[Question #12209] Testing

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9 months ago

Sorry to be back. I had protected vaginal and protected oral w a female CSW masseuse back on Oct 12. I panicked and got on PEP after 60 hours but later stopped after two doses after realizing I may have over reacted. I am freaking out now bc I went for a PCR test 12 days for piece of mind and after not getting results for over a week, was told no result was found due to “non-amplification of the internal control suggests the presence of PCR inhibitors in the patient sample. An additional sample should be submitted for testing if clinically warranted. blood test hiv. Could the PEP have been a factor? Is this a false positive? The lab indicated that there was a problem with the testing sample and to not be concerned, as if it were positive, I wouldve been notified. Should I be concerned? 

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H. Hunter Handsfield, MD
9 months ago
Welcome back, but I'm sorry you found it necessary. There is absolutely nothing in this that suggests you have HIV. I cannot say the frequency of this finding, i.e. possible PCR inhibitors. To my knowledge it has nothing to do with PEP, especially since your last dose of drug apparently was at least a week before the blood sample was obtained. I agree with the lab's advice. And of course they have not tried to mislead you. You would have been informed if the test were actually positive.

There is no point in further discussion unless and until you have the additional test recommended by the lab and would like to let me know the result. In the meantime, I suggest you re-read your original thread and my replies. You were at zero risk of HIV and there is no chance you have it.

HHH, MD
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9 months ago
Thank you for your response Dr. I’d like you to ask what a PCR inhibitor is? I’m guessing it doesn’t have anything to do with HIV? Btw- why is it rare for women to transmit to men? Just trying to understand that part more and calm my fears. 
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H. Hunter Handsfield, MD
9 months ago
I don't know the chemical or biological characteristics of PCR inhibitors. The lab may have more information about it.

The anatomy of sex explains the lesser transmission of HIV from females to males. If you think about it, the reason is pretty obvious. After a typical sexual encounter, the woman has received an internal deposit of large amounts of the virus in semen and her exposure lasts for as long as semen remains in the vagina, i.e. hours or even days. Even then, the odds she will be infected, if her partner has untreated HIV, averages one chance in a thousand. By contrast, the male has a much smaller exposed surface -- the urethral opening and the tissues under the foreskin if uncircumcised -- and the amount of fluid exposure is obviously much less than in the vagina. The average risk from an HIV infected female to her male partner from a single episode of unprotected vaginal sex is around one chance in 2,500. With a condom, that chance is reduced at least 99%, i.e. to something like one in 250,000. If we assume there was a 1% chance your partner had HIV, then your risk from the exposure described was one chance in 25 million -- which fits with what I advised in my initial reply in your previous thread. That's why I said that if I had been in your situation, I would not have even been tested for HIV. (In that sense, your current anxiety is the direct result of being tested when it wasn't needed!)

Threads are closed after two follow-up comments and replies, and repeat questions on the same exposure or risk are not permitted -- so this is your last thread on these issues. So no more discussion until you have followed the lab's advice and had another PCR test, if you would like this forum to comment on it.
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9 months ago
Hi Dr.
I received my PCR today and it was negative. The test was taken on Nov 8 about 20 days after I stopped PEP on Oct 16 (which I had stopped after two days dosage). I had protected vaginal and oral with a masseuse CSW on Oct 12. Can I trust these results? I understand the PCR tests are the gold standard for early detection. Did the 2 days of PEP cause a false negative? What are my odds that I am negative at this point? I have not had any symptoms, only extreme guilt and anxiety. I’ve been drinking daily and avoiding sex w my wife since, which I know has not been helpful for my health. Thanks for all you do. 
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H. Hunter Handsfield, MD
9 months ago
The RNA PCR at 20 days is proof. You can trust the result; you don't have HIV. And as discussed you had a zero risk exposure anyway. "What are my odds that I am negative at this point?" 100%.  You did not need to stop having sex with your wife and certainly can resume it now.

That concludes this thread. Repeated questions are not permitted, especially when anxiety driven. This being your second, it must be your last. Such questions may be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is intended to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thanks for your understanding. I do hope the two discussions have been helpful. If your anxieties continue, I would suggest first carefully re-reading both threads; and if that doesn't do it, seek professional counseling. It really isn't normal to remain so fearful after the repeated science based reassurance, at least on this forum and perhaps from your own doctor. Good luck.
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