[Question #10730] High Risk Exposure to HIV
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20 months ago
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On Sep 2, at 6 pm, the condom broke during an encounter with a Trans woman where I was the insertive partner. As a precaution, I obtained a PEP prescription and began it at 1 am the next morning, approximately 7 hours later. Post-incident, I tested positive for Gonorrhea and promptly received treatment from a different doctor. The PEP regimen concluded on Oct 3. On Oct 31, I had a stomach virus (diarrhea for 4 days), followed by a wet cough on Nov 5, diagnosed as bronchitis on Nov 10, treated with a 6-day course. Symptoms resurfaced on Nov 21 after being with my son diagnosed with RSV. Until Dec 2, I dealt with sinus congestion, a wet cough, sneezing, and a runny nose. On Dec 6 (day 65), a low-grade fever (100.2) and night sweats occurred. Symptoms briefly subsided but returned on day 66, leading to an urgent care visit where an ear infection was diagnosed. OraQuick Saliva test on day 68 was negative. Seeking insights or guidance on these symptoms.
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Edward W. Hook M.D.
20 months ago
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Welcome to our Forum. Thanks for your detailed description and your questions. I agree that the exposure you describe was relatively high risk and support your decision to take PEP. I understand that after such an exposure you would want to have the best possible information about your status. Your OraQuick result is very strong but not perfect information that you were not infected.
Given the fact that you had a less than 1 in 1000 chance of being infected, IF your partner had untreated HIV (and you apparently do not know her status- statistically it is unlikely that she was infected), and the fact that you took PEP, it is unlikely that you were infected. Your OraQuick result strengthens this assumption. Having said that, the OraQuick is our least favorite test for HIV as, on rare occasions, it can miss infection. While I am confident that you were not infected, if you wanted to be entirely sure that you were not infected, I would suggest one more test using a laboratory-based, combination HIV antigen/antibody test. When that result is negative, as I assume it will be, you can be entirely sure you were not infected. EWH
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20 months ago
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Thank you, Dr. Hook. I am taking another OraQuick Test today and going to the clinic tomorrow for a 4th gen test. My only follow-up here is the symptoms I shared. Are they typical of an early infection? Or, since I have been sick for a bit, could this be Acute HIV compromising my immune system so that I catch all of these other viruses?
1. Diarrhea (by itself) 28 days later (my son had the same symptom two after mind started, except he was vomiting as well)
1. Diarrhea (by itself) 28 days later (my son had the same symptom two after mind started, except he was vomiting as well)
2. Wet/Productive Cough more than 30 days later
3. Sinus congestion, a wet cough, sneezing, and a runny nose all at once over 50 days later
4. Low-grade fever (100.2) and night sweats 65 days later for only one night
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20 months ago
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Dr. Hook,
I apologize for the follow-up, but I have a few additional questions I'd like to address before receiving your response to my previous inquiry.
- What is the likelihood of PEP failing if taken within 7 hours of exposure? I adhered to a daily regimen for 30 days with no more than an hour difference between doses on occasion.
- Is it probable that my OraQuick test results may differ from a 4th generation test given my type of exposure? I received two negative results at 11 weeks via oral testing.
Thank you!
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20 months ago
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Hi,
My apologies for reaching out again before a response from someone. I am reaching out again because I am terrified that there has been no response to my questions. Maybe I'm thinking too much into it, but because my questions haven't been answered, it's making me think there are no good answers to my questions.
I am sorry again since this is more than likely due to the volume of questions you get and bandwidth. I still have not gotten another blood test since pep because I am afraid. If I had more faith not to worry too much about the questions I posed and that the oral tests were 99% accurate, I would be less frightened.
Either way, I do appreciate your guidance!
I am sorry again since this is more than likely due to the volume of questions you get and bandwidth. I still have not gotten another blood test since pep because I am afraid. If I had more faith not to worry too much about the questions I posed and that the oral tests were 99% accurate, I would be less frightened.
Either way, I do appreciate your guidance!
Best!
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Edward W. Hook M.D.
20 months ago
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Thank you for re-contact me, I missed your 3rd f/u 3 days ago.
I think you are worrying far too much about the possibility of HIV at this time. Here are the facts:
1. You do not know that your partner had HIV- most trans women do not
2. Even if she did have untreated HIV, your risk for acquiring HIV as the insertive partner is less than 1 in 2000
3. PEP reduces the risk for HIV acquistion by 90% among persons who start the medication less than 72 hours following exposure- there are no hour-by-hour data on the effectiveness once PEP is started but certainly earlier is certainly better
4. You have not one but two negative OraSure tests for HIV at times when the results are reliable.
Taken together, the chance that you acquired HIV is virtually zero. Further testing, while scientifically entirely unnecessary, will only provide yet more evidence that you were not infected.
You need to move on. You did not acquire HIV from the exposure you described. EWH
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