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4th gen test negative but still hiv symptoms

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  • 4th gen test negative but still hiv symptoms

    Hi Dr, I wonder if you can help. I had exposure to possible hiv2 in 2014 (woman of African origin) . 4+ months after exposure, I had rapid finger prick test which was negative (I think 3rd gen but not sure). I have no further exposure, but in late February this year(2020) I had cold and bad chest and was ill for a few days but after this developed oral thrush on tongue. This is late stage hiv opportunistic infection? I have also had muscle ache and sore throat. Oral thrush for 4 months now. I have had two further self tests (2nd and 3rd) generation, both negative, and a 4th gen lab test (antibody/antigen) test (blood taken from arm) all negative since I got oral thrush. Could the problem be it is not showing positive because of hiv2? Or could I be seronegative? What is best option, further 4th gen test or HIV RNA? Will this pick up what 4th gen hasn't?

    Someone please help I cannot sleep.

  • #2
    Dear Dr, can someone please offer some advice, I am really worried. Continued late stage hiv symptons despite negative test. What type of test should I now go for? Hiv rna for type 1 and type 2?


    • #3
      Hi Anx01,

      You do not have HIV. 4th Gen HIV Ab/Ag testing will be able to pick up HIV2 as well.

      You might want to speak to your healthcare providers regarding other investigations like blood works or scans for your symptoms.



      • #4
        Dr Zeng. I really appreciate you taking the time to answer my question. It means a great deal. Thank you. I will take your advice and continue to consult my health care provider.

        I got paranoid as all the literature presents oral thrush as meaning hiv? Only immune suppressed get it? In my scenario, I am seronegative, so not picking up hiv2 antibodies. If this were true, and It probably only exists in my mind, but if it were, what test would I need after 4th gen to be sure? A hiv rna/dna specifically for hiv2, as read they usually only look for hiv1?

        I promise no more questions after this. Thank you again.


        • #5
          Hi Anx01,

          There are many reasons for oral thrush, for which HIV infection is one of those. Other reasons are like poorly controlled diabetes or use of corticosteriods.

          You might consider HIV2 RNA PCR or ProViral DNA testing if you really want to rule out HIV2. I'm not sure whether you have access to these tests in your area though.



          • #6
            Dr Zeng. Thank you so much for your advice. I really appreciate you taking the time. I am based in UK at present, which is where I took hiv 4th gen. It seems to just be focused on HIV 1 RNA PCR here. I will seek advice at clinic.

            Thank you and best wishes.


            • #7
              Dear Dr Zeng. Thank you for your help so far. I am wondering if someone can help me one last time. I went for a Hiv PCR test at private clinic. I was worried about hiv2 but I thought the Dr told me it was a hiv-1 rna pcr test I was taking. However, the test reults given back the lab to me are as follows:

              MPX HIV1/2 HBV HCV PCR

              HIV 1/2 PCR NEGATIVE
              Hbv PCR NEGATIVE
              HCV NEGATIVE

              Is MPX a testing standard/ machine?? Is this reliable for ruling out hiv1/2 6 years post exposure?

              Since February this year I have has 2 home self test fingerprick hiv1/2 tests both negative.
              June-4th gen lab test at hospital. Negative.

              I have not been with my wife in 6 months, is OK to rule out hiv infection, including hiv2, and resume relations?

              Many thanks for all your help.


              • #8
                Hi Anx01,

                It's pretty conclusive that you do not have HIV, with a negative HIV PCR testing.



                • #9
                  Thank you once again Doctor. I want to believe my results, but believe I have fallen into the trap of doubting them due to symptoms.

                  As I have only taken one 4th gen lab test at hospital,I see some people have taken many, and one mutiplex hiv1/2 Qualitative rna pcr test, both negative, should I take another 4th gen to rule out error or false NEGATIVE? Or should I proceed to asking Dr to order a cd4/8 count? I have also taken 2 home self test finger prick hiv1/2 ab tests. I have also been tested for hep b, hep c and syphilis all negative.

                  Thank you for time answering my repeated questions from my worried mind. I know you have answered me many times.


                  • #10
                    Hi Anx01,

                    There is no point in doing more tests. They will all be negative for HIV. CD4/CD8 does not offer any diagnostic utility

                    You have HIV Paranoia. I would suggest seeing a psychologist for counselling instead.



                    • #11
                      Thank you Doctor for all your help. I think have got hiv paranoia to some extent. I am usually rational and logical, so don't know
                      why I doubt tests, but symptons persist.

                      The problem I have with last test, is the doctor or lab won't give anymore details apart from this. I have no idea what limit of detection was, and the laboratory lists this as HIV/HBV/HCV Screen by PCR/NAAT (10 days post exposure).

                      Does it matter I did this 6 years post exposure? Results were:

                      MPX HIV1/2-HBV-HCV PCR .
                      HIV1/2 PCR negative
                      HCV PCR negative
                      HBV PCR negative

                      I am going to move on, but do you think the above test, and 4th gen lab test would be enough to pick up infection including hiv2? I believe hiv2 has lower viral load. What I mean, what would be next step IF hiv was still suspected by Doctor? Proviral DNA?

                      Thank you and I will seek help regarding this.


                      • #12
                        Hi Anx01,

                        All the tests you have done is enough. I would not recommend any further testing.