[Question #12970] HIV related

3 months ago

My exposures with hiv positive person which was unknown to me during all of this: A handful of deep kissing sessions (don’t believe there was blood or sores but not 100% sure), he kissed me with pre-chewed food in his mouth (possible pre masticated encounter), I received oral sex from him (I am a female and was given pep after oral which was taken 60 something hours after exposure, he bit my toe playing around but did not see blood or broken skin. I know these are low to negligible risks but I am traumatized and need reassurance from a specialist. I had a 4th gen test 8 weeks post pep which was also 89 days post exposure. I tested negative with three oraquick swabs 6 months post exposure. Can I move on with my life? I am in therapy but still struggling and with anxiety and depression.

H. Hunter Handsfield, MD

3 months ago

Welcome to the forum. Thank you for your confidence in our services. I'm sorry to hear of your struggle with anxiety and depression; I'm happy to see you're in therapy, but I hope this reply contributes to your recovery.

First and perhaps most important, test results overrule risk every time. No matter how high the risk of HIV at the time of exposure, your HIV test results are 100% proof you were not infected. You mention PEP only in passing, but the results 8 weeks after the last dose of drug was conclusive. (The OraQuick results are reassuring as well, but you should know that OraQuick is never advised after a known HIV exposure. The oral fluids testing method misses up to 5% of HIV infection no matter how long after exposure or PEP.

I am happy to confirm your knowledge "these are low to negligible risks" even with a known HIV infected partner, and even if that person was not taking effective anti-HIV treatment. Even before I saw that statement, I was about to write that this probably was a zero risk exposure. Even if untreated and/or with a high viral load, kissing rarely if ever transmits HIV. Interesting that you mentioned pre-masticated food -- it implies you are aware of rare HIV cases in children transmitted through pre-chewed HIV by an infected adult. However, this has only been known to happen once or twice, despite millions of events like it (in societies where pre-mastication of young kids' food is common. So even this is very close to zero risk. Oral sex also is very low risk: there has never been a known case of HIV transmitted by cunnilingus (oral-vaginal sex). Although I can understand how you and your doctor or clinic decided on PEP, I would have advised against it if you had asked before starting treatment. PEP usually is reserved for higher risk exposure than these.

In any case, as already noted, the risk at the time of exposure is irrelevant since the test results prove you aren't infected. I hope this information is helpful. (You might consider printing out this thread to discuss with your therapist.)

HHH, MD

---

3 months ago

Doctor, Thank you for your quick reply and helpful insight. You did not mention anything about the bite to my toe, I did not see any blood or broken skin so I assume that was also not a risk of exposure? My brain keeps harassing me with thoughts of what if, which is triggering me to continue testing, but still getting no relief, so I am stuck in this horrible cycle. 2nd question: My doctor told me to have my last test 90 days post exposure but I see that the cdc recommends final testing 4 months post exposure for pep. Do I need to test again with 4th gen test? Am I safe to move on with my life and have unprotected intimacy with my current partner. Thank you.

H. Hunter Handsfield, MD

3 months ago

Sorry I didn't comment on the bite, but it doesn't change my comments or advice. As I said, at this point the risks for HIV at the time of exposure mean nothing; you should do your best to entirely ignore them. In any case, biting is one of those theoretical risks that have not panned out in the real world. I am unaware that there has ever been a proved case of HIV from a bite.

That "my brain keeps harassing me", "what if" thoughts, being "stuck in this horrible cycle", and repeated testing without relief all are issues to address with your therapist -- but they make no difference in my assessment and medical advice. You do not need to test again and you definitely are "safe to move on with [your] life and have unprotected intimacy with [your] current partner."

I repeat my advice to print out this discussion in order to share my perspectives with your therapist. That is if you're really in therapy. Honestly I'm wondering if that was a truthful statement. Pardon my suspicions, but we've had many forum questions from people who claimed to be in therapy but clearly were not. If not, for sure you should seek counseling now.

---
---

3 months ago

Thank you for taking the time to answer my questions. I am a little bothered you questioned if I’m actually in therapy but that’s okay. I know you deal with lots of people who may not always be honest. I will be sharing this with my psychologist. Have a good night, you can end our session.

H. Hunter Handsfield, MD

3 months ago

Glad to hear my fears were wrong and sorry my comment concerned you.

That completes the two comments and replies included with each question and so ends this thread. I hope the discussion was helpful. Best wishes and stay safe.

---