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HIV test taking a long time to show positive result
Nov 18, 2006

I'm not sure this is the right forum, but I couldn't find any other that's more suitable. This is a bit long, so brace yourselves...

I just tested positive for HIV on October 27 (with result on November 1 ...). The test was done as part of my annual physical, not because I thought I had taken any risk. I had tested negative on June 25, as well as on March 6. I was monogamous with my new partner since April, and he was negative at that date and not with anybody for a year before meeting me.

I did have a dozen encounters between January and March, but always used protection for anal sex, and there was no condom breakage. I didn't use protection for oral sex, though.

During the same period, I was having unprotected sex with my ex of 3.5 years with whom I had been monogamous before, until we broke up in March. I don't believe he was seeing anybody else, but we aren't speaking anymore, so I don't know for certain.

My belief at this point is that I'm one of the unlucky guys who got HIV through oral sex, and I got infected between January and March, although I don't know who from. My gums do bleed once in a while when I brush my teeth, so in retrospect I think this is a possibility.

I did get quite sick in April which is consistent with a recent HIV infection. I tested positive for strep throat, and it was very severe (almost total loss of voice, high fever). But it was cured with antibiotics.

Unfortunately, the HIV test at the time at showed nothing.

In June, close to my 30th birthday, I was diagnosed with chlamydia. I was very worried about having caught HIV a few months before at the same time. But once again antibiotics fixed the chlamydia, and the HIV test came out negative.

I was quite shocked to come out HIV positive in October. Unfortunately, my partner and I had unprotected sex after 2 negative HIV tests. He just took an HIV test the day after I got my positive result (November 2), and it came out positive too on November 16. In his, case he knows who the infection vector was - me ...

I am somewhat upset that my HIV infection couldn't be detected earlier - from a January to March infection to a late October positive result. If I had known I was positive earlier, I could have prevented my partner's infection.

I am aware it sometimes takes up to 6 months, and I unfortunately got unlucky here.

My questions are :

1) Why do some individuals develop the HIV antibody that are checked by the HIV tests quickly after infection, and others much later (in my case between 4 and 8 months given the timing of my infection and my 3 HIV tests) ? I think I read somewhere the average was 25 days to develop the antibody, so I am way off.

2) Is a late production of the HIV antibody a sign of a weakened immune system ?

3) Why do the HIV detection tests only check for the antibody, and not also for viral load ? My understanding is that for most individuals, the HIV viral load is highest immediately after infection, and drops down afterwards even without meds as the immune system fights it. So, the viral load test would seem to be a useful detection tool, in addition to the 2 HIV antibody tests. I asked my HIV specialist doctor why this test isn't used for detection, and he said the viral load test was unreliable and could give some false positives or negatives. I have a hard time accepting that, since the test is used all the time in labs after diagnosis at regular intervals, as evidenced in this forum. I can't really see how additional data from a 3rd test would hurt in detection. Can you expand on why viral load test isn't used as a component of the HIV detection tests ?

4) To try to stay on topic, my first labs from my November 2 sample are HIV Viral load 598/mL Log10 RNA 2.78 CD4 716/uL CD8 929/uL CD3 1693/uL Help/supp ratio 0.77 CD4 32% CD8% 42%

The CD8% is considered too high (normal range 11 - 37). Viral load should also be <75. The help/supp ratio is also on the low side of the normal range - 0.74 - 5.30 .

Can you expand a little on the abnormal results ?

5) My doctor thinks the numbers look good and I don't need meds at this time. I'm still extremely worried as I have always had a weak immune system. As a kid up to my teenage years, I was sick about 3 months of the year consistently in the winter, with all kinds of weird diseases that don't normally happen at that age - like getting shingles in my left eye at 15 - and I wasn't sexually active at all then. At 19, I moved to a warmer climate area, and my illnesses have been down to about 1 month of the year, before I was infected with HIV. I know it is early in the process to make the decision to be on meds, but would it be harmful to my long term survival prospects to start HIV meds earlier rather than later, if I can afford them and tolerate the possible side effects ?

Response from Dr. Holodniy

1. It may relate to someone's underlying immune system and genetics, the amount of HIV received and the method (sexual vs. injection drug use). 2. No. 3. Because the look for antibodies and not the virus. The position of the US FDA has been up til recently that antibody testing (other than in blood banks) was better than viral load testing for diagnosis. 4. The CD8 count is elevated as natural and good reaction to HIV infection. 5. Currently you don't need HIV meds and I wouldn't recommend them.



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