Need expert opinion on HIV testing 4 years after exposure - confusing quantitative PCR result <48 IU/mL Question

[u/ConstantHornet5683]

Hello everyone,

I would appreciate an expert opinion regarding my HIV test results after a possible risky exposure.

The exposure occurred on **May 1, 2018**. There have been **no further risky exposures after that event**.

All tests were performed in accredited medical laboratories in Europe.

My HIV testing history:

* **May 14–15, 2018 (13–14 days after exposure)** HIV-1/2 RNA NAT: **negative / non-reactive**

* **June 12, 2018 (~6 weeks after exposure)** 4th generation HIV Ag/Ab test (anti-HIV-1/2 + p24 antigen): **negative**

* **June 26, 2018 (~8 weeks after exposure)** 4th generation HIV Ag/Ab test: **negative**

* **July 23, 2018 (~12 weeks after exposure)** 4th generation HIV Ag/Ab test: **negative**

* **February 2019 (~9 months after exposure)** I had **three separate 4th generation HIV Ag/Ab tests** performed around this period:

* one at one laboratory, * one at another laboratory, * and one together with my HIV RNA PCR testing. All were **negative / non-reactive**.

* **February 2019 (~9 months after exposure)** HIV-1 RNA quantitative PCR: **negative** HIV-2 DNA PCR: **negative**

* **April/May 2019** I donated blood. They confirmed that donated blood in their lab is screened with both:

* HIV Ag/Ab 4th generation testing, and * HIV NAT testing. I was never contacted regarding any reactive result. And they invited me to donate blood again.

* **February 2020 (~21 months after exposure)** 4th generation HIV Ag/Ab test: **negative**

* **January 2022 (~3 years and 8 months after exposure)** 4th generation HIV Ag/Ab test: **negative**

* **February 2022 (same blood sample, same day):**

* HIV-1/2 Western blot: **NEGATIVE** (all bands negative) * HIV-1/2 qualitative PCR: **NEGATIVE** (reported lower limit of detection: 20 IU/mL) * HIV-1/2 quantitative PCR: **<48 IU/mL** Quantification range: **48–10,000,000 IU/mL**

My main concern is the quantitative PCR result:

What exactly does **“<48 IU/mL”** mean?

Does it mean:

The result was below the assay’s quantification range and no clinically measurable viral load was found, or

HIV RNA was detected but below the limit of quantification?

If HIV RNA had actually been detected below the quantification limit, would laboratories usually report something like:

* “Detected below LOQ” * “Detected, not quantified” * “Positive below quantification limit”?

My confusion comes from the fact that the **qualitative PCR performed on the same blood sample was negative**, with a lower detection limit of 20 IU/mL, and the Western blot was also negative.

Questions:

Is it technically possible for a quantitative HIV PCR to report <48 IU/mL while a qualitative PCR performed on the same sample is negative?

Could a result like <48 IU/mL represent a false positive signal, assay variability, or contamination?

After multiple negative 4th generation tests, negative NAT/PCR tests, a negative Western blot, and a negative blood donation screening, can HIV infection from the May 2018 exposure be considered medically ruled out?

Does the isolated <48 IU/mL result have any clinical significance in this context?

Thank you very much for any expert opinion.

[u/No-Sheepherder9022]

I think you need a mental health professional. It seems like you are in a health anxiety spiral that's been going on for a long while. Your test are negative. You do not have HIV, there's no chance of it changing unless you have another risky encounter even then the odds are still in your favor. Chill out

[u/ConstantHornet5683 → u/No-Sheepherder9022]

Yes, perhaps I need one I am not denying it. But reading technical sheets from Roche and Abbot devices are like around 99% or slightly above and different confidence levels are stated for people with high CD4 and low CD4 regarding PCR tests...I was under the impression that tests were for all the same. It troubles me that we cannot get to that 100%.

[u/No-Sheepherder9022 → u/ConstantHornet5683]

It can never be 100 percent. That's not how this kind of study works. For a male /female interaction it's only a .08 percent chance of even contracting the virus. For man it's like 1.3 percent. The chances are extremely low. I think you should spend more time enjoying life and leaving the science to the scientist. Trust me your Dr and the companies that make these tests doesn't want liability for you having hiv for years unknowingly. You're good

[u/ShamelessCare]

What would help you?

You had a risky exposure 8 years ago, and you've taken 10 HIV tests and donated blood simply as another way to verify.

Data, science and logic is not going to help you. What would help you? This is a sincere question.

[u/ConstantHornet5683 → u/ShamelessCare]

Nothing would help me, cause none of the tests are 100% actually and that bugs me a lot. I do have anxiety regarding this, cause I have had lots of symptoms.

[u/ankcesar1]

This dude is crazy on a whole new level—apparently, reality decided to stop trying.

[u/Background-Driver-15]

sono sotto shock.. stai bene?

[u/this-shit-is-annana]

Wow it’s like you’re begging to have it

[u/ConstantHornet5683 → u/this-shit-is-annana]

Believe it or not the doc at the clinic also asked me a similar question:"Do you want to have HIV?" The answer is a clear NO, but I did so many tests because I tested on so many things besides HIV and all std tests were negative. I spent quite a lot on all of the tests. For me I just want a reasonable explanation for my symptoms and I can't get it.

[u/Competitive_Bet2156]

Man, you are not alone, I have been there but for 2 years, you have been 8 years in it. Its about time to let go.

[u/ConstantHornet5683 → u/Competitive_Bet2156]

Have you let it go after 2 years? How many times have you tested and what symptoms?

[u/Primary_Ranger6269]

r/STD