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Further testing despite results?
Doctor I hope you can shed some light on
My situation. I am a young male who has had multiple exposures overseas over the past few years. My latest exposure was in japan in October of '09. These unfortunately were unprotected sex. To make it short, I have had an Elisa test at 3,5,7,8 months(mix of Elisa by quest, ICMA by labcorp, and oraquick advance)post last exposure, in which all were negative. I also had a negative pcr dna hiv-1 at six months, an hiv-1 Rna at 8 1/2 months that were negative. I continue to have symptoms of white tongue which have improved with an antifungal mouth rinse. I am concerned that my testing may have missed a strain that is more prevalent overseas. 1) is it possible that with all of the tests I have had, that they could have missed any Hiv? 2) if I would be HIV positive, would my RNA level be detectable > 48 copies at 8 1/2 months. 3) Would any of these tests be able to pick up "N,O,CRF" strains? 4) is there any other testing in the US that I could do to eliminate the rare possibility of the rare/missed strain? I appreciate your input on my situation, and look forward to your response.
My situation. I am a young male who has had multiple exposures overseas over the past few years. My latest exposure was in japan in October of '09. These unfortunately were unprotected sex. To make it short, I have had an Elisa test at 3,5,7,8 months(mix of Elisa by quest, ICMA by labcorp, and oraquick advance)post last exposure, in which all were negative. I also had a negative pcr dna hiv-1 at six months, an hiv-1 Rna at 8 1/2 months that were negative. I continue to have symptoms of white tongue which have improved with an antifungal mouth rinse. I am concerned that my testing may have missed a strain that is more prevalent overseas. 1) is it possible that with all of the tests I have had, that they could have missed any Hiv? 2) if I would be HIV positive, would my RNA level be detectable > 48 copies at 8 1/2 months. 3) Would any of these tests be able to pick up "N,O,CRF" strains? 4) is there any other testing in the US that I could do to eliminate the rare possibility of the rare/missed strain? I appreciate your input on my situation, and look forward to your response.
MEDICAL PROFESSIONAL
Hello again
I'll go through your questions - forgive the capital letters but this Forum doesn't have any other way of differentiating my responses from your questions.
Thank you for answering. I FULLY understand your statements, I just have never been ill like this for so long. I have had to take and advil or two each day for the last 7 months to control the irritation of my throat which concerns me. So to be clear--sorry 1) the series of tests I had would detect any CRF's (a/e,etc) as well any odd strain known throughout the world?
YES - THE SERIES OF TESTS YOU HAVE HAD IS "FULL" IN THE EXTREME
2) even if tests not designed for that subtype(s), IF there was ANY HIV, would tests have shown some weird result so as to investigate further?
I THINK WITHOUT DOUBT THAT THE SERIES OF TESTS YOU HAVE HAD WOULD DEFINITELY IDENTIFY ANY OF THE KNOWN HIV STRAINS. FOR EXAMPLE, THE INSTI TEST WHICH IS AN EXCELLENT QUICK AND EASY MODERN 3RD GENERATION HIV TEST IS NOT LICENSED IN THE EU FOR LOOKING FOR SUBTYPE O - BUT THAT IS AN ORGANISATIONAL THING TO DO WITH THE REGULATORY PROCESSES - EVEN THOUGH NOT APPROVED, THE DATA SHOWS THAT IN 22 OUT OF THE 23 STUDIES LOOKING FOR SUBTYPE O THE INSTI TEST SUCCESSFULLY AND CORRECTLY IDENTIFIED IT. THUS REGULATION DOES NOT ALWAYS MATCH UP WITH REALITY OF PERFORMANCE.
3) is it correct that if available, a p24 test at eight months would be pointless because there would no longer be detectable levels of it?
NO - COMPLETELY FALSE. P24 IS A PROTEIN PRODUCED BY HIV 1 - BUT THE KEY IS THAT IT IS PRODUCED IN VARYING QUANTITIES THROUGH THE COURSE OF THE ILLNESS. IN THE INITIAL PHASE WHICH FOR ARGUMENTS SAKE I AM GOING TO DESCRIBE AS THE FIRST THREE MONTH POST INFECTION, VIRAL LOAD - THE AMOUNT OF VIRUS IN THE BLOOD STREAM ETC IS MASSIVE - RUNNING LITERALLY INTO MILLIONS OF COPIES PER ML OF BLOOD. IN PARALLEL WITH THIS THE AMOUNT OF P24 SOARS ALSO. AS THE THREE MONTHS OR SO DRAWS TO A CLOSE THE AMOUNT OF VIRUS WILL NATURALLY (USUALLY) DECLINE TO MAYBE BETWEEN 20,000 TO A FEW HUNDRED THOUSAND COPIES PER ML AND USUALLY THIS WILL CONTINIUE TO DECLINE. ONE RECENT NEW HIV POSITIVE PATIENT OF MINE HAD AN INITIAL VIRAL LOAD OF 750,000 WITHIN THE FIRST MONTH AND THIS COLLAPSED TO 1500 AT MONTH 13. AS THE VIRAL LOAD DROPS, SO DOES THE P24. BUT, UNLESS THERE IS COMPLETE SUPPRESSION OF VIRAL LOAD BY TREATMENT, THERE WILL ALWAYS BE P24 PRESENT - ALBEIT IN SMALLER AMOUNTS.
4) I have been bruising VERY EASY with nosebleeds as well, and have lost 15lbs, which is not normal for me, do you have any suggestions of any other stds that may be cause(I had full negative STD panel at six months), or any thoughts on direction I should take?
THE ONLY THING I WOULD SUGGEST IS DISCUSSING WITH YOUR DOCTOR THE POSSIBILITY OF OTHER DISEASES - I'M NOT GOING TO GUESS THEM HERE - YOU NEED TO SEE AND DISCUSS WITH A DOCTOR.
Again, thank you for your time and attention.
VERY WELCOME
I'll go through your questions - forgive the capital letters but this Forum doesn't have any other way of differentiating my responses from your questions.
Thank you for answering. I FULLY understand your statements, I just have never been ill like this for so long. I have had to take and advil or two each day for the last 7 months to control the irritation of my throat which concerns me. So to be clear--sorry 1) the series of tests I had would detect any CRF's (a/e,etc) as well any odd strain known throughout the world?
YES - THE SERIES OF TESTS YOU HAVE HAD IS "FULL" IN THE EXTREME
2) even if tests not designed for that subtype(s), IF there was ANY HIV, would tests have shown some weird result so as to investigate further?
I THINK WITHOUT DOUBT THAT THE SERIES OF TESTS YOU HAVE HAD WOULD DEFINITELY IDENTIFY ANY OF THE KNOWN HIV STRAINS. FOR EXAMPLE, THE INSTI TEST WHICH IS AN EXCELLENT QUICK AND EASY MODERN 3RD GENERATION HIV TEST IS NOT LICENSED IN THE EU FOR LOOKING FOR SUBTYPE O - BUT THAT IS AN ORGANISATIONAL THING TO DO WITH THE REGULATORY PROCESSES - EVEN THOUGH NOT APPROVED, THE DATA SHOWS THAT IN 22 OUT OF THE 23 STUDIES LOOKING FOR SUBTYPE O THE INSTI TEST SUCCESSFULLY AND CORRECTLY IDENTIFIED IT. THUS REGULATION DOES NOT ALWAYS MATCH UP WITH REALITY OF PERFORMANCE.
3) is it correct that if available, a p24 test at eight months would be pointless because there would no longer be detectable levels of it?
NO - COMPLETELY FALSE. P24 IS A PROTEIN PRODUCED BY HIV 1 - BUT THE KEY IS THAT IT IS PRODUCED IN VARYING QUANTITIES THROUGH THE COURSE OF THE ILLNESS. IN THE INITIAL PHASE WHICH FOR ARGUMENTS SAKE I AM GOING TO DESCRIBE AS THE FIRST THREE MONTH POST INFECTION, VIRAL LOAD - THE AMOUNT OF VIRUS IN THE BLOOD STREAM ETC IS MASSIVE - RUNNING LITERALLY INTO MILLIONS OF COPIES PER ML OF BLOOD. IN PARALLEL WITH THIS THE AMOUNT OF P24 SOARS ALSO. AS THE THREE MONTHS OR SO DRAWS TO A CLOSE THE AMOUNT OF VIRUS WILL NATURALLY (USUALLY) DECLINE TO MAYBE BETWEEN 20,000 TO A FEW HUNDRED THOUSAND COPIES PER ML AND USUALLY THIS WILL CONTINIUE TO DECLINE. ONE RECENT NEW HIV POSITIVE PATIENT OF MINE HAD AN INITIAL VIRAL LOAD OF 750,000 WITHIN THE FIRST MONTH AND THIS COLLAPSED TO 1500 AT MONTH 13. AS THE VIRAL LOAD DROPS, SO DOES THE P24. BUT, UNLESS THERE IS COMPLETE SUPPRESSION OF VIRAL LOAD BY TREATMENT, THERE WILL ALWAYS BE P24 PRESENT - ALBEIT IN SMALLER AMOUNTS.
4) I have been bruising VERY EASY with nosebleeds as well, and have lost 15lbs, which is not normal for me, do you have any suggestions of any other stds that may be cause(I had full negative STD panel at six months), or any thoughts on direction I should take?
THE ONLY THING I WOULD SUGGEST IS DISCUSSING WITH YOUR DOCTOR THE POSSIBILITY OF OTHER DISEASES - I'M NOT GOING TO GUESS THEM HERE - YOU NEED TO SEE AND DISCUSS WITH A DOCTOR.
Again, thank you for your time and attention.
VERY WELCOME
Thank you for answering. I FULLY understand your statements, I just have never been ill like this for so long. I have had to take and advil or two each day for the last 7 months to control the irritation of my throat which concerns me. So to be clear--sorry 1) the series of tests I had would detect any CRF's (a/e,etc) as well any odd strain known throughout the world? 2) even if tests not designed for that subtype(s), IF there was ANY HIV, would tests have shown some weird result so as to investigate further? 3) is it correct that if available, a p24 test at eight months would be pointless because there would no longer be detectable levels of it? 4) I have been bruising VERY EASY with nosebleeds as well, and have lost 15lbs, which is not normal for me, do you have any suggestions of any other stds that may be cause(I had full negative STD panel at six months), or any thoughts on direction I should take? Again, thank you for your time and attention.
MEDICAL PROFESSIONAL
Hello,
Doctor I hope you can shed some light on
My situation. I am a young male who has had multiple exposures overseas over the past few years. My latest exposure was in japan in October of '09. These unfortunately were unprotected sex. To make it short, I have had an Elisa test at 3,5,7,8 months(mix of Elisa by quest, ICMA by labcorp, and oraquick advance)post last exposure, in which all were negative. I also had a negative pcr dna hiv-1 at six months, an hiv-1 Rna at 8 1/2 months that were negative.
ALL OF THESE TESTS ESTABLISH WITHOUT DOUBT THAT YOU ARE INDEED HIV NEGATIVE. WHILST YOU MAY REGRET HAVING UNPROTECTED SEX, THE REALITY IS THAT YOU HAVE NOT CONTRACTED HIV FROM ANY OF THE EPISODES
I continue to have symptoms of white tongue which have improved with an antifungal mouth rinse.
THE WHITE TONGUE IS IRRELEVANT - I HAVE A WHITE TONGUE AND I AM NOT HIV POSITIVE - I JUST HAVE A WHITE TONGUE. MY DENTIST PRAISES ME ON MY ORAL HYGIENE, BUT STILL I HAVE A WHITE TONGUE - C'EST LA VIE MY FRIEND.
I am concerned that my testing may have missed a strain that is more prevalent overseas.
AN EMPHATIC NO. TESTING METHODOLOGIES TAKE INTO ACCOUNT ALL THE KNOWN STRAINS AND ARE CONSTANTLYT BEING REFINED AS POTENTIAL NEW CHALLENGES ARE IDENTIFIED. YOU HAVE GUILT, NOT HIV.
1) is it possible that with all of the tests I have had, that they could have missed any Hiv?
NO AS ABOVE
2) if I would be HIV positive, would my RNA level be detectable > 48 copies at 8 1/2 months.
YES
3) Would any of these tests be able to pick up "N,O,CRF" strains?
YES - YOUR IMAGINATION IS GETTING THE BETTER OF YOU. YOU DO NOT HAVE HIV
4) is there any other testing in the US that I could do to eliminate the rare possibility of the rare/missed strain?
NO SIR. THE ONLY TEST LEFT IS AN AUTOPSY WHICH DEFEATS THE PURPOSE A LITTLE. YOU ARE NOT HIV POSITIVE, YOU DO NOT HAVE A RARE STRAIN. YOU ARE SUFFERING FROM GUILT AND ALSO CYBERCHONDRIA - THE DISEASE INDUCED BY LOOKING AT THE WEB TOO MUCH.
I appreciate your input on my situation, and look forward to your response.
Very best wishes, Sean
Doctor I hope you can shed some light on
My situation. I am a young male who has had multiple exposures overseas over the past few years. My latest exposure was in japan in October of '09. These unfortunately were unprotected sex. To make it short, I have had an Elisa test at 3,5,7,8 months(mix of Elisa by quest, ICMA by labcorp, and oraquick advance)post last exposure, in which all were negative. I also had a negative pcr dna hiv-1 at six months, an hiv-1 Rna at 8 1/2 months that were negative.
ALL OF THESE TESTS ESTABLISH WITHOUT DOUBT THAT YOU ARE INDEED HIV NEGATIVE. WHILST YOU MAY REGRET HAVING UNPROTECTED SEX, THE REALITY IS THAT YOU HAVE NOT CONTRACTED HIV FROM ANY OF THE EPISODES
I continue to have symptoms of white tongue which have improved with an antifungal mouth rinse.
THE WHITE TONGUE IS IRRELEVANT - I HAVE A WHITE TONGUE AND I AM NOT HIV POSITIVE - I JUST HAVE A WHITE TONGUE. MY DENTIST PRAISES ME ON MY ORAL HYGIENE, BUT STILL I HAVE A WHITE TONGUE - C'EST LA VIE MY FRIEND.
I am concerned that my testing may have missed a strain that is more prevalent overseas.
AN EMPHATIC NO. TESTING METHODOLOGIES TAKE INTO ACCOUNT ALL THE KNOWN STRAINS AND ARE CONSTANTLYT BEING REFINED AS POTENTIAL NEW CHALLENGES ARE IDENTIFIED. YOU HAVE GUILT, NOT HIV.
1) is it possible that with all of the tests I have had, that they could have missed any Hiv?
NO AS ABOVE
2) if I would be HIV positive, would my RNA level be detectable > 48 copies at 8 1/2 months.
YES
3) Would any of these tests be able to pick up "N,O,CRF" strains?
YES - YOUR IMAGINATION IS GETTING THE BETTER OF YOU. YOU DO NOT HAVE HIV
4) is there any other testing in the US that I could do to eliminate the rare possibility of the rare/missed strain?
NO SIR. THE ONLY TEST LEFT IS AN AUTOPSY WHICH DEFEATS THE PURPOSE A LITTLE. YOU ARE NOT HIV POSITIVE, YOU DO NOT HAVE A RARE STRAIN. YOU ARE SUFFERING FROM GUILT AND ALSO CYBERCHONDRIA - THE DISEASE INDUCED BY LOOKING AT THE WEB TOO MUCH.
I appreciate your input on my situation, and look forward to your response.
Very best wishes, Sean
I forgot to add that the last few days I am
Feeling ill and running a low grade fever ~ 99.8 if that influences your thoughts in any way. Thank you.
Feeling ill and running a low grade fever ~ 99.8 if that influences your thoughts in any way. Thank you.
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