Q. My HIV test came back negative at eight weeks. Am I all clear?

Hello doctor,

I would like some advice, please regarding HIV testing. 10 days following a sexual encounter, (protected penetrative sex, unprotected oral sex) I was tested at my local GUM clinic. Although the lady from my encounter tested negative, mine came back as weakly reactive (fourth generation test). I retested which was now 21 days from the encounter and the result was exactly the same. The clinic sent some blood away for a viral load test which came back as negative/undetectable. Four and a bit weeks (eight weeks since the initial encounter) later, I returned for the follow-up blood test which, as I was advised, was weakly reactive again. This time the clinic sent some blood to a lab abroad for a confirmatory test which came back negative. What are your thoughts on this? Given that my results from the fourth generation test are the same over an eight-week period and viral load negative and whatever test they did abroad was negative should I be considered all clear? I cannot seem to shake this doubt that I have.

Hi doctor,

Thank you for the reply.

I hope you can offer me further reassurance as I am going out of my mind with worry and stress still as I have had further tests since my original question. I am unsure what the test method was at the eight-week mark, but as it took seven days I am guessing it was the WB. Please see below my timeline of tests and results:

• 10 days after - standard STD screening. HIV fourth generation test was 'weakly positive/reactive.
• 21 days after - I repeated an HIV fourth-generation test at the same clinic and the result was exactly the same. The doctor said that if I had had an early infection, this test would have more than likely been fully positive at this time and not the same as before. At this point, they sent my blood away for a test that detects the virus itself (viral load/PCR). This test came back as undetectable.
• 3.8 weeks after - repeated the same test (fourth generation) at the same clinic, which came back with the same level of reactivity as the previous test done almost five weeks prior. At this point, they sent my blood to a different lab for a confirmatory test (test method unknown). To my relief, this came completely negative. This test took around a week to come back. At this point, I considered myself all clear.
• 4.5 months after - I started to get really anxious again and stressed. So, booked into a private clinic where I tested negative on the HIV INSTI test. Given my test history, they also sent a sample of blood to have a lab test which I was told the next day needed further confirmatory testing. I believe they used the same fourth-generation duo test as all my others. So, I expected it to be reactive. However, later the same day, I was informed that the confirmatory test had come back as indeterminate. One out of the three categories was positive, whilst the other two were negative.

Surely, if I had had HIV, the 8-week confirmatory test would have been positive, not negative? The 5-month Insti would have been positive, not negative, and whatever confirmatory test the private clinic did would have been positive, not indeterminate. Can it be that my blood just reacts to all the antibody tests and that I am just worrying myself stupid, or do you think that given my test history, I could be HIV positive? Would a PCR RNA test be categorically conclusive at this point?

Hello doctor,

A couple of further questions, if I may. Given that the private clinic I went to after five months were able to do a confirmatory test the same day as the standard test, does this rule out that they used a WB test? I was under the impression that a WB is much more labor-intensive and took several days. Can I really feel confident in my negative status if after a negative Rapid-INSTI a more thorough lab test came back as indeterminate?