[Question #11812] Type/brand of test and new exposure

12 months ago

Dear Doctors

I hope you’re well. 2 clarification points and a question please:

6 months ago I wrote question #10883 and you very kindly helped me. Only wanted to please bring 2 points and say (happily) that you were right re. me being overly anxious. I tested and all the tests were negative, inc. a 4th gen test on 13th Mar (still on PrEP) and 90 days after fully stopping it, a 4th gen test (16th July) plus 2 PCRs, a qual & a quan. I’m happy all was negative and I’m also now on treatment for my anxiety. THANK YOU for all that you do!! :)

Two points only for future clarity pls:

1-Is your advise is to always test for HIV 30 days AFTER last dose of PrEP or PEP?

2-The viral load test they did on me in Argentina is the “HIV-RNA CUANTITATIVE (ROCHE) - Method: Cobas Taqman HIV-1 Test - Dybamic range: 20 a 10.000.000 copies/ml” — do you know it? Does it comply with CDC and/or European standards?

12 months ago

Finally: last Sunday I had a day date w/a guy I met on Grindr. We only French-kissed at the park. The following day I developed a very bad sore throat which remains up to today, also some coughing & mucus. Do you think it could be HIV at all? That day I brushed my teeth intensely before meeting him.

Thank you AS EVER!!! :)

12 months ago

Apologies - forgot to say that when I kissed with this guy I was NO LONGER on PrEP - after stopping it back on 13th April, I have not started taking it again as don’t intend to have any sex for the time being.

Edward W. Hook M.D.

12 months ago

Welcome back to the Forum. I'll be glad to comment. FYI, I am having trouble access your previous questions so I'll do my best to respond. I'm glad to hear of your results. The prove you did not acquire HIV.

1-Is your advise is to always test for HIV 30 days AFTER last dose of PrEP or PEP?

Yes, that remains our advice. When persons fail PEP or PrEP their tests may become positive before 30 days have passed following discontinuation of the medication but it is best to wait for 30 days. This is particularly true for PEP. For PrEP, as a generalization, we don't want clients to be at risk for the sake of testing so we would not necessarily recommend stopping PrEP just to check their status. I realize this is a bit confusing but we have great confidence in PrEP for prevention of HIV and would not want someone to become infected becasue they had stopped their PrEP to reassure themselves that the PrEP was working.

The Roche test is approved in the US and Europe. The quantitative test is most often used to monitor the viral load response to therapy

French kissing is not recognized as a risk factor for HIV acquistion. HIV is inhibited by saliva. The symptoms you describe do not suggest HIV and have occurred too soon after your encounter to be due to HIV acquired the previous day

I hope this information is helpful. EWH

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12 months ago

Many thanks, Dr Hook.

As follow up:

1. So you’re saying the test I had is approved in both the US and Europe. Is it “better” than the Abbot or other brands? What about the specific method that they used?

2. You said the viral is to monitor the efficacy of therapy. Does that imply that it’s always best not to have a quantitative but a qualitative PCR when unsure if having acquired HIV? Would you have done or usually recommend a qualitative one instead for diagnostic purposes? Of note, in my case I did have the two and AFTER a 4th gen, so it’s was more for my peace of mind.

3. I know kissing is low risk, but what if there was blood on my “partner”’s mouth or on mine after brushing my teeth intensely before seeing him, plus I have a bit of an open cavity.

4. You noted that the symptoms do not suggest HIV infection, and I don’t intend to dispute this, but I’ve read that sore throat is actually and very often one of the main, core symptoms of ARS. Also, I’ve never had this type of sore throat before, its feels sore at the end, when the neck touched or joins the shoulders. What about mucus on nose and throat — is that a frequent ARS symptom? And you said the sore throat is too soon - when you expect somebody with recently acquainted HIV to develop that of other symptoms.

Thank you as ever.

Edward W. Hook M.D.

12 months ago

1. The test you had was high quality. The performance of all approved RCR tests are similar and there is no need of benefit to trying to figure out if one is better than another. Don't be paranoid.

2. The CDC recommend qualitative PCR tests for diagnosis. You should not worry you have more than proven that you were not infected. Once again, don't be paranoid

3. Even if your partner had blood in his mouth, dental disease, or oral sores the kissing would still be no risk. More paranoia.

4. You are being argumentative. The ARS does NOT occur within a day of contact because there must be an antibody response to cause it- it's too soon to have developed antibodies to HIV. The ARS most typically occues between one and 3 weeks after acquistion of infection. Further, a severe sore throat is PART of the the ARS syndrome which also typically includes HIGH fever, widespread muscle or joint aches. Mucous and runny nose are cold symptoms and are NOT part of the ARS.

You have one follow-up remaining. EWH

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11 months ago

Dear Dr Hook

Thanks a lot for your answer. And first of all let me apologise if I somehow came across as argumentative — I truly, genuinely wasn’t acting like that. Please note that English is not my first language (Spanish is) so I try to write as good as I can. Also, it’s true that sore throat was mentioned as symptoms online — now I understand your point that it’s PART of ARS and not the only symptom. Thank you :)

I also wanted to clarify that all of the tests I was walking about were due to some exposures in Sep-Oct (with one guy and before being on PREP) and December 2023 (a one off whilst on PREP). I am happy they are all negative.

As regards the new exposure, 15 days ago, the guy sent me his 4th gen test results and is negative, but he doesn’t want to say when he last had sex so I’m worried about window period. Also Dr, I have bad news — I woke up today with chills, nausea, feeling feverish (although normal temperature on thermometer, and rash on arms and chest. Sorry if I come across as repetitive, but do you think it could be ARS at all from kissing? Are the symptoms I describe ARS-related? Would they appear sharp at day 15?

I’m due to get tested today w both a 4th gen and a PCR, I can let you know the result and thanks you!!

Edward W. Hook M.D.

11 months ago

Regarding your new exposure- HIV is not transmitted by persons with negative tests other than those who are in the "window", developing a positive test. However, the window period is a rare event- your partner has not acquired HIV thus far and thus is unlikely to be in the process of becoming positive at this time. Further, as I have already said, kissing is NOT a risk for HIV acquistion. The symptoms you are experiencing at this time are among the symptoms associated with the ARS, along with muscle aches and a severe sore throat (all happening at the same time). They far more likely to be the flu or COVID.

If your symptoms are due to HIV, your 4th generation test will be positive. If you acquired HIV from your recent encounter, your HIV RNA PCR test will be positive. I am confident both will be negative. When they are, it is time for you to put your fears behind you and move forward.

There will be no further answers but I will leave the thread open for a few days so you can share your test results. As I said, I am confident they will be negative. EWH

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11 months ago

Thank you Dr Hook.

I can confirm that I tested earlier today (14.5 days post kissing this guy) with both a 4th gen test and a PCR test (HIV-1 RNA and proviral DNA - test called Cephid Gene Xpert Qual). Both were negative :)

I know the 4th gen is not yet conclusive and that perhaps it was too early for testing but I truly could keep my anxiety at bay.

On the less positive side, I keep on vomiting a lot and having chills and hot flushes in my face.

Thank you!!

Edward W. Hook M.D.

11 months ago

Your test results prove you were not infected and that your symptoms are not due to HIV. The test results will not change.

Closing the thread noe. Take care. EWH

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