[Question #11185] HIV risk - help in moving on
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16 months ago
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Hello doctor, thank you for all the work you do here.
1. Had an encounter with a high-end, expensive, & appt-only escort. Condom was used throughout for oral and vaginal sex, and it did not break (I think). Also, no open-mouth kissing or cunnilingus was involved. She was very cautious & her previous reviews indicated the same. She said her last test results were 2-3 weeks before our encounter and were clean. Not sure how much to trust and not trust her verbal confirmation. As I grew up in the '80s & early '90s, the HIV fear + shame/guilt took over my mind. I did 2 x gen 4 lab tests (Quest Diagnostics) on the 19th and 28th day, both negative. Waiting for results gave me crippling anxiety, so not sure I have it in me to do the 6-week test if given a choice. I read other similar posts here, and I kind of know the answer, but hearing directly from you will help with the last push I need to move on; I am at week 8 post-encounter. So, considering the use of a condom + both test results, can I put this conclusively behind me, or 6-week test is warranted?
2. Naive question - gen 4 test checks ag and ab. Data says, p24 max is on the 21st day, and usually, by the 28th, both ag + ab are positive for a positive patient. So is the scenario of on the 28th day both ag + ab are -ve & then on day 42, both or just ab are +ve a possible real-world scenario (non-PEP)? If someone has delayed ab generation, then ag would be crazy high on day 28, and that part of the test would be positive, correct?
3. Is 28+ days good enough to stop attributing every small symptom to ARS?
4. With CRISPR HIV success in the news, if you had to make a bet on a cure for HIV, what would be your prediction, and are there trials promising?
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H. Hunter Handsfield, MD
16 months ago
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Welcome to the forum.
I think you realize your fears are completely unrealistic and you have seriously overreacted. I don't think I could better define the lowest risk female sex partner someone could choose. Probably a lot lower risk than anyone you would meet at work, through friends, or anywhere else. Women like your partner generally care about their health, use condoms consistently, and have mostly very low risk clients -- men like you! Putting this in a personal context, if somehow I had been in your position I would not have been HIV tested at all. But in any case, your negative test results so far are nearly conclusive anyway -- 99% or better. (If we assume one chance in a thousand your partner has HIV, a typical risk of less than 1 chance in a thousand of transmission even with unprotected vaginal intercourse, and 99% effectiveness of condoms, the chance you caught HIV -- even before you had the negative test results -- calculates as 0.001 x 0.001 x 0.01 = 0.00000001, or one chance in 100 million. Now add a test that is 99% reliable and the possibility you have HIV becomes one chance in ten billion.
No, you don't need another test at 6 weeks. There is no chance you have HIV. That said, if you need a 100% reliable test -- disregarding the other calculations -- you'll just have to bite the bullet and have another test now.
Those comments address question no. 1.
2. You misunderstand the AgAb (4th generation) blood test. It's a mistake to get into the weeds about time to positive result for the two test components, p24 antigen and antibody. The important thing is that once positive-- whether for antigen, antibody, or both -- the test remains positive for life. There are no exceptions.
3. ARS symptoms are caused by the immune response, not HIV itself. it is not possible to have HIV symptoms with negative test results. Therefore, the answer is yes: with your negative results, no symptom you have now or might have in the future can possibly be due to an HIV infection.
4. I'm not sufficiently expert in HIV biology to estimate the likelihood of a cure. As a rough ballpark, not in the next decade.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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16 months ago
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Thank you for answering.
1. The intellectual part is also telling me that I overreacted. My overactive brain was in the over-analysis mode with thoughts like, "Maybe she is this cautious because she has HIV, but if that is the case, then she would be on ART, and then that would be safe, but what if she doesn't care, etc, etc." So, your reply confirms that my fear is misplaced as there is no HIV risk, and I should only focus on getting over the guilt that I am feeling. The math you shared shows the HIV probability is lower than getting hit by a meteor. I am a healthy mid-40s (occasional acid reflux) person. You + Dr. Hook have mentioned before that practically speaking, you have not seen a 28-day test negative turn positive later. I am looking for a rope to hold on to if my CBT attempts fail and I need to gather the courage to do the 6+ weeks test. So, is it safe to assume that I shouldn't be anxious about the 6+ week test?
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H. Hunter Handsfield, MD
16 months ago
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We not only have not seen anyone whose 28 day negative was later positive -- we've never had an HIV positive person on the forum. That is, during the 20 years of this and our preceding forum, with thousands of questions about people worried about HIV after a sexual exposure, nobody has yet reported that they eventually tested positive. You certainly will not be the first, even if you continue testing.
I'm glad to see you understand the distinction between anxiety over a regretted sexual decision and infection risk from the event. Obviously they aren't the same. Deal with the former as you need to, but the latter is not a realistic concern.
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16 months ago
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This is precisely the metaphorical "kick in the pants" I needed. I will prioritize dealing with regrets over the 6+ week test because if it is not resolved, then I might end up doubting the 6+ week test as well. I don't want to keep coming back here and keep bugging you and/or Dr. Hook.
I am very grateful for giving me the last push I needed. Lessons have been learned & I know my next steps; it is time to move on!
PS: My data analysis with the Gen 4 test was triggered by my confirmation bias to find a way to justify 28th day result. I will drop that pursuit.
Thank you for everything!!!!
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16 months ago
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Hello Doctor,
I will ask my last question so we can close this thread.
I tested on 27 days 18 hours and not exactly after 28 hours post encounter due to lab schedule. I am assuming there isn’t a massive statistical difference because of those 6 hours.
Even though my test was unneeded and I tested anyways, in the end still okay to round up to 28 days to apply the 99%+ accuracy you mention?
Wanted to say before the thread is closed that I am very grateful for the answers and this forum.
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H. Hunter Handsfield, MD
16 months ago
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Correct, a few hours makes no difference. 99% is good.
Thanks for the kind words. I'm glad to have helped. Best wishes and stay safe.
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