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HIV Testing Window: What's the Real Story?

Apr 29, 2016

Everywhere is saying after a certain window period time (3months) after getting negative is conclusive & even after (6months) confirmation is definitely negative. But why are all these other people saying you can go years without showing positive & that's really freaking me out big time . Is it true that it takes your to come up positive or does it only take 6months to know 100%. What's true?

Response from Mr. Vergel

In a study published in 2003 that used stored blood samples that were obtained twice weekly from unrecognized seroconverting blood donors, Dr E. Fiebig and his team described 6 stages of acute viremia and early seroconversion characterized by viral replication and evolving antibody responses. In Fiebig stage 1 during ramp-up viremia, only HIV1 RNA in the blood can be detected. About 7 days later, results of tests to detect p24 antigen become positive ; p24 antigen is a viral core protein that transiently appears in the blood during the ramp-up phase once HIV viral load rise above 10,000 copies/mL and before the development of detectable HIV antibodies.

During the ramp-up phase of acute HIV infection, an acutely infected individual develops an intense inflammatory response characterized by high levels of cytokines and chemokines (proteins produced by immune cells to communicate), creating a "cytokine storm" . Some individuals, but not all, will develop signs and/or symptoms of acute retroviral syndrome, which can include fever, rash, night sweats, severe fatigue, headache, diarrhea, pharyngitis, fever and body aches. The onset of symptoms of acute retroviral syndrome typically occurs at about 2 weeks after HIV infection, coincident with peak HIV virus load.

Within about 5 days after p24 antigen test results become positive, HIV antibodies reach levels that can be detected with sensitive enzyme immunoassays (EIAs) (third-generation EIAs) capable of detecting immunoglobulin (Ig) M antibodies, corresponding to Fiebig stage III. Stage III typically occurs 12 weeks after the onset of acute retroviral symptoms. Fiebig stage IV represents the development of an indeterminate Western blot test and occurs about 3 days after sensitive EIA tests show positive results. Conversion to a clearly positive Western blot test, Fiebig stage V, generally occurs after another 7 days, or about 1 month after initial infection.

Three months after infection is still the recommended window to wait for a definite HIV test result to take into account people who may have variations in these five Fiebig stages of infection.

I get a lot of emails from those "worried well" people who still think they are HIV positive even with negative ELISA and WESTERN BLOT after 3 months. They are convinced that their often repeated results are wrong since they "have all the symptoms". All I can tell them is to spend money on a PCR viral load test to convince themselves that there is no detectable virus in their blood. But even with this suggestion, many still would not believe a negative PCR test. It gets frustrating for me to receive emails from those people weekly for the past 10 years!

Nelson



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