[Question #2182] HIV risk

46 months ago
Hello, 
48 hours after a potential sexual exposure, I started and eventually completed 29 days of PEP treatment with once daily Tenofovir 300 mg/Lamivudine 300 mg + Ritonavir 300 mg + Atazanavir 300 mg. I had a flight 1 day after starting PEP. Five days after exposure I developed cold type symptoms with nasal congestion and runny nose which resolved within about 8 to 10 days. No recollection of rash or fever. 52 days after exposure, cbc, kidney, liver blood tests were OK. Two months after exposure, I was evaluated and then treated for sinusitis. At 3 months post exposure, rapid HIV testing is negative (only C bar) with the known gum swab test. Please, where do I stand? Thank you for your work and advice.  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Welcome to the forum. Thanks for your question.

You don't describe the exposure, which would be helpful in judging the likelihood of infection and therefore the valididty of your negative test results so far. At one end of the spectrum might be unprotected anal sex with another man, especially if known to have HIV, and at the other end receiving oral sex, or condom protected vaginal sex with a woman not known to be infected.

The symptoms you describe do not suggest a new HIV infection, which generally does not cause typical cold symptoms like nasal congestion or runny nose, or sinusitis. (The main symptoms are sore throat without other cold symptoms, fever, skin rash, and enlarged lymph nodes -- none of which you apparently had.)

PEP is believed to be highly effective. The oral fluids HIV test at 3 months is quite reliable, but not quite proof you weren't infected. Even without PEP, the oral fluids test can take up to 3 months to become positive (longer than all blood tests, typically 4-6 weeks), so the interval was borderline. And if PEP doesn't work, in theory it can delay development of a positive test.

All things considered, it is extremely unlikely you have HIV from the exposure described, probably under one chance in hundreds of thousands. However, for truly conclusive testing, you should have a lab-based blood test, preferably an antigen-antibody test (4th generation, "duo" test). You can expect a negative result.

I may have more to say if you would like to say something about the sexual exposure. In the meantime, I hope this information has been helpful. Let me know if anything isn't clear.

HHH, MD

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46 months ago
Thanks for your response, Dr. Hansfield. The potential exposure was 6 months ago and would have been toward the high risk of the spectrum. No additional interval exposure. I was relieved and took the negative 3-month gum swab as conclusive of status at the time. Now, I'm dealing with another unusual bout of sinusitis/ear discomfort and some weight loss. I suspect HIV. I appreciate your "You can expect a negative result", but a dreaded positive result is also possible. A recent WBC was mildly high at 11K with a mildly high 3.2K lymphocytes and normal 6.6K neutrophils. Thanks again for your input. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
The kind of immune deficiency caused by HIV does not increase the risk of sinusitis. It also is an unlikely cause of the very slightly abnormal WBC count and lymphocyte counts; those results are essentially normal (although perhaps slightly elevated lymphocyte count as a result of your current cold or sinusitis). As I said above, there is no realistic chance you have HIV. For the reasons above, you should have another HIV test to be sure -- but you definitely can expect it to be negative.

I'll be happy to comment one more time if you would like to post your next HIV test result. But there is no other information you can provide, or other issues that might come to mind, that are likely to change my opinion or advice, and threads are limited to two follow-up comments and replies. So let's hold off on other comments until and unless you have another test result to report. Stay mellow in the meantime; it will be negative. (You may also be interested to know that in 13 years of doing this or another online forum on HIV risks and prevention, with over 10,000 posted questions, not one person who asked about an HIV exposure turned out to have been infected. I'm confident you won't be the first!)

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46 months ago
Dr. Hansfield,
I hope your optimism is based on my prior completion of PEP and the negative rapid HIV gum swab test. As for my very high risk exposure, I went through something horrendous which I will not detail here.  T cell vs B cell dysfunction, there is a bunch of documentation that sinusitis is more common and more severe in HIV patients. I have not been able to shake off this new bout of sinusitis for more than 3 months. I never had major sinus issues before. I am not motivated unrestrained paranoia. I appreciate your value input. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
My reply above gives all the reasons for my optimism you don't have HIV.

Sinusitis indeed can be a problem in HIV, but only in advanced infection, i.e. overt AIDS -- generally a few years after catchign HIV. That you "never had major sinus issues before" is a trivial issue compared with the combination of low risk of HIV transmission for any single exposure (even the highest risk sexual exposure, receptive anal sex with a known infected partner, results in HIV transmission only 1% of the time), having had PEP, plus your negative test result so far.

I certainly understand that some events can be emotionally stressful, especially "something horrendous". Still, do your best to separate your emotional reaction and concern about that event from an objective analysis of the scientific information availalble. In any case, you can have a truly conclusive HIV test at any time now, i.e a 4th generation (antigen-antibody) test and perhaps a plasma RNA test. If your exposure was truly high risk, I would think your doctor would have already planned on this and discussed it with you.

Threads are normally closed after two follow-up comments and replies, but in the circumstances, I'll leave this open for one more exchange, if you have more concerns or questions. In the meantime, do your best to mellow out. It is exceedingly unlikely you have HIV.

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46 months ago
Dr. Hansfield,
I thank you for your expert advice, but I am very worried about the WBC and I think it is a reflection of HIV. I don't think PEP worked in my case. I'm also hearing that the use of the gum swab test is not advisable for detection of HIV antibody after PEP, even 2 months after PEP completion. I keep having disconcerting recurrent ear pains even though ear infection has been ruled out. Ear pain is very common in HIV patients. I am also aware of sinusitis being very common at any stage of HIV, even early on, in comparison to HIV negative patients. I have sustained significant weight loss. I know what I'm feeling. I dread and expect a positive result on repeat HIV testing. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
You are free to believe whatever you wish. But I leave it to you (and perhaps other forum readers) to judge whether your opinion or mine is more valid and more likely to be correct.

I have never heard that "ear pain is very common in HIV patients" and to my recollection I have never had an HIV infected patient with such a complaint. In any case, this is like arguing that everybody with meningitis has headache, and therefore my headache is from meningitits. The causes of ear pain other than HIV are thousands of times more common than HIV. You need to stop reading lists of HIV symptoms and drawing conclusions that are unwarranted.

Your repeat HIV test will remain negative. Unfortunately, you have ignored my going beyond normal forum policy to keep this thread open for you to post your result. This thread is now closed.

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