Dr. Sushil Kakkar
Dermatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I had a deep-mouth kiss with a sex worker, and now I am anxious about HIV (human immunodeficiency virus). I tested negative with the fourth generation combo test three weeks before. The combo test detects only HIV-1 p24 antigen, so shall I consider it conclusive for HIV-2? Or do I need to repeat the test, and when?
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern. Kissing is generally not a risk factor for transmission of HIV (human immunodeficiency virus) unless the saliva is contaminated with gross blood or there are open sores or ulcers in the oral cavity. Moreover, a fourth-generation HIV screening test at three weeks is fairly reliable, but I would still suggest you repeat it at six weeks for it to be considered conclusive. A combo test screens for HIV-1 p24 antigen and HIV-1 and 2 antibodies. HIV-2 is very rare, and for it, you need to do an antibody test ELISA (rapid card test) at 12 weeks since antibodies may take 4 to12 weeks to become detectable. Thank you and take care.
Patient's Query
Thank you doctor for your reply.
Can saliva alone cause HIV if there is an open ulcer in the mouth? And the combo test is conclusive at four weeks after exposure, so is it necessary to be taken at six weeks? As you said, HIV-2 is rare and so are there chances of transmission of HIV-2 with saliva contaminated with blood?
Hello,
Welcome back to icliniq.com.
An open sore or oral ulcer increases the risk of transmission. In such a case, it is better to get tested. I would suggest you take a test at six weeks as the window period of the HIV combo test is 18 to 45 days. So, considering the upper limit, six weeks result is the most conclusive. HIV-2 has low infectivity but is still transmitted through the same routes as HIV-1. Thank you and take care.
Patient's Query
Hello doctor,
Thank you for the reply. I came to know that a person who is co-infected with hepatitis-C causes a delay in HIV seroconversion. Is it possible for the fourth generation test to not pick the p24 antigen and antibody at six weeks?
Hello,
Welcome back to icliniq.com.
The kissing never leads to HCV (hepatitis-C virus), so there is no question of delayed seroconversion. Thank you and take care.
Patient's Query
Thank you for the reply, doctor.
Is there a chance for the delay in HIV seroconversion if an individual previously infected with hepatitis-C virus gets HIV?
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern. No, an existing HCV infection does not delay HIV seroconversion. Thank you and take care.
Patient's Query
Thank you for the reply, doctor.
Does it mean HIV seroconversion may delay if the person gets both HIV and HCV from the co-infected person?
Hello,
Welcome back to icliniq.com.
If coinfection does not lead to any illness, then a negative test at three months for HIV is conclusive. However, if the patient develops acute hepatitis only, then an HIV test at 12 months would be required for a conclusive result. Thank you and take care.
Patient's Query
Thank you for the reply, doctor.
I understood that if HIV and HCV got transmitted simultaneously to a person, the window period might only be extended when a person got ill with the transmission of HCV. Am I right, doctor? And can a combo test detect the antigen in the above situation, doctor? If yes, can a 28 days test be conclusive?
Hello,
Welcome back to icliniq.com.
Yes, you are correct. The combo test may detect p24 antigen at four weeks, but if a person gets ill from acute hepatitis, then seroconversion may take longer. It implies that we need to repeat HIV tests at 12 months for it to be considered conclusive. Thank you and take care.
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