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Q. Are ELFA and HIV DUO tests conclusive at three and six months post-exposure?

Answered by
Dr. Sushil Kakkar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 14, 2017 and last reviewed on: Oct 09, 2018

Hello doctor,

I have had a few unprotected high-risk exposure in my life so far. I had a concern and checked my status of HIV through an ELFA test after three months of the last encounter. I did another ELFA test after six months, and both were non-reactive. I did not have any exposure in between the tests. My condom broke after the six months test, so I did fourth generation HIV test, syphilis, chlamydia, HSV-1, and HSV-2 at six weeks post my last exposure, and they were all non-reactive. I also got an ELFA test after three months post my last exposure, which was also non-reactive. I had a qualitative EDTA plasma HIV-1 RNA PCR test four months post my last exposure with a minimum assay range of 35 copies per ml. The reports said viral load not detected. I got an HIV DUO test, 23 weeks post my last exposure.

I have fever and cold for almost six months now. I am a known asthmatic for years, and my IgE levels are 900. I get recurrent and persistent rashes like hives on arms, back, and legs since a year. I also have a persistent sore throat since a few months and painless muscle twitching now and then since a month. I am panicked and restless since six months now, and I had a recent episode of anal fissure following a couple of days of constipation, which healed without any medication. I am going crazy, and I had gone to the extent of killing myself of being guilty because I am recently married. Kindly help, if the above tests are sufficient to allay my fears of HIV.

Are ELFA and HIV DUO tests conclusive at three and six months post my last exposure, irrespective of previous exposures? Can there be any point where both antibodies and p24 antigen are not detectable in an HIV infected patient? If there is a seroconversion stage now, will there be no antibodies detected till now? I am not on any antiretroviral or immunosuppressive drugs, and I am confused and not able to take this off my mind. Will there be no HIV antibodies detected if I had been exposed five years before? If I had acquired HIV, would my immune system go so weak? Having said all, am I HIV negative? Please help.

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Hello,

Welcome to icliniq.com.

I have gone through your query, and I have noted your concern.

  • Your last screening tests for HIV (human immunodeficiency virus), that is, fourth generation p24 antigen and anti-HIV antibody screening test is conclusive for all previous exposures. Negative antibody screening test further substantiates this after three months from your last exposure.
  • Antibodies cannot be detected only very early after infection, that is, the first 7 to 10 days. After that, p24 antigen appears until its levels start falling after 3 to 4 weeks of infection, by which point, antibodies would become detectable.
  • Seroconversion happens during 2 to 3 weeks after infection when the antibodies start appearing against the virus. If you were infected, then by this time you would have already seroconverted, and the screening tests would have been positive.
  • Usually, the T cells get depleted in HIV, which is cell-mediated immunity. B cells are antibody-producing cells, and they are not depleted in HIV. Therefore, antibody screening test is reliable throughout the course of infection. You are not HIV positive, and your screening tests are conclusive with respect to your history of sexual exposures.

Regards.

For more information consult a dermatologist online --> https://www.icliniq.com/ask-a-doctor-online/dermatologist

Hi doctor,

Thanks for your reply. It has brought a smile on my face after almost a year now. I have one other confusion. I am a known asthmatic since childhood. I was given Wysolone for a course of several months when I was in school, and I had been using Budecort and Seretide inhaler for years. I also use Symbicort now. I remember I had been given cortisone injections during asthmatic attacks in my adolescence too. Last year, I had a shot of Decadron from a local physician for severe wheezing. Would all these have had any effect on me and made me immunosuppressive? Having considered these factors, are my negative test results reliable? And should I start living my life normally?

#

Hello,

Welcome back to icliniq.com.

  • Intermittent use of oral steroids or injectable steroids does not cause immunosuppression.
  • Moreover, intake of steroids even though may theoretically delay antibody response to HIV, it would have no effect on HIV antigen detection and HIV PCR RNA test. Since you tested negative for PCR RNA and HIV p24 antigen at four months and six months, respectively, therefore, there is no need to worry.
  • PCR RNA has a short window period of 9 to 13 days whereas HIV p24 antigen has a window period of 1 to 2 weeks. Beyond window period, the results of these tests are reliable and conclusive, and even if we presume that you were infected with HIV, then steroids would not have interfered with these tests, and in fact, it would have aided viral multiplication.

Regards.

For more information consult a dermatologist online --> https://www.icliniq.com/ask-a-doctor-online/dermatologist

Hi doctor,

Thanks for your reply. I did another HIV DUO test the day before yesterday, and it was non-reactive as well. Should I take any other test to reassure or should I seek medical help for my symptoms of rashes and random muscle twitching concluding my HIV status as negative? Please advice.

#

Hello,

Welcome back to icliniq.com.

  • Your HIV screening tests are conclusive. There is no need to undergo any further tests for reassurance. For your other medical concerns, you may contact an appropriate specialist.

Take care. Regards.

For further queries consult a dermatologist online --> https://www.icliniq.com/ask-a-doctor-online/dermatologist

Thank you doctor,

One last question out of concern is, whether EBV or CMV interfere with HIV results or delay seroconversion beyond so months.

#

Hello,

Welcome back to icliniq.com.

  • No, these are common viral infections and the majority of the common population is infected with CMV (cytomegalovirus) and EBV (Epstein-Barr virus). They do not cause any health problems in healthy individuals unless there is an underlying immunosuppression, for example, HIV or AIDS patients. These infections do not delay HIV seroconversion.

Regards.

For more information consult a dermatologist online --> https://www.icliniq.com/ask-a-doctor-online/dermatologist

Thank you doctor,

One other clarification from your expertise. Does MS delay detection of HIV or interfere with seroconversion by any chance? This is because I have random muscle twitches. I am very anxious. Please help.

#

Hi,

Welcome back to icliniq.com.

  • Multiple sclerosis does not delay detection of HIV or interfere with seroconversion. Multiple sclerosis has no effect on antibody formation against the virus.

Regards.

For further queries consult a dermatologist online --> https://www.icliniq.com/ask-a-doctor-online/dermatologist


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