[Question #13509] Hiv Risk - Testing Conclusive

4 days ago

Hello and thank you for this service in advance.Around 5 and a half weeks ago I had a one off sexual encounter with a trans female who I met on a website for swingers. It was an intensely regrettable sexual encounter for me and I truly wish I had never done it. I failed to confirm the HIV status of the partner before, my mental state was in a terrible place and I realise this should have been the first question I asked, I also deleted my account on the site straight after and was therefore unable to question this after the fact.The risk event was protected anal sex, I am fairly certain the condom did not break and it was still on after the action. I realise this means there is very much little/no risk, but my anxiety is winning the fight sadly. Things became worse when around ten days post exposure I started to get intermittent headaches and neck/shoulder pain (lasting no more than 30 mins maybe 3 times a day), no fever but I would occasionally feel hot flashes, even if temperature was normal. I then developed muscular pains which occasionally worsened through the day. This caused severe anxiety, so I felt it necessary to take a HIV 1 PCR RNA Qual test 19 days post exposure, whilst still experiencing headaches and muscle pains. This result was negative. I felt relief but became concerned that the daily aciclovir I was taking for HSV-2 infection suppression may have impacted the result somehow. Research suggested this was unlikely and I tried to move on However I started getting intermittent tingling skin all over my body around 23 days post exposure and felt symptoms of hsv2 outbreak, this caused anxiety and I decided to take a HIV 4th Gen test 34 days post exposure at an NHS drop in. I appreciate the window is 45 days for these tests but I have read that this is for rare cases. With the testing undertaken and the relatively low risk nature of the protected sex, would you feel comfortable stating I conclusively do not have HIV?

4 days ago

Sorry meant to add the 34 day 4th gen test was also negative

H. Hunter Handsfield, MD

3 days ago

Welcome. Thanks for your confidence in our services.

Your questions have a simple reply that should resolve your concerns. It is not possible to have symptoms from HIV and to test negative. Any and all existing HIV tests always are positive in the presence of symptom caused by HIV, including acute HIV infection (i.e. acute retroviral syndrome or ARS). This is regardless of time since exposure; the 45 day window for the AgAb test is for asymptomatic infection. (There's an exception for the HIV PCR RNA tests, i.e. "viral load". These tests often are negative in people taking anti HIV drugs; and sometimes in the rare HIV infected persons called "elite controllers". Further, none of your symptoms is typical for HIV/ARS or even suggestive of it -- but even if they were typical, your test results show HIV isn't the cause.

You also describe a low risk exposure. Condom protected anal sex isn't completely risk free, since unexplained condom failures sometimes occur. But combining your negative test results, no typical symptoms, and the nature of the exposure, there is no realistic chance you have have it.

And to clarify my comments above, skin "tingling" is not an HIV symptom. Finally, whenever someone suspects their own symptoms have an emotional or psychological origin -- like anxiety -- usually they are right.

So all is well. In the 21 years of this and our previous forum, with thousands of questions from users worried about HIV, none has yet reported they eventually tested positive. You won't be the first! For final reassurance have another AgAb test at the 6 week mark (or 45 days if you want to follow that guideline). It also will be negative.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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3 days ago

Thank you so much for the reassurance Dr Handsfield, it truly is appreciated. Can I just ask a few final questions? ( Purely to satisfy my anxiety which I am currently working on)

1) the tingling skin seems to be more like neuropathy, sometimes causing burning or pins and needles sensations in my extremities but this is rare during the day. I know HIV can cause neuropathy but am I correct this is more typical in late stage?

2) I notice in recent months you have mentioned that PCR tests post 14 days are conclusive, so although you have reassured me that I have almost no realistic chance of having been infected, the negative result here would be final in this case? (Outside of the incredibly rare elite controller scenario)

3) I am due to leave the country this week so may struggle to get further testing at 45 days. I don't plan on any unprotected sex, but as we know rarely issues can occur with condoms during protected sex. In your opinion should I avoid sex at all until I return and get a final test which may take several weeks/months?

H. Hunter Handsfield, MD

3 days ago

1. You describe a highly typical symptom of anxiety, much more likely than neuropathy -- which is not likely to come and go. You're correct about neuropathy and late stage HIV; it's pretty much limited to advanced AIDS and probably never the only symptom of HIV. And please remember and accept the main point of my reply above: with negative HIV test results it impossible that any symptoms you have are due to HIV, or to any of the opportunistic diseases due to immune deficiency from HIV.

2. You're only a few days from the 42-45 time needed for a conclusive AgAb test, at far less cost. You don't also need the PCR test (which is consultive at 11 days, not 14).

3. However, now seeing your travel plans, you could have a PCR test before departure to further prove you don't have HIV. But it's already clear there is no realistic chance you have HIV. From a partner protection aspect, you do not need to wait to have sex; it could be tomorrow. (But of course you should plan on condom use for your own health and protection, independent of partner protection.)

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3 days ago

Thank you again Doctor. I understand this is my final follow-up question and again appreciate the time given. I may not have been clear in my initial message but I have already completed a negative PCR test at 19 days, since this is after day 11 would this then be conclusive especially when completed with the negative 4th gen test? Just trying to avoid paying for an additional unnecessary PCR test

Also to confirm the daily suppressive acyclovir would not impact any of the testing? I had concerns it may suppress somewhat

Thanks again for all your support

H. Hunter Handsfield, MD

3 days ago

I misunderstood; you mentioned your 19 day PCR in your opening question but I missed it. Sorry. You conclusively do not have HIV. You've been over tested already and certainly do not need any more!

Despite outrageous and/or nonsensical claims online, no medications, drugs, or medical conditions exist that have any effect at all on the timing or reliability of any HIV test, with the exception of anti HIV drugs themselves. Acyclovir has no effect.

That completes the two follow-up comments and replies included with each question and -- as you already understand -- concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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