Are ELFA and HIV DUO tests conclusive at three and six months post-exposure?
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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 have had a few unprotected high-risk exposures in my life so far. I had a concern and checked my status of HIV through an ELFA test after three months following 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 that the viral load was 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 my arms, back, and legs for a year. I also have a persistent sore throat for a few months and painless muscle twitching now and then for a month. I am panicked and restless for 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 for being guilty because I am recently married. Kindly help, me 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 everything, am I HIV-negative? I am currently taking tablets Allegra, Xyzal, Goutnil, Glace X, and Symbicort accuhaler. Please help.
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 of your last exposure. Antibodies cannot be detected very early after infection, that is, in the first seven to 10 days. After that, p24 antigen appears until its levels start falling after three to four weeks of infection, by which point, antibodies would become detectable. Seroconversion happens during two to three weeks after infection when the antibodies start appearing against the virus. If you were infected, then by this time you would have already been 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.
I hope I have resolved your queries.
Thank you.
Patient's Query
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 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? Considering these factors, are my negative test results reliable? And should I start living my life normally? Kindly help.
Hello,
Welcome back to icliniq.com.
Intermittent use of oral steroids or injectable steroids does not cause immunosuppression. Moreover, the intake of steroids even though may theoretically delay antibody response to HIV, it would have no effect on HIV antigen detection and HIV PCR (polymerase chain reaction) 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 nine to 13 days whereas HIV p24 antigen has a window period of one to two 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.
Thank you.
Patient's Query
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.
Wishing you good health.
Thank you.
Patient's Query
Hello doctor,
Thank you for the prompt reply.
One last question out of concern is, whether EBV or CMV interfere with HIV results or delay seroconversion beyond so many 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.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
I need 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 the detection of HIV or interfere with seroconversion. Multiple sclerosis has no effect on antibody formation against the virus.
Thank you.
Patient's Query
Hi doctor,
If my exposure five years ago had exposed me to HIV and if it had transformed into AIDS, will my negative HIV Duo test still be conclusive? Would my antibodies have been depleted? Please help.
Hello,
Welcome to icliniq.com.
I have viewed the images as well as the test reports (attachments removed to protect the patient's identity). The neck lump is perhaps a swollen lymph gland which may have been due to the recent sore throat. It is not something to be worried about. The rashes that you have are urticaria that is, hives. Hives are more common in patients who have a history of asthma, and allergic rhinitis. I suggest you take a tablet of Montelukast and Fexofenadine (Allegra) 120 mg once daily for three weeks. Topically, you may use a soothing lotion like zinc oxide and 0.5 % iron oxide (Calamine) lotion. Again, I would like to reassure you that your screening tests are fine, and your symptoms are not related to HIV infection.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
I have rashes on my palms on and off too. I have tested for VDRL thrice and the results are attached. My dermatologist says it is dermatography and an allergic manifestation. Should I be more proactive and do more tests? Please help.
Hello,
Welcome to icliniq.com.
Dermographism is a type of physical urticaria. It is a type of chronic urticaria. Unfortunately, I have not received the image or attached file. I request you to kindly upload again.
Thank you.
Patient's Query
Hello doctor,
I am hereby attaching the pictures of my rashes on palms and the VDRL test reports. One is at 46th day of my last exposure (about four and a half months after my last exposure), and another one is at six months. VDRL alone is negative (not attached). The rashes are itchy as well. It gets controlled upon taking Allegra. Should I do any other specific tests? I am so confused and losing my life. Please advise.
Hi,
Welcome to icliniq.com.
I have gone through the attachments (attachments removed to protect the patient's identity). All your tests are normal and conclusive.
As far as the itchy rashes are concerned, they are hives, that is, urticaria. Urticaria can be due to allergy to food or food preservatives, infections (viral, bacterial, fungal, dental), drug or medications, autoimmune diseases, and so on. However, a vast majority of chronic urticaria is idiopathic that is, there is no identifiable cause. You may do a few more blood tests like CBC (complete blood count), ESR (erythrocyte sedimentation rate), thyroid profile, comprehensive allergy panel test, chest X-ray, urine routine, stool for ova or cyst, ANA (antinuclear antibody) in quest of identifying the cause. They may guide future treatment. Till then you may continue taking a tablet of Montelukast and Fexofenadine (Allegra) 120 mg daily.
Thank you.
Patient's Query
Hi doctor,
Should I be worried about elite controllers or suppressors or slow progressors in my case related to HIV? I am asking because I feel my armpits to be tender since morning. I feel worried. Please help.
Hi,
Welcome back to icliniq.com.
Elite controllers and long term non-progressors constitute a very low percentage of HIV infected individuals who are able to maintain an undetectable or low viral load and higher CD4+ cell counts as compared to the majority of HIV infected individuals who display a gradually progressive decline in CD4+ cell counts. In these very few individuals, even though HIV RNA PCR may yield a false negative result because of a check on viral multiplication but the antibody response to HIV is elicited as expected and therefore HIV DUO Ag (antigen) or Ab (antibody) test and HIV ELFA Ab tests would be positive and reliable. Tenderness in armpits may be due to a local cause like bacterial folliculitis or intertrigo.
Thank you.
Patient's Query
Hello doctor,
With the amount of test results showing negative results, can I allay my fears of HIV? Please help.
Hello,
Welcome back to icliniq.com.
Yes, absolutely. Your tests are conclusive.
Thank you.
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