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EDITORIAL A Negative HIV Test Doesn’t Mean What You Think

By
Dr. Know
– September 3, 2009Posted in: Dr. Know, Features, Health & Fitness, The Whole Man

Dear Dr. Know,
What does a negative HIV test really mean?  Am I off the hook?
Worried in Washington.

Dr. Know writes:

HIV is an RNA retrovirus.  What this means is that the genetic material in the HIV virion (virus particle) is RNA.  Once a cell is infected, the RNA must be converted to DNA before more virus particles can be produced in the cell.  Unfortunately, the HIV DNA is inserted into the nucleus of every infected cell.  This means that once you are infected, you can never be cured, at least not with current technology.  A cure would require the destruction of the HIV DNA in the genes of the nucleus, and we don’t have the technology or medications to accomplish this.  The human genome project has discovered countless strands of retrovirus DNA in our genes, so HIV and retroviruses in general are not new to us.

An HIV test detects antibodies to the virus, or the immune system’s attempt to fight the virus.  It only detects antibodies, it does not detect the virus.  Most people convert to HIV positive within 6 months of infection, but some people take 12 months or longer to become positive.  This means that people think that they are safe to have unsafe sex with a partner when they are most infectious.  Think about it.  Early in HIV infection, HIV viral loads can be one million copies of HIV per milliliter of blood or more.  Let me say that again:  one million or more copies of HIV per milliliter of blood. And, the HIV test will be negative.  So, who do you think is more infectious:  someone HIV negative but just infected, or someone HIV positive on medications whose viral load is undetectable?

So, a negative HIV test doesn’t mean that you don’t have HIV, it only means that you haven’t yet produced antibodies to HIV.  The only truly negative HIV test is a negative HIV test and a negative viral load. Very few doctors are aware of this fact.  I have attended lectures on LGBT health care, and asked the speakers if they screen for acute HIV infection, and the response I get is a blank look.  When you are first infected, it feels like the flu; the symptoms are the same.  If you become ill with a flu-like syndrome, you should consider HIV as the cause if you have had any unsafe contacts within a month of the symptoms.

Do you have a question for Dr. Know?  Email dr.know@men4men.com

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