[Question #1435] HIV Tests

45 months ago
Hello Doctors,

About four months ago I had unprotected vaginal and oral sex with a woman of unknown status. She was someone I met at a bar. Not a commercial sex worker. A few weeks after the event, I became symptomatic. Low grade fever, nausea to name a few. After a lot of research it became clear that symptoms do not diagnose HIV, only testing does. I built up the courage to test with these results:

30 Days: HIV 1 RNA, QL TMA (Not Detected)
50 Days: HIV 1 RNA, QL TMA (Not Detected)
70 Days: 4th Generation EIA DUO w/ Reflex (Non Reactive)
90 Days: 4th Generation EIA DUO w/ Reflex (Non Reactive)

a- How accurate are the HIV tests I have taken?
b- In your experience, have you ever seen any of these tests change after the given time frames?
c- Should I test out to 6 months? seems to be conflicting information on this.
d- Am I HIV negative conclusively?
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

Welcome to our Forum. I will be pleased to comment.  I can assure you that you did not acquire HIV form the exposure that you describer above.  Even before we consider your test results, the odds of you getting HIV were quite low.  Relatively few women have HIV- in the U.S. this would be far less than 1% of women, then , even if she did, the risk for infection is also low since there is no known risk for HIV from receipt of unprotected oral sex from an infected person and the risk of acquiring HIV if your partner did have HIV is, on average, less than 1 infection per 1000 sex acts.  Thus, mathematically, based on the figures above, your risk for HIV form a single unprotected encounter of the sort you describe is less than 1 in 100,000.

Strange things happen however and the only way to make sure you were not "the 1 in 100,000" we are talking about, testing was the right thing to do.  Your tests now unequivocally PROVE that you did not acquire HIV form the exposure that you have described.  Each of the tests you describe is highly sensitive and completely reliable for HIV detection at the times you describe.  They absolutely, 100% rule out the possibility of HIV.  Further testing is a waste of time and money. 

Thus, in reply to your specific questions:

a- How accurate are the HIV tests I have taken?
Completely reliable, you do not have HIV.

b- In your experience, have you ever seen any of these tests change after the given time frames?
Not ever, nor have I seen it reported in reliable medical literature.

c- Should I test out to 6 months? seems to be conflicting information on this.
Absolutely not.  You are negative.

d- Am I HIV negative conclusively
Yes.
I hope these comments are helpful to you.  The symptoms you describe are certainly not due to HIV acquired from the exposure you describe above.  I would not worry further about this possibility.  EWH
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45 months ago
Thanks Dr. Hook. That provides a lot of re-assurance. I think more than anything this episode has turned me into a "cybercondriac", which is not helping me get better I can tell you.

Any idea what happened in this NIH Case Report? Long story short, a person was repeatedly negative on antibody testing, only to be found positive through T-Cell counts and RNA. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821828/

Makes me feel like I should get another RNA or get a T-Cell count done to be 100% sure.
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
The more than five year old case report that you describe is of a patient who was not tested for HIV until his infection was far advanced.  Once therapy was started and his immune function improved, his HIV blood tests became positive as well.  This phenomenon, in sick persons with far advanced HIV is well known and has no relevance to your situation.  Further RNA testing is a waste of time- the money would go to far better use if you donated it to a charity.  I, once again, urge you to move forward without concern and not to wste your time of money with further testing.  EWH
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45 months ago
Thanks Dr. Hook. I am glad to hear that I can move on from this. I can't seem to shake some symptoms which happened just weeks after this exposure.

Could you recommend which other testing (non HIV) I should seek to rule things out, as well as their window periods for reference?

Since I am feeling charitable, I will donate $100 to charity in honor of the RNA test I forewent! Any recommendation as to which charity?

Have a nice weekend.
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

Thanks for your Thanks Daniel.  I appreciate it.  My sense is that the symptoms you are experiencing are more likely a coincidence than related to the casual sexual encounter that you mention.  There are a lot of illnesses which can cause symptoms of the sort you describe.  Among sexually transmitted diseases these include hepatitis B and mononucleosis, both of which could explain your symptoms.  for better of worse, both of these illnesses are typically self limited and simply have to run their course if that is what has happened.  Equally or even more likely however is that you happened to "run into" one of the sorts of unnamed viral illnesses that most people get once in a while and have related it to the sexual encounter your described.  Rather that embarking on a "fishing expedition" for STIs which are rather unlikely, my advice would be to see your regular doctor and describe your symptoms (including your history of a casual sexual encounter, your doctor will keep this confidential) and get a check up.  His/her findings from taking a complete history and examination will guide their decision making in whether you need testing and what tests you need - that's what they went to medical school to learn to do.

As for a donation, if you wanted to support the sort of work we do, it would be great to donate to The American Sexual Health Association (ASHA), the non-profit that sponsors this web site and does much good work.

Finally, I need to point out that this is my third response to your questions and, as per Forum guidelines, this will complete this interaction on my side.  The thread will be closed later today.

Take care.  Try not to worry.  EWH

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