Dr. Kiran Anaparthi
HIV/AIDS specialist
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,
The last exposure was a year back, had pin-prick sensations on head and arms. After three months, I had three HIV (Human Immunodeficiency Virus) tests, two were blood and one rapid test oral. Eight months later, I had a PCR (Polymerase Chain Reaction) RNA (Ribonucleic acid) qualitative and another fourth-generation blood test antigen and antibody, both were negative. I also got tested for Hepatitis C, HTLV I and II. But signs of lipodystrophy are present, fat relocation to the abdomen. Legs are thinning. Low testosterone, lipid abnormalities as well. Elevated sedimentation rate and CRP (C- reactive Protein) come and go as well. I really think this is HIV but if it does not show up on a test I cannot get treatment. Or if this is not HIV what else should I get tested for?
Hi,
Welcome to icliniq.com.
As per description, you are more obsessed with HIV rather than the actual scenario. Any infection will have a remnant in the body, called the footprint of the infection. In case of HIV, the virus leaves its particles in the body, of which p24 is the core protein that protects HIV DNA. For HIV to infect human CD4 cells, it needs to break this core protein and release RNA material from the virus which passes to human cells and then further replication continues and the virus spreads through the body. So, we test for p24 particles in the body. If they are present, then you are infected and if it is not present, then you are not infected in any case (even you highly suspect or think). So, the fourth generation detects, not just these particles but also the body's response to these particles, called p24 antibodies. So, if you are negative after three months by this test, then there is no chance of being positive with the exposure. You have to accept the truth. And coming to other conditions, lipodystrophy, check for the endocrine problem which may be a cause of low testosterone. All your complaints may have undiagnosed conditions but HIV is not at all the cause. Do not be obsessive, accept the truth that you are free of infection.
Patient's Query
Thank you doctor,
But does the P24 antigen die off after so long? After a year now there should not be much of it in my system. Is there a strain that could be hard to detect? I thought running the PCR RNA test qualitative would have picked up an infection no matter how much time had elapsed and there should still be antibodies present as well. I agree that the logic would say I am not infected, it is just hard dealing with symptoms and not finding any answers. I have also been checked for Lyme and rheumatoid factors in the blood, both negative.
Hi,
Welcome back to icliniq.com.
You are missing simple things. You are testing RNA by RNA PCR amplification to detect HIV infection but before RNA to come out, it should break protection around RNA, that is core proteins, which is p24. So, once a person is infected, inevitable p24 will be detected but the detection can be done best after three months. Coming to the disappearance of p24, it will not happen, theoretically, every antigen will have antibody developed by the body which neutralizes it and negative will be the result, that causes inability to detect the virus. But practically, virus always replicates first, so, there will be a continued supply of viral particles, like p24 and other antigens. That is why HIV antibody once detected in a person will always be detectable for life long. That is why, no HIV treatment advertising will not show as being a negative but show as cleared off from body, the difference is, RNA viral load is the test done and machine have calibration to detect more than 40 copies only (as of now), and virus copies of particles less than 40 copies will be given as target not detected, which is being used as cleared off from the body. So, once you are infected, then no way to stop it from being detected. If you are negative, then again, no way to show you positive (excluding window period of 3 to 6 months). Coming to symptoms, HIV symptoms are symptoms of virus infection but not HIV specific because HIV specific appears after the drop of CD4 less-than 350, to be specific, less than 200. So, do not worry, as these symptoms happen after at least 3 to 5 years of infection. So, do not worry.
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HIV/AIDS specialist
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