[Question #1716] What next?

75 months ago

About 3 weeks ago received oral sex multiple times from multiple csw's in red light area Mumbai. Was very inebriated so couldn't remember much and if I also had sex. Started pep within 48 hours and visited brothel and they confirmed no sex. So stopped pep after 1 dose. 

didn't think much of it but took the rna test at 18 days and was called in today to resubmit sample (I'm assuming the result was positive and they are re-checking). Been thinking about this and I did have some symptoms (red bump rash on penis which started day 5 and lasted 10 days, gastric symptoms like feeling very full after eating with pain under left rib, diarrhoea, loss of appetite, pain while straining to defecate, etc along with one night of night sweat and left shoulder pain and leg weakness which I thought was heart related). I was also feeling tired during this time  and had sore throats upon waking with the taste of blood for a few days along with dry mouth where lips stick to teeth. 

Either the girls lied about sex because I can't understand how the result was positive if only oral sex. They did rub penis with towel vigorously to clean it before oral sex. What is the correct test to take now that it is 22 days? Am numb with disbelief and wish I had completed pep. 
Edward W. Hook M.D.
75 months ago
I hesitate to welcome you back to the Forum as I wish the circumstances were not as you described.  You are correct that there are no proven cases in which HIV has been acquired from receipt of oral sex or from the sort of cleaning you describe.  Further, non of the symptoms you describe are suggestive of the ARS or HIV in any way.  

There may be other reasons for being called back, including problems in the lab.  When you return I would suggest the following:
1.  If the test was positive, in addition to repeating the test, I would ask what the quantity of virus detected was.  
2.  If the test was positive, in addition to repeating the test already done, I would suggest testing with a 4th generation, combination HIV antigen/antibody test at the same time.  If your earlier PCR test was positive, the 4th generation test should be positive at this time as well.
3.  Do your best not to panic.  Get retested and let's go from there.

Please let me know as you learn more and don't hesitate should new questions occur.  EWH
75 months ago
Hi Dr. Hook,

Thank you for your reply. 

The RNA test was repeated as the first time the result was positive. It is a qualitative test so no qty of virus. I will get the results tom. In the meantime I did the duo test and the result was non reactive. So am I correct in assuming that if the RNA re-test results are positive then this means I am in the window period with acute HIV? And if the re-test is negative, the first one was a false positive?  Would the duo be accurate at 22 days in these circumstances or do I need further testing?

Also, summarising the symptoms, in the first 7 days I had the rash on prnis head which lasted 10 days. From the second week onwards till now I have experienced all the gastro symptoms including early satiety, pain under left rib when eating more, diarrhoea, appetite loss, etc. I don't recall having a fever not measured my temp ever, and the rest of the symptoms are as described earlier. 

I've been trying to assess risk through the risk of the act and not symptoms but the test results are very scary and confusing. Please let me know what you think and what I should do next. 

Edward W. Hook M.D.
75 months ago

The fact that your 4th generation DUO test was negative at 22 days  and several days after your PCR was taken raises the possibility that the PCR was falsely positive.  Nucleic acid amplification tests can be falsely positive on the basis of the test, or related to problems in the lab itself.  The repeat PCR should be back to you quickly since it only takes a few hours to run the test in the lab. 

The symptoms you describe really are not suggestive of recently acquired HIV.  The rash of early HIV is typically generalized and not limited to the penis and the GI symptoms you describe likewise are not typical- the most common GI symptoms with recent HIV is diarrhea. 

I anticipate the your repeat HIV will be negative.  If it is not, it will be important to you to start therapy quickly. Please keep up appraised of your test results.  Hoping for (and expecting) a negative repeat test.  EWH

75 months ago
After a sleepless night, I received the RNA repeat test results - "Not Detectable" using Cobas Ampliprep and Cobas Taqman with sensitivity of 20 copies/ml.  

Phew!!!  You were right!  

With a negative RNA at 21 days and negative Duo at 22 days, do I need further testing or can I close this chapter?

Incidentally, just curious, if P24 is detectable after 15 days, then why is the Duo timeframe at 28 days - shouldn't it be 15 days because after 15 days, it will either be P24 or Antibody that will be present.  Or perhaps P24 is not a very sensitive test?

Lessons learned:
Dont use RNA for determing HIV status and wait till 4 weeks for Duo
Test only based on risk level and not on symptoms or lack thereof

Thanks for your help!
75 months ago
Sorry, wanted to edit the last question, but could not see the edit option.  But just wanted to know, I took 2 grams Azihthromycin and 800 mg Cefixime as prophylaxis a few days after the exposure.  Would that cure all potential bacterial STDs or would there be any remaining that I should worry about or get checked?
Edward W. Hook M.D.
75 months ago

Glad to hear of your result.  With your two negative tests you can be confident that you did not acquire HIV from the exposure that you describe and there is no need for additional testing.

Your experience is, unfortunately, not all that uncommon upon persons who use the PCR type tests to evaluate whether or not they have acquired HIV.  These types of tests have somewhat higher, but poorly defined false positive rates than the better tested, recommended 4th generation duo type tests. 

In answer to your question, while the p24 antigen can appear as early as 15 days, not all persons are positive at that time and  for that reason, results are not conclusive until 28 days.

As you know, this is my third reply to your posts.  This thread will be closed later today.  Glad to hear of your result.  Stay safe EWH