[Question #13560] HIV exposure

1 months ago

Hello, I have one detailed HIV question. In May 2022 I (M26) received oral sex (insertive partner) from a sex worker. I know this is very low risk, but I developed strong HIV anxiety. After 7 months I tested negative on a 4th-gen HIV Ag/Ab CLIA test and also negative on an OraQuick oral fluid test. I am not sure if I took biotin around that time; if I did, it was only a normal ~200 μg dose. Could such a small amount (or none) affect the accuracy of a 4th-gen test taken 7 months after exposure, especially the antibody part, or is that only an issue during the early p24 stage? Is it still realistically possible that I could have HIV despite those tests? Also, today at work I had a small cut on my finger with blood dripping, and I accidentally touched a client’s forehead, leaving some of my blood on his intact skin before i wiped it (maybe a small non-bleeding pimple). Is there any HIV transmission risk for him from this contact? Thank you.

Edward W. Hook M.D.

1 months ago

Welcome to our Forum. Thank you for your implied confidence in our service. I'll be glad to comment. The exposure you describe did NOT put you at risk for HIV and your tests results since then confirm that this is the case. There are many reasons I say this with complete confidence. These include:

1. Most commercial sex workers do not have HIV.

2. There has NEVER been a case of HIV proven to have been acquired from receipt of oral sex. The CDC, which tends to be quite conservative in such matters estimates the risk to be less than, on average, one infection for every more than 10,000 exposures and as I said, there has never been a case of HIV acquired due to receipt of oral sex.

3. The theoretical inhibition of HIV tests by biotin, if it occurs at all, would only occur with far, far higher doses of biotin than you report takings.

4. 4th generation, combination HIV antigen/antibody tests of the sort you mention provide conclusive results any time more than 6 weeks following a potential exposure- you 7 month results are conclusive.

You do not have HIV. Thus your client was NOT at risk for HIV from having touched their forehead.

It's time to put any lingering concerns about HIV aside and move on. There is no reason for continuing concern or for further testing. EWH

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