[Question #11019] Clarity
17 months ago
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- Back in October of 2023 I had an “incident” where I rolled my window down to give a homeless person money, he had a bottle of liquid in his hand where some spilled into my vehicle and on clothing. I wiped things down with disinfectant wipes but got paranoid about having an open cut on my hand and possible contamination if there was blood in this liquid. I bite my nails as well. If somehow this liquid did indeed have some blood in it or other bodily fluids that I happened to touch, is this a worry? Some spilled on my work bag which I use daily and in my car that I did not wash immediately, would I be in danger to contact the virus if I touched any of the fluid? I have taken probably upwards of 10 Oraquick tests since this incident. Yes it has been very expensive. The first was about two weeks after the “incident”. Most recent was 2 weeks ago 4 months past. Are these conclusive?
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H. Hunter Handsfield, MD
17 months ago
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Welcome to the forum. Your question is an opportunity to review (again) some of the history of HIV/AIDS, with information you should find reassuring. Pardon the greater detail than you might have expected; I occasionally wrote blog-like replies that can benefit other users.
From the earliest days of the appearance of HIV/AIDS in North America and Europe -- in the early to mid 1980s -- it was apparent that all infected persons had experienced high risk sexual exposures or shared drug injection equipment with other persons. Within another year, it was known that blood transfusion or organ transplantation explained some cases, and that it could age transmitted from infected mothers to their babies during delivery or by nursing. The once the causative virus was identified in the mid 1980s, it was possible to test people and it was confirmed that nobody ever tests positive without such exposures. Because blood was an obvious vehicle for transmission, public advice about prevention has mentioned "blood contact". However, we public health experts often have not been very good at clarifying the KINDS of blood contact that are necessary for transmission. Large amounts of blood are required, and/or blood must have contact with certain kinds of cells that are deep inside the body.
The fact is that there has never been a known case of HIV transmitted by the minor, superficial kinds of blood contact that are implied by your question. In fact, even if the "bottle of liquid" were blood itself, this would have been a zero risk event. On top of all that, studies in unhoused persons have shown HIV to be no more likely than in the general population -- so the chance that person had HIV is very low, probably under one chance in a thousand. You should not have been HIV tested on account of this event. However, all standard blood tests are conclusive when done sufficiently long after exposure -- within 6 weeks for the usual test (an antigen-antibody or AgAg test, also called "combo", "duo", and "4th generation" tests). Your multiple negative test results prove conclusively you do not have HIV. Please stop testing, and stop worrying.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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17 months ago
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Thanks for the response. My testing whether warranted or not is something I did to try to relieve some anxiety. They were not the duo blood test but rather the Oraquick oral one. I have read through some posts here that even past 3 months they aren’t reliable. Would the conclusiveness of the results be the same having done 3 of them past the 3 month mark which all came back negative? In fact I’d say I’ve done probably 6 total since around Thanksgiving of 2023 which came back negative. I had labs done for a routine physical in December as well which did not specifically check for hiv but all my bloodwork came back normal. I just want to know if I can put this behind me.
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H. Hunter Handsfield, MD
17 months ago
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The oral fluids test misses up to 5% of HIV infections, even after 3 months. Given that you weren't at risk at all and that no testing was medically necessary, I don't think this matters. But if you feel you need a conclusive test, have a lab-based blood test.
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Routine blood tests, like CBC and standard blood chemistries, are entirely irrelevant in regard to evidence for or against HIV.
---You should be able to put all this behind you now. But feel free to have a lab based HIV test if you like. It will be negative.
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17 months ago
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So even having taken 3 separate oral swab tests on separate occasions past 3 months all negative, you are saying that isn’t enough evidence? My understanding is some of this is based on user error, not waiting long enough etc. But if I understand you correctly, there is a chance that every single oral quick tests I’ve taken, and it has been roughly 10 beginning 3 weeks after this incident and then lastly 4 months after could all be wrong?
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H. Hunter Handsfield, MD
17 months ago
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Your test results ARE "enough evidence" you don't have HIV since no testing was needed anyway. But even under perfect circumstancs plus user error, the oral fluids test misses some HIV infections. It's a simple technical issue: in HIV infected persons, the amount of antibody in crevicular fluid (i.e. from under the gums) is far lower than in blood, creating a challenge to the very concept of this test. It just doesn't work as well as the blood tests and should not be expected to do so. However, given the absence of risk, there is zero chance you have HIV, regardless of your test results.
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That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Please do not return with any more questions about this situation. There is no possibility there is anything more you can think of that would change the reasoned, science based advice I've given. If you still doubt that, I would advise re-reading my opening comments above; and also consider whether there are underlying psychological issues that make you so worried about HIV despite public knowledge known and understood for years, and despite this reasoned, science based advice.
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