being HIV antibody positive. It is possible to have seroconversion without a detectable viral load - the long-term non-progressors that I noted above.

However, I think that you are really asking whether someone can have symptoms of an acute retroviral syndrome and an undetectable viral load. And no, if there are acute retroviral symptoms, then there would be a detectable viral load.

No, that is not what the site says. The phases of HIV infection is different than seroconversion. The site says very clearly that there has not been a case of seroconversion after 3 months since 1990. That is different than saying that the acute or early phase of HIV infection is the first 6 months.

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Customer reply replied 10 months ago
Thank you doctor for all your answers actually on the health department they had told me that the 4th gen duo test are no longer available with them cuz all the false positive sit was given , so they did a EIA test, its that a 3rd or 4th gen test? and so to finish the conversation if I had symptoms of acute infection its cuz my my viral load was high at the time and there is not way that now 3 months after that's undetectable right?? so why my boyfriend at the time had the ulcers on his penis when for over a year he never had something like that? he went to doctor and they only did std testing and everything was ok , so I'm thinking that if he was going to seroconversion obviously he tested neg at the time, otherwise I don't see other reasons for our symptoms doctor, its like we were together long time enough and I had this with this guy and we start getting all this symptoms, I don't know if that make sense to you? Obviously I think I got hiv from this guy and gave it to my boyfriend at the time.

The only differnece betweent he thrid and fourth generation test is the addition of the test for the p24 antigen. The antibody component of the test is the same in the third and fourth generation tests.

Correct, if your symptoms were from acute HIV infection, then your viral load would not be undetectable at this point.

I would need to know more information about your boyfriend to be able to comment upon his symptoms. He would need to post a separate question.

No, it is not obvious that you gave HIV to your boyfriend, because your tests are negative, and as I said above every symptoms that can occur during the acute period of an HIV infection can be caused by pother conditions. You would need further evaluation of the symptoms to discover the cause of these symptoms.

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Customer reply replied 10 months ago
Thank you doctor, so which explination would you give if I came back here with you in 3 more months telling you I had tested positive by then?

There is no need to discuss hypothetical situations that have not happened since 1990.

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Customer reply replied 10 months ago
ok doctor, I will try to stay positive and will re-test at 6 months just in case, thanks for all your help!!!!

You are very welcome.

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Customer reply replied 10 months ago
Hi Dr. Love, I hope you doing well, I have another question, are you avaliable now?

I am back online now.

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Customer reply replied 10 months ago
Dr. How you doing today. Ok since my sore throats and the flu its not going away and Im feeling with no energy that all!! I went to the clinic 2 weeks ago and they did all kind of blood tests and everything was ok, what it brings my mind back to hiv, can I pls send you the pictures of the rash I had and you can give me a better advise, Im confident that I got hiv doctor
Customer reply replied 10 months ago
I can't get just believe on those hiv tests when I'm having all the symptoms, I hope you understand my point. here are my symptoms that I never had before
1-Rash, starting on my back 1st an then my my whole torso
2-loss of appetite & nauseas
3-menstual changes
4-flu like symptoms with sore throats for over 1 month
5-feeling sleepy all time & tired even when I have enough rest.
6-like cramps pain with-out period been present
7-mouth ulcers (I also have pic of that)
**tell me and I will send you all pictures and then you could understand my worry better, what else could be when everything else is testing ok**

I will be glad to look at a picture, but it is impossible to diagnose HIV based on a picture of a rash. Just as every symptom of an early HIV infection can be due to another condition, the rash also can be due to other conditions.

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Customer reply replied 10 months ago
that's the thing doctor, I went 3 times to the doctor because the rash wasn't going away, it wasn't a regular rash easy to treat, they sent me 3 different creams and no-one worked finally the rash went off by itself, and I had the rash along with loss of appetite and nauseas, I been healthy all my life I know this wasn't normal,, even the doctor didn't know were the rash was coming from

That does not mean that it is HIV. There are many people with rash of uncertain origin that is not due to HIV.

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Customer reply replied 10 months ago
OK RASH ok, but other symptoms, the body response is clear when something is wrong. I will send u the pics in a min

Every symptom - every symptom - that occurs in an early HIV infection can occur from other conditions.

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Customer reply replied 10 months ago
Take a look
Customer reply replied 10 months ago
The last one I had,,I been having all this little red points all over my body that comes and goes
Customer reply replied 10 months ago
the first rash I had in my torso, started with 1 on my low back, and then I had more on my upper body and then the reddish little points came out on my torso , and then the rash took like over a month to disapear cuz the creams weren't working, and then after that I keep having the little points , the only thinh I know Dr. is Tthat I don't belive on coincidences I been healthy all my life and if all my other tests results are coming ok, I can only think on hiv acute infection., and rash along with other symptoms are typicall first symtpoms of hiv

The appearance on the images could be due to many conditions, but it is most likely from eczema.

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Customer reply replied 10 months ago
I don't think so eczema doesn't come with other symptoms, I'm gonna prove you Dr, that all those tests are not accurate that all and that seroconversion after 3 months it does still happening-unfortunelly.
Customer reply replied 10 months ago
there is not other reason for my symptoms, believe it.

I have already given you a reference on the subject, but if you do not want to believe it, that is your choice.

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Customer reply replied 10 months ago
the references are not coordinating with how I been feeling, I'm sorry but that's the reality. I will show you my test results at 3 more months and then we'll see.////thanks

OK

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Customer reply replied 10 months ago
Hi again doctor Here is some proove that ppl still testing positive after 3.months.. pls see attached. I took this from poz forum where people share their experiences and this guy tested neg at 3 months and poz after..

I am not going to respond to non-medical documentation.

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