Is the HIV RNA test at 10 days after exposure reliable?

Question

Hello doctor,

I have OCD (Obsessive Compulsive Disorder) and health anxiety. The last two months have been the most challenging months of my life. I think I have ALS and crippling anxiety. I have all kinds of symptoms where I feel twitching and cramping. My EMG (electromyogram) was fine. I had unprotected sex with a girl.

The next day, I had a CBC (complete blood count) done, which showed my WBC (white blood cells) was 3.6. Immediately, I thought, what if the girl gave me HIV, and my anxiety spiked. I had my WBC checked again within a week, and it was 4.4. In the next ten days, it was 4.9, and again after three days, it was 3.6. I had a tender lymph node in my armpit (very small). I got in the other armpit (tender) also within three days.

Both have gone within a week. Also, I had diarrhea once. I had a small patch of oral thrush on my gum that I wiped away hard with a towel. But this was not on my tongue or cheeks; it was only on the gum, and it never reappeared. The girl and I took a fourth-generation antigen-antibody test. However, I am aware of the window periods. Soon after that, I developed pain in my left rib cage (spleen). My antibody test comes back negative (no antigen). For some reason, the doctor put me on PEP (25 days after intercourse).

Ten days after being on PEP, I took an HIV RNA viral load test that came back not detected. I also had an antigen-antibody test that was non-reactive. I noticed a tiny lymph node in my armpit that disappeared within two days. I noticed that my right parotid gland is slightly bigger than the left, without pain or a visible difference.

But when I started stressing about it, I felt a tiny non-tender lymph node about the size of a small pebble pop up. Besides the symptoms I listed, I have not had any others. No fevers, aches, rashes, or other lymph nodes. Is my RNA (ribonucleic acid) HIV (human immunodeficiency virus) test conclusive as negative? Or could ten days of PEP antiviral bring me to an undetectable level? Generally, how long does it take someone to become undetectable? Could you tell me a little bit about HIV?

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Your HIV (Human Immunodeficiency Virus) RNA test result is not conclusive at this stage. Testing at 10 days after exposure is too early to provide a definitive result. Although HIV RNA (Ribonucleic Acid) tests can detect the virus earlier than antibody tests, they are still affected by the timing of exposure and treatment.

Here are the key points to understand:

Early testing is unreliable: An HIV RNA test at 10 days may not detect the virus accurately, especially if viral replication is still low.
Timing of PEP matters: It is unclear why post-exposure prophylaxis (PEP) was started many days after exposure. PEP is most effective when started within 72 hours of potential HIV exposure.
PEP can delay viral detection: PEP can suppress the virus temporarily, which may interfere with HIV test results and delay detection.
Recommended follow-up testing:

Repeat the HIV test at three months (12 weeks) after the exposure.
Repeat at six months to confirm your HIV status conclusively.

Monitoring is essential: Continue regular follow-ups and avoid further exposure. Testing as per schedule ensures accurate diagnosis and peace of mind.

If you have concerns, speak with your healthcare provider for personalized guidance and care.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.