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What confirmatory tests must be taken after a needlestick exposure with an HIV patient?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At December 7, 2022
Reviewed AtDecember 6, 2023

Patient's Query

Hello doctor,

I had a needlestick exposure two months back with an HIV (Human Immunodeficiency Virus) patient, and I did not start ART (Anti- Retroviral Treatment) yet. I had the following tests, which showed negative. Individual donor nucleic acid test (ID-NAT) for HIV - 19 days. HIV duo fourth-generation test - 45 days. HIV-1 RNA (Ribonucleic Acid), Quantitative, Real-Time PCR - 60 days. HIV-1 and 2 RNA, Quantitative, Real-Time PCR - 67 days. Chemicluminescent microparticle immunoassay (CMIA) fourth-generation test - 82 days. Electrochemiluminescence immunoassay (ECLIA) fourth-generation test - 100 days. Chemicluminescent microparticle immunoassay (CMIA) fourth-generation test - 117 days. My doubts are Are any more tests required to rule out my negative results conclusively? I started getting joint pains with dull throbbing pain at the extremities like wrists, carpels, toes, heels, and shoulders from the 92nd day after exposure, so only I took tests: Electrochemiluminescence immunoassay (ECLIA) fourth-generation test and Chemicluminescent microparticle immunoassay (CMIA) fourth-generation test. So, if these symptoms are related to HIV, would it be shown in these two fourth-generation tests taken 8 and 23 days after symptoms? After the onset of HIV symptoms, how long will a fourth-generation test take to show reactivity? Based on epidemiological and clinical expertise, have you seen any patient who tested negative till the 90th day, then turned positive later?

Hello, Welcome to icliniq.com.

I read your query and can understand your concern. The following are the answers to your queries. No more tests are required if the 117-day test result is negative and there is no other exposure. No symptoms can diagnose HIV (human immunodeficiency virus). These symptoms are nonspecific. Get your fasting vitamin D3 levels and thyroid profile. We can only diagnose HIV through the tests, which are negative in your case. Acute retroviral syndrome (ARS) may or may not always be present in all cases. Fourth-generation test also looks for antigens besides antibodies. The recommendations are to get HIV fourth-generation test at 3 to 4 weeks of exposure, and if the result is negative, a confirmatory HIV rapid test at three months of last exposure. I have not seen such cases in my clinical practice.

I hope this helps.

Thank you and take care.

Patient's Query

Hello doctor,

Thank you for the reply.

My final question is if all these joint pains and peripheral neuropathy-like symptoms were related to HIV, the fourth-generation test taken 22 days after the onset of the symptoms would have been reactive, right?

Hello, Welcome back to icliniq.com.

I read your query and can understand your concern. As I mentioned, there are no specific HIV-related symptoms. Knowing the levels of vitamin D3, B12, and folate for any neuropathy-related symptoms is important. Also, these could be due to any chronic illness like diabetes or a deranged thyroid profile. So, it is important to investigate these initially. In more than 95% of individuals infected due to HIV, fourth-generation tests will be reactive in three to four weeks if the infection has occurred. I hope this helps.

Thank you and take care.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Ravinder K. Sachdeva
Dr. Ravinder K. Sachdeva

HIV/AIDS specialist

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