[Question #1656] HIV risk and test results

48 months ago
Hi. 
I will try to be as brief and specific as possible :)

I have had three episodes that concerns me.

1. Seven months ago i had protected oral and protected vaginal with a street worker. The condom broke under vaginal, but the girl noticed and pulled out immediately. I saw that the condom had a little tear and my tip was exposed, but it had not broken completely open, so i guess it was caught very early. New condom put on after.

2. Three months ago i had unprotected oral for 1-2 min, and protected vaginal on brothel in munchen. No breakage of condom.

3. 20 days ago i had unprotected oral for 1-2 min, and protected vaginal. No breakage of condom.

These episodes started to concern me a little so i went to get a full check-up.  This was on the 9th of january. I called in 3 days later, and the lady that took a look at my testresults said everything was NEGATIVE AND OK. 

But, two days later the doctor called me, and said that the HIV test (combo-test) came back at 0,9. And that this was on the limit. She said it should have been under 0,8. And that she wanted me to take another test to confirm. This will be done in february, and worries me. 

So the questions i have are:

1. Does 0,9 mean positive? - because, first they said negative and that all were ok. But doctor called back later to say that this was on the limit, and should be retested. 

2. would`nt the two first episodes, since it is such a long time ago, come up clearly on a test? - If i caught HIV seven or Three months ago it would most likely be a positive test without any doubt?

2. Could the last episode have given me HIV, and the test means that it is in develpoment in my body? Therfore the high values (0,9)?

Thank you for your time, and your answers.
 
Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago

Welcome to our Forum.  I'll try to help.  Presuming that when you refer to oral sex you are speaking of receiving oral sex the only exposure you describe of concern is the 1rst episode, 7 months ago when your condom broke.  There has NEVER been a case of HIV documented to have been acquired through receipt of oral sex.  Since that exposure took place 7 months ago, not only was it statistically low risk (because most CSWs do not have HIV, because it was a single exposure, and because it was brief) but had you acquired HIV your test should have been clearly positive you had been infected.  Thus I expect that you did not acquire HIV and that the call-back that you received from your doctor has more to do with questionable test performance than a likelihood that you acquired HIV.  My advice would be for you repeat the test as requested (and thank your doctor for being cautious with your health) but not to worry too much about it while you wait for results.

As for the test value, different tests report out their results with different numerical values.  Thus I cannot comment about a value the came back as 0.9 rather than 0.8.  On the other hand, give your concern and the fact that your last significant exposure was 7 months ago, I see no reason to wait until February to repeat the test.  As for your specific questions:

1. Does 0,9 mean positive? - because, first they said negative and that all were ok. But doctor called back later to say that this was on the limit, and should be retested. 
No, at worst this result is equivocal, not positive.  Repeating the test, possible using a different brand or type of test is the thing to do.  As I said, had you acquired HIV 7 months ago, your test should be clearly positive at this time.  That it was not suggests that you do not have HIV but that there was a problem with how the test performed.

2. would`nt the two first episodes, since it is such a long time ago, come up clearly on a test? - If i caught HIV seven or Three months ago it would most likely be a positive test without any doubt?
Precisely, see my comments above.

3. Could the last episode have given me HIV, and the test means that it is in develpoment in my body? Therfore the high values (0,9)?
Most unlikely.  condoms are highly effective at preventing HIV and receipt of oral sex has never been shown to lead to HIV infection.

I hope my comments are helpful.  My recommendation is to go on and get your test repeated now.  EWH
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48 months ago
Thank you for your answer.

One follow up question. 

As I understand, the combo test often have a signal cut off at 1. Where anything above is positive and anything below is negative. I am not sure if this is the same measurements in every country (I'm in Norway by the way), but I believe that this country is using the latest and best tests. 

Do I understand it correctly that 0,89 is a definite negative? And why is suddenly 0,9 an indication that something is wrong and retest is needed? Maybe this is a question you can not answer, but I just don't understand these readings that much.

How often does eqivocal or borderline results in my case end up positive?

This will be my last post. I know you have a lot to do, and will not spam you guys with more questions. Your answers are much appreciated.

Thx
Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago

As I said, cut offs for tests vary from company to company and test to test.  if your test is negative, it is negative.  I suspect your doctor is being conservative (and perhaps not totally believing your history) which is in your best interest. 

The vast majority of equivocal or borderline tests are negative unless the person has had a recent exposure and is in the process of becoming positive.  This is uncommon and by your history is most unlikely. 

Sorry I cannot be more precise on this than what I said.  I think your own doctor might be the best person to answer your questions. 

You may certainly ask one more question if you wish.  Happy to do this. EWH

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47 months ago
Hi again  :)

Last post then, hehe :)

Took your advice and went to get a rapid test today. Came back negative. 

So my question is. My last exposure  (probably no risk though), was 24 days ago. Do I need to test again, or can I conclude that I am negative at this point?

Thx 
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
Your exposure 24 days ago ( receipt of unprotected oral sex  and kind of protected genital exposure  in which the condom did not break) was essentially a no risk event.   While your test results are not at a time when they can provide definitive results, given the nature of the exposure and your test results, were I you I would not feel the need for further testing related to the exposures you have described. 

 I hope this information is helpful to you. As you know this is my third response to your questions. Therefore according to Forum guidelines this thread will be closed later today. Take care.  EWH
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47 months ago
Thank you doctor.
Yes I know the guidelines, and will not follow up on this. 

Just to clarify: you wrote "kind of protected".

The last exposure was unprotected oral and protected vaginal. The condom was intact the whole time from start to end for the vaginal part. 
Do you mean that there is still somewhat risk, when you say "kind of protected"?

Now, I'm done! Promise... :)
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

Kind of refers to the fact that: you have received unprotected oral sex which does not put you at risk for HIV but could lead to other STIs such as gonorrhea or NGU.

This thread is now closed.  EWH

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