Q. What are the confirmatory tests available to diagnose HIV?

Hi doctor,

I am a 26-year-old male. I had three protected sexual exposures eight years ago with female sex workers and one protected sexual exposure five years ago with a female sex worker. From then till now there was no sexual exposure. I was feeling good and I had no problem regarding sexual exposure. But three years ago I developed COVID-19 phobia and started symptoms like palpitations, weakness, a burning sensation in my hands, and a low mood. So I consulted a psychiatrist and took medicine. I felt good in the next two-three months but in that period I lost three kilograms of weight. I thought that it was due to HIV. I searched for symptoms of HIV on the internet. For the last two years, I am experiencing symptoms like a burning sensation in my hands, feet, legs, and thighs, weakness, low mood, and concentration issues. So I started testing myself for HIV with HIV rapid test kits. Till now I tested myself with five different manufacturers' rapid test kits. I tested with 40 rapid test kits and the result came to be negative. Is this result conclusive after eight or nine years of sexual exposure?

Please answer my following questions.

1. Can a rapid HIV test detect HIV infection if sexual exposure occurred nine years back?
2. Is the test I performed accurate and conclusive and am I 100 % HIV-negative?
3. I tested with the whole blood finger prick method, can HIV antibodies be in the same amount as in whole blood, serum, and plasma?
4. Is whole blood gives an accurate result like a serum specimen?
5. Do the symptoms I mentioned above resemble the last-stage symptoms of HIV infection?
6. I am experiencing these symptoms for the last 1.5 years. Do you think these are last-stage HIV symptoms?
7. In the last three to four years I do not have a long period of fever, diarrhea, or something. I only have the above-mentioned symptoms. I fear testing in the laboratory because I think that the result will change if I test in the laboratory. So I continuously tested with home-based HIV test kits. I had done multiple HIV rapid tests appropriately 40 times with 40 test kits and all were negative.
8. If I test in the laboratory with ELISA what will be the result?
9. I am going through huge anxiety every day and these symptoms continue. I want treatment for this and I am collecting the courage to test with ELISA. Will the ELISA result be negative or positive?
10. I performed HIV rapid test with the manufacturer's instructions. It was written that 20 ul of blood sample is needed for the test. Sometimes I draw 20 ul of the sample with a dropper, sometimes I use one drop of blood or half a drop of blood and the result came negative. Is this the correct procedure?
11. I read somewhere that in the last stage of HIV, HIV antibodies will not be detected. Is this true? I only have the above symptoms, not any other serious symptoms.
12. If I am negative for HIV, why I am experiencing these symptoms continuously?

I am attaching my CBC report. Please look at it and tell me if you find anything suggestive of immunosuppression in that report. Please tell me whether I need other HIV tests.

Thank you.

Hi doctor,

Thank you for your answer.

Please answer my question point-wise.

1. Can 3rd generation and 4th generation duo HIV rapid test kits detect all types, strains, and subtypes of the HIV virus? I used rapid tests and it was described in their user manual that they also detect subtypes.

2. I tested with the whole blood finger prick method. In the laboratory, they test serum, does HIV antibodies similar in amount in whole blood, serum, and plasma? Does whole blood give accurate results like serum?

3. I have had this burning sensation in my whole body for the last 1.5 years. Do you think HIV's last stage symptoms last for this long period without any serious symptoms like prolonged fever, diarrhea, or weight loss? I do not have diarrhea or fever which lasted for three or more days in the last four years.

4. One month ago, I was with my friend and I assume that he is HIV positive as he used to have sex with multiple female sex workers. I was standing with him and at that time he was chewing tobacco. He split it, and his saliva spreads on me. I feel that some drops of his saliva were on my tongue. Is there any chance of transmitting HIV infection from this incident?

5. In the last stage of HIV which serious symptoms can the patients experience?

6. In the last two to three years my lymphocyte counts are always near 20 %. So do you think my CD4 counts are within range with respect to 20 % lymphocytes?

7. If I test for ELISA in the laboratory, what is the possibility that it will come negative? Can I go for the test without any fear? I am dealing with anxiety and fear for the last two years with sleepless nights.

8. If ELISA came negative, do I need to test with a Western blot or DNA or RNA PCR?

9. Four years ago, I developed some white blisters on my face, so I consulted a dermatologist and he prescribed me medicines. Please see the attached pictures and tell me if is it a herpes zoster infection or an insect bite infection.

Please help.

Thank you.