[Question #11371] HIV fear - Trying to move on from encounter

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15 months ago
I posted here months ago regarding an encounter on October 13, 2023 when I had protected sex with two Asian massage parlor workers. I was highly intoxicated and my memory is flawed which is a contributing factor to my anxiety (i.e. what if they didn’t put the condom on correctly?) but I do remember condoms being used. The following tests were conducted since that encounter and I have had no new exposures: HIV 1 RNA lab test 32 days negative, 4th generation AgAb lab test 41, 47, 60, 96, 103, 196 days negative, Rapid 4th generation AgAb POC fingerprick test (Abbot alere determine) 91, 102, 138, 180 days negative. All lab tests were conducted through STDcheck.com and done at either Quest, LabCorp or Sunrise Medical Laboratories. The Rapid tests were conducted at local LGBTQ+ community centers in my neighborhood. I have lately been feeling random spots of sensitive to touch skin, almost burning sensation on different parts of my body (wrist, left side of stomach, inside of ankle) but no visible rashes. I also had a small patch of red bumps on my right wrist - I went to urgent care and the nurse practitioner said it looked like allergic reaction/irritation and suggested hydrocortisone cream which I used and it went away after a few days.. I guess I’m just seeking reassurance -from your professional opinion should I stop worrying about HIV based on all of this information? 
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Edward W. Hook M.D.
14 months ago
Welcome to our forum. Thank you as well for your confidence in our service. I’ll be glad to comment.  The exposures you describe were low risk. Please remember that most CSWs do not have HIV and that when condoms are used by commercial sex workers they have as much interest in protecting themselves from infection as you do from them.

You have seriously overtested for HIV and have conclusively proven you were not infected. Your rash is not due to HIV acquired at the encounter you describe.  

Please don’t worry.  It’s past time for you to move forward without concerns.  There is no need for additional testing.  EWH
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14 months ago
Thank you for your response Dr - I recognize that you, Dr HHH and Nurse Warren are among the top experts in your field and are doing God's work by providing this service. Just a few follow up questions to help me really understand this:
1. Based on my research, it appears that the CDC and leading health agencies base their guidelines and recommendations on current studies and data regarding modern testing. From what I understand, virtually all infections would be detected in antibody only tests by 60 days and 45 days for the 4th gen AgAb tests: the CDC says 90 days for Antibody only tests as an overly CONSERVATIVE guideline to account for those with pre-existing immune deficiencies that may take longer to develop antibodies.  Is this accurate? 
2. The CDC says Rapid POC tests even the 4th gen AgAb fingerpick test is conclusive at 90 days even with AgAb despite the research data saying that it can be conclusive before that. Is that because it's using whole blood instead of blood from a vein from a lab so they're being extra conservative or is it due to another reason? 
3. I am aware that 6 months was an older guideline and have found numerous studies and official guidelines that state very clearly that testing 6 months after an exposure is no longer recommended. Is this guideline considered obsolete? If so, why do you think there are Doctors out there that still advise testing at 6 months? In India apparently according to their agency (NACO) guidelines, they state that one has to be followed till 6 months to declare one as negative.. the Indian doctor that told me this said that one would be considered negative way before this but that what their guidelines still state. Are they being overly conservative? (I'm in the US not India, just curious why they still say 6 months)

Again, thanks - I look forward to your reply.
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14 months ago
Doctor - I would greatly appreciate a follow up whenever you get a chance. It would be helpful in me understanding it in contrast to all the conflicting information out there to help me move forward. Thank you!
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Edward W. Hook M.D.
14 months ago
My apologies- I missed your follow-up questions and will address them now:

1.  your summary is accurate.  4th generation, combination antigen/antibody tests for HIV are conclusive at any time more than 45 days following exposure.  Antibody only tests are not conclusive until after 60 days.

2.  CDC is typically very conservative in their recommendations.  This is an example of this

3.  Health care providers who continue to state that HIV test results are not conclusive until 6 months following an exposure are incorrect.  They may be out of date, mis-informed, or overly conservative

Again, sorry for the delayed response.  EWH
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14 months ago
Thank you for your follow up Dr. I, with the help of my therapist, have realized that this encounter triggered OCD regarding fear of being infected of HIV which I am receiving mental health treatment for (weekly therapy sessions). I have been making great progress and slowly moving on from this. The problem is trying to get past my fear of HIV whenever I feel any type of physical symptom or sensation no matter what it is - my automatic thought is, “is that HIV?”

I have stopped looking for information on places like Quora and Reddit because those places seem to inflame my anxieties more and I have seen people write on there stories that they heard of people testing positive later but have no actual proof of this . I have decided to ask myself, “am I going to listen to the CDC, the WHO, leading infectious disease experts, up to date peer reviewed official scientific literature and state government’s health department guidelines? Or am I going to listen to what some random person on the internet is saying…” 

Anyways, I would appreciate any closing thoughts on this and again want to thank you for your input - you are helping a lot of people here.
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Edward W. Hook M.D.
14 months ago
Thank you for your follow up comments. We fully understand just how easily a person can be misled by stories that can be found all too readily on the Internet. You are strategy of believing or authoritative sources such as the WHO, CDC, etc. is right on target. I wish you the best going forward and addressing your OCD. It sounds like you are on the right path. 

As you know, with this third response, this thread is complete and will now be closed. Take care. We wish you well. EWH.
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