[Question #1466] HIV concern

45 months ago

Dear Dr. Handsfield


8 weeks ago I had an exposure with a shemale escort of unknown status,all what I know about him that he travels much as sex worker (That’s why I highly suspect that he is poz and exposed for both HIV1/2).

We kissed, he gave me Bj and I gave him Bj about 2 minutes no ejaculation. No open cuts/sores in my mouth. I only had gum abscess. I tried to penetrate him. I used condom but I didn’t have hard erection that day so the penetration was unsuccessful .He asked me to stop trying because I was hurting him while trying penetration. When I finished trying, the condom was in its position but I didn’t look at the tip part to check if tear happened. In short, virtually I didn’t penetrate, but my worries keep telling me that maybe my tip went in while trying and maybe a condom tear I didn’t notice was present.  And of course he didn’t penetrate me. It was my first sex exposure, I am in Beirut, Lebanon.

Sore throat started (week 2) and persisted for 5 weeks and attributed to allergy by dr.
Nasal mucus and green phlegm started week 6.

Tests taken:

Day 25: rapid blood test negative.
day 36: lab based test called HIV(1+2) result 0.14 negative.
Day 45: rapid blood test negative
day 50: 4th generation ELISA HIV1/2 abs and p24 negative.

1-      1.What level was my risk? Am I conclusively negative? No further testing?

2-     2. France ministry of health say 6 weeks conclusive. Are the 4th generation testing used in France different than 4th generation testing in other countries? I am sure that France care about their citizens as other countries do and wouldn’t claim 6 weeks conclusive if it wasn’t. I did my 4th generation test in the best hospital in Middle East (AUBMC lab). Then why still more than 90% of countries including US stick to 3 months? Despite of the manufacturer stance, France legal Window period is 6 weeks.  

3-    3.What about HIV2? I read that p24 antigen is HIV1 specific.

 

Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

Welcome to the Forum.  As you probably know but are trying to work around, clients on this site are not permitted to request who responds to their questions.  All questions regarding herpes go to Ms. Warren and Dr. Handsfield and I split all other questions.  As it happened, today I happened to pick up your question.  As an FYI, having worked closely for more than 35 years, Dr. Handsfield and I never disagree on the content of our replies although our verbal styles vary.  I will be addressing this question.

The event you describe was virtually no risk and your tests prove that you were not infected and co-infection with HIV-1 and HIV-2 is extraordinarily rare, even among persons with HIV.  Most commercial sex workers do not have HIV, there are no know cases of HIV acquired from persons who receive oral sex from infected partners, the risk for infection from performing oral sex on an HIV infected sex partner is very, very low, and condom protected sex is safe sex.  Thus this was a very, very low risk event.

Your test results are conclusively negative as well proving that your sore throat is not HIV-related. If it were due to HIV of any sort, your tests would have been positive.  While different countries use different guidelines, research shows that after 4 weeks, results of the generation, combination HIV antigen/antibody tests are completely reliable.


In answer to your specific questions:

1-      1.What level was my risk? Am I conclusively negative? No further testing?

See above- this was a virtually no risk exposure.

2-     2. France ministry of health say 6 weeks conclusive. Are the 4th generation testing used in France different than 4th generation testing in other countries? I am sure that France care about their citizens as other countries do and wouldn’t claim 6 weeks conclusive if it wasn’t. I did my 4th generation test in the best hospital in Middle East (AUBMC lab). Then why still more than 90% of countries including US stick to 3 months? Despite of the manufacturer stance, France legal Window period is 6 weeks.  

Well respected organizations such as governements and for the U.S. the CDC which give overly conservative recommendations and advice.  At the same time however, we can understand the CDC's perspective, as a governmental agency providing scientific guidance which is obligated to follow results provided by other “official” agencies such as the FDA to a broad array of people, their stance is that they cannot "afford" to make a mistake.....even once.  Thus their advice tends to conservative and they will often fail to provide definitive advice "just in case".  These recommendations however are more conservative than they need to be.


3-    3.What about HIV2? I read that p24 antigen is HIV1 specific.

You You are correct, the antigen in 4th generation tests is an HIV-1antigen and is relatively specific.  Nonetheless given the time course or your testing, the nature of your exposures and your test results, there is no realistic reason to be worried about HIV-2.

 I hope these responses are helpful.  there is no reason for further concern or testing.  EWH



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45 months ago

Thanks so much for your answers doctor. And apologies for addressing the question to specific expert. Maybe my worst mistake the last 2 months was surfing the internet the last 2 months. Honestly, before googling I never thought of a risk from oral sex. I came across many horrible things. And now after testing I am closing this page and putting what happened behind me. But I need your kind expert words about these things, just to eliminate the remaining residues from my mind:

-Late seroconversion and seronegative HIV people.

And finally, All 4th generation testing are same around the world ? 

Thanks
45 months ago
Dear Dr,

Sorry If I sounded much anxious over this incident. I promise you this is my last question and I will put this behind. Is the 4th generation test conclusive after 4 weeks because there is no one turned positive after 4 weeks? Or this fact based on researches ?
 In UK, BASHH states that 4 weeks conclusive for low risk and 8 weeks for high risk. Did they put 8 weeks as a cautious step or there were cases who turned positive after 4 weeks after a high risk exposure? 
I am asking this question just because I noticed in your replies ( you and dr hunter) here and your previous Medhelp forum that a negative at 4 weeks overrule symptoms and risk level (low or high). 
Thanks and your answer is highly appreciated ending my anxiety over this incident.  
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

Your follow-up questions essentially repeat your original questions and since repeating your questions does not change the answers, I will repeat my original answers:

"there are no known cases of HIV acquired from persons who receive oral sex from infected partners, the risk for infection from performing oral sex on an HIV infected sex partner is very, very low, and condom protected sex is safe sex.  Thus this was a very, very low risk event"

"Your test results are conclusively negative as well proving that your sore throat is not HIV-related. If it were due to HIV of any sort, your tests would have been positive.  While different countries use different guidelines, research shows that after 4 weeks, results of the generation, combination HIV antigen/antibody tests are completely reliable."

"Well respected organizations such as governements and for the U.S. the CDC which give overly conservative recommendations and advice.  At the same time however, we can understand the CDC's perspective, as a governmental agency providing scientific guidance which is obligated to follow results provided by other “official” agencies such as the FDA to a broad array of people, their stance is that they cannot "afford" to make a mistake.....even once.  Thus their advice tends to conservative and they will often fail to provide definitive advice "just in case".  These recommendations however are more conservative than they need to be."

Your mistake is going to the internet for information where much of the information presented is out of date, taken out of context, or just wrong. 

Late seroconversion is an internet-based myth, it does not exist in people who have not taken anti-HIV medications.  Similarly, with the 4th generation tests, essentially all persons with HIV will have a positive 4th generation HIV test.  All approved, licensed 4th generation tests perform similarly around the world.  Your results are conclusive- this has been studied and my statement is based on scientific research.  EWH

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