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1451936 tn?1294898715

Anxious even after test at 84 days - An exposure is an exposure!

Dear Joggen, friends
I find myself anxious after a 84 day test (4th generation hiv test for Hiv 1/2 antibody and Hiv 1 antigen).
My risk is deep kissing and saliva exchange. I had symptoms at some 7 days after exposure (rash) and diarrhea + oral ulcers all within the first 2-3 weeks following exposure.  
I subsequently tested at 25 days, 42 days, 56 days and 84 days, all AG/AB 4th Generation tests, with a negative result.  I am now also in psychotheraphy, am taking Zoloft and also lorazepam for my anxiety.
The reason I am so concerned - there is a theoretical risk and "an exposure is an exposure".  Many resources, nurses, clinics, Dr. BOB on the body.com advise taking a 6 month test for a definite exposure - they even go on to say tha the CDC states the same, and it is the Gold Standard. When one reads this, it does not invalidate our test results, but it surely leads to confusion and further anxiety, as when does one know how much testing is absolutely definite and enough. It is logical tha one must consider exposure history and evaluate risk, but isn't a possible exposure, a theoretical exposure, and a definite exposure still an exposure, so should warrant one conclusive guideline to ensure that all in such a predicament test conclusively, and thoroughly, so as not to avoid any chance of error / miss - as we cannot further spread the virus, pass it along to our wives and kids, girlfriends, boyfriends etc.  Yes, I am still a bit anxious and seek your advise / your thoughts / and your reasoning.
Would appreciate a response.
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Avatar universal
Not a problem- I think we're both saying essentially the same thing. It was the other poster who hijacked the thread.
Helpful - 0
Avatar universal

Of course, and entirely proper of you to just delete the discussion between the other poster and I. And my apologies, you are entirely correct that such discussions have no place here. Thanks for catching and rectifying my mistake.
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Avatar universal
This forum does not get involved in these type of discussions raised by worried-wells, because they always split hairs and miss the main point. If somebody searches the literature hard enough they will find an exception that happens to 1 in 1000 people- the exception that proves the rule. The problem is that worried wells always dwell on the exception and not the rule. I don't allow this forum to discuss these kind of papers because it inevitable freaks out worried wells. I agree with your point that the cited paper has nothing to do with the original poster and is a thread hijack, which is why I deleted the discussion.
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Avatar universal
This is an HIV Anxiety Support Group. If you want to discuss the literature then I suggest you find a more appropriate forum. Case reports such as the one that you cited are not relevant towards risk assessment and are not appropriate for this group. This thread is closed for further discussion as the original poster's concerns have been addressed.

---------------------------------------THREAD CLOSED---------------------------------

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Avatar universal
When dealing with Modern ELISA Antibody assays which are the Gold Standard for HIV Testing , a NEGATIVE at 3 months is CONCLUSIVE. A NEGATIVE at 6 Weeks is HIGHLY INDICATIVE and UNLIKELY to change.
-JC-
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1451936 tn?1294898715
Thanks Jean. So all tests, rapid, oralquick, 3rd gen, 4th gen are all conclusive at 12 weeks?
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Avatar universal
The DUO test is indeed a combination assay (3rd Gen Ag/Ab). These tests are advantageous in detecting EARLY infection <4 Weeks. After that point, due to antibody production and antigen suppression, (if an individual is actually infected), the Ag component would be negative(based on individual titer) and the Ab would be positive.

In essence, if a person has been infected more than 4-6 weeks, there is NO advantage of a DUO over s 3rd Gen Mono Ab test.The accuracy of each of the DUO's individual tests are extremely accurate when utilized at their respective appropriate times. With infections <4Weeks,The science/research implies we would miss more actual infections when using the 3rd Gen mono Ab assay as opposed to the the DUO.
-JC-
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1451936 tn?1294898715
Dear Joggen,
I read on the Int'l form where a questioner asked:
I heard some people saying that the DUO test are not as reliable as the third gen tests.This is not true right?
I thought the 4th gen test is a mix of the 3rd gen test with a AG element also.
Sorry for my badgering with perhaps ridiculous anxiety ridden questions.
Would appreciate your 2 cents / thoughts.
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Avatar universal
No problem at all- I hope it was helpful. You have done the right thing by seeking professional care and I'm glad it's starting to help.

J.
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1451936 tn?1294898715
Thanks again. And sorry to bother you with my anxiety and irrelevant and irrational obsession.  I am trying to cope and the good thing is that i am seeking help for anxiety and am on medication, which is now helping a bit.
You do good work Joggen and your voice and experience benefits many.
Appreciate it.
Helpful - 0
1469227 tn?1293110880
Hi dd816, maybe my story can help you a bit. I had unprotected sex six months ago. A couple of weeks latter, I began to have symptoms, enlarged lymph nodes, pain in the legs, night sweats, some rash, shaking hands, an herpes-like infection in my tongue. I couldn't sleep not work or live for months. However all my tests have been negative (11 of them, including a 4th generation test at three months, and the last one at six months). Although I still a bit concerned by all the symptoms, it seems that anxiety can cause a lot of damage. You can't diagnose HIV by symptoms, and you didn't had a risk. I'm also taking psychiatric medicine to cope with all this situation. Truly you are safe.
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Avatar universal
That's look at it another way. You have had 4 FOURTH GENERATION tests, which test for both the presence of ANTIGEN and ANTIBODY. The logic of the fourth generation tests is that antigen is present in blood earlier than antibody; testing for both makes the tests more SENSITIVE at an earlier time than simply antibody tests. At the time that you took your first 4th generation test (25 days), an infected person would almost certainly have either antibody or antigen present in their blood, and it is IMPOSSIBLE that both of these would be absent at 42 days, 56 days, and 84 days in an infected person. It doesn't matter what a person's risk is- even if somebody injected HIV infected blood into their vein, the negative 4th generation test result at 25 days would still be solid proof against infection. The 4th generation tests essentially shorten the window period to 4 WEEKS.

The controversy regarding three months vs. six months applies to THIRD GENERATION tests (antibody ONLY) and isn't something you need to be concerned about. The test you took was so SENSITIVE that you did not gain any additional accuracy by repeating the test- the first test should have been MORE than sufficient. I am surprised that a health care provider agreed to test you in the first place let alone keep testing you over kissing- the only thing that accomplished was adding FUEL to your anxiety by validating your fears- you have been SEVERELY OVERTESTED over this and need to stop the cycle NOW.
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1451936 tn?1294898715
Joggen,
I understand what you are saying and I am taking this up with my therapist.  In fact i just changed my meds from Lexapro to Zoloft, more due to availability issues in the country in which i reside.  This will take 2-3 weeks to take full effect, but i think my anxiety and guilt need attention, and therefore i am seeing such support.
Is a 3 month negative (12 week) only then conclusive for a low risk exposure. The reason I am stuck on this is that i had symptoms following my exposure,  and apparently i am attributing these symtoms to the so called "no risk" exposure and constant questioning it, despite there being no rational justification to all this train of thought, and as you rightfully said, advise from well renowned doctors on these forums.
My question is - is testing at 12 weeks conclusive, no risk, low risk, or high risk - would 12 weeks, 84 days, give one a conclusive result? I just want to move on with family life, and this uncertainty is not allowing me to do this, which I am also taking up in my therapy. Thanks again.
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Avatar universal
"The reason I am so concerned - there is a theoretical risk and "an exposure is an exposure"."

When I read your post it is very clear that your thinking on this is completely DISTORTED and ILLOGICAL. I am familiar with the advice that Dr. Bob gives on The Body regarding a DEFINITE exposure- what that means is somebody who had UNPROTECTED SEX with a CONFIRMED POSITIVE partner. You don't even REMOTELY qualify under that category- KISSING A GIRL is NOT an EXPOSURE to HIV.  Saliva is NOT INFECTIOUS with respect to HIV and that's all there is too it: you could have drunk a gallon of an HIV-infected woman's saliva and had absolutely NO RISK WHATSOEVER for HIV infection. Since saliva is NOT infectious, kissing CANNOT even be considered a THEORETICAL risk. Your mind has taken something completely INCONSEQUENTIAL with respect to HIV infection and has DISTORTED it to equate to ESTABLISHED routes of infection such as unprotected vaginal or anal sex.

The other comment I wanted to make is that you've been posting on here since September, including posts to Dr. Cummings and Dr. Handsfield on the HIV Expert forums. The question you need to ask yourself (or better yet work with your therapist on) is why can't you accept the advice of RENOWNED professionals in the field of HIV testing who BOTH TOLD YOU UNEQUIVOCALLY that you DON'T HAVE IT based on your test results. Your internet reading on HIV has only CONFUSED you; STOP trying to figure this out by taking statements from websites OUT OF CONTEXT and TRUST the professionals who have DECADES of combined education and experience in this field.

I am glad that you are in psychotherapy and hope that you have included the advice that you have received from Dr. Cummings and Dr. Handsfield in your discussions with him/her to provide proper context. I suspect the main reason that you have been resistant to their advice is GUILT, perhaps due to cultural/family background, and I suggest that you discuss this with your therapist as well.
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