[Question #11231] HIV question for Dr. Hunter.

16 months ago

Hi Dr. Hunter, I am a 26 male in a long term relationship and had a “low” risk exposure with an unknown HIV status female partner (not my regular partner) (insertive vaginal protected sex, no visible tear or damage on the condom but after we finished, when I was removing the condom some vaginal fluids from the condom came in contact with a fresh wound from nail and cuticle biting in my finger from 1 hour before the act).

I was having symptoms like sore throat, mild flu symptoms, white tongue (not sure if oral thrush or white coating), night sweats and jaw discomfort (no swollen lymph nodes).

I had three 4th gen HIV lab tests from vein, one at 27 days after exposure and came negative at my doctor's office. two following HIV 4th gen tests from LabCorp (the name of the test is HIV Ab/p24 Ag with Reflex) at 43 and 46 days after exposure. Both came negative. For the test at 43 days, I took a One a Day multivitamin that contained 43 mcg of Biotin like 6 hours before the test (came negative). When I realized this, I decided to repeat the test on day 46 (52 hours / 2 days without taking any multivitamin).

I am still concerned since I still have jaw discomfort, stiff neck, sore throat, occasionally night sweats. I did not have any sexual activity with my gf after the exposure. Would you recommend me to retest at day 60 & 90?

Edward W. Hook M.D.

16 months ago

Welcome to our Forum. Thanks for your questions. FYI, clients are not permitted to choose who answers their questions. Dr. Handsfield and I have worked together for over 40 years and while our verbal styles differ from one another, the information contained in our replies is always the same. Today your question was assigned to me.

Your symptoms are not due to HIV. This is certain. Your exposure was condom protected and therefor, if your partner had untreated HIV (this is very unlikely), the condom provided reliable protection. That some of your partner's genital secretions remaining on the condom may have contacted a fresh wound does not change this fact in any way. Further and more importantly, your tests prove that you were not infected. The 4th generation, combination HIV antigen/antibody tests you describe provide entirely reliable results at any time more than 42 days (6 weeks) after an exposure, thus both your 43 and 46 day tests prove you were not infected as well. The amount of biotin in the multivitamin you took is not enough to have any effect on the reliability of your test results. The concerns raised on the internet about biotin interference with test accuracy is an alarmist myth.

Your current symptoms are due to something other and HIV. There is no reason related to the encounter you describe to avoid unprotected intercourse with your regular partner.

I hope that this information is helpful. Please don't worry. EWH

---

16 months ago

Hi Dr. Hook, thank you for replying my question. I am having a really bad time after this encounter (hard way to learn a lesson).

Thank you for your clarification about the Biotin. I did not take this multivitamin for more than 48 hours since the instructions for the test required that and the result came back negative at 46 days. I still have three concerns:

Is not possible to contract HIV from a fresh superficial wound even if it contacted body fluids from an infected person?

I have been reading information in internet and some guidelines recommend to test 90 days after the exposure even if the CDC states that a test performed after 45 days is conclusive. The test website where I ordered the tests recommend to test 90 days after the exposure, that's why I am concerned. Is it possible to test positive after a 45 days negative test?

Can I rely in LabCorp for these results?

Thank you.

Edward W. Hook M.D.

16 months ago

My sense is that you may have been carrying out research on the internet about your risks. In this situation, the internet is not your friend. Much of what is said there is incorrect, either because it is exaggerated, misinterpreted, out of date or just plain wrong

Regarding your follow up;

Is not possible to contract HIV from a fresh superficial wound even if it contacted body fluids from an infected person?

AS I said above- "That some of your partner's genital secretions remaining on the condom may have contacted a fresh wound does not change this fact in any way." HIV is NOT acquired in this way

As I also said above, 6 week test results are conclusive. Recommendations for testing out to 90 days are out of date and overly conservative. There are no cases in which persons who were not taking anti-HIV medications had tests turn positive after 45 days- none!

Lab Corp is a reliable, highly respected lab. Have confidence in their test results.

Please don't worry. EWH

---

16 months ago

Thank you so much for your answers Dr. Hook. I feel more confident after reading this.

I have one last question about the performance of the 4th generation test, since I did three tests in different dates if I was infected by HIV the P24 antigen should have been reactive in any of those three dates correct? Besides that if my symptoms were caused by HIV, the HIV antibodies should have been positive also right? HIV antibodies generation for HIV 1 & HIV 2 have the same window period?

Again, thank you so much for your answers, I really admire your job and appreciate your time for answering these questions.

Thank you.

Edward W. Hook M.D.

16 months ago

When the p24 antigen appears is a bit variable however, in nearly everyone it would have appeared when you had your 27 day test. For your later tests the P 24 antigen or both the p24 antigen and antibody tests would have been positive. You seem to have trouble accepting this but that is the case. As I've said repeatedly, your results are conclusive and should be believed. Your results are conclusive for HIV-1 and HIV-2.

As you know, we provide up to three responses to each client's questions. With this 3rd thread, we are done and the thread will be closed shortly without further replies. There should be no need to return to the Forum regarding the encounter you have described. EWH

---