[Question #2249] Risk

47 months ago
Respected Doctor,
I took some time to reflect on the previous threads. I value greatly your professional service available to me. I may be bothered by the thought of having possibly acquired HIV, but I am not mentally unstable. I had a very unfortunate experience outside of the US involving high risk exposure to HIV followed by initiation of PEP in 48 hours. I regained US soil just days after the event. I am not making things up as I go along nor do I seek to manipulate anything. I did not experience typical ARS while on the 1 month of PEP. I took comfort in the negative 3-month gum swab test, but I still have to contend with the serious possibility of a false negative. I want to embrace the communicated reassurance and prediction that repeat HIV testing will be negative. Again, I am not blinded or driven by unstable anxiety. I have dealt with bouts of sinusitis, unusual sun related photosentivity affecting the left arm (known in HIV), unusual rash in fingers, ear discomfort, weight loss. HIV comes to my mind. 
Respectfully submitted. 
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
Dr. Handsfield and I have discussed your post and debated whether or not to reply.  With a certain amount of trepidation (based on my concern that what I have to say will have not impact and be a waste of both my and your time) I have opted to.  I really do not see a question in your follow-up post but I will reflect on several things I noted in reviewing your prior interactions with Dr. Handsfield.

1.  You are hampering our abiltiy to provide you with facts or suggestions by failing to tell us about your "horrendous" experience.  If you want our advice, we can do a better job when provided with detail.
2.  Like Dr. Handsfield, I have a difficult time believing that you had a very high risk sexual encounter followed by being injected while you sleep.  It really does strain credibility when not details are given.
3.  I agree with Dr. Handsfield regarding your illnesses and symptoms- none are specific or even highly suggestive of HIV.  As an FYI since you argued with him about it, I would point out that the association of HIV with sinusitis is an association which is operative among persons with advanced HIV, not recently acquired infection and even with that association, the vast majority of sinusitis occurs in persons who do not have sinusitis..  Likewise photosensitivity, rashes and ear discomfort are all non-specific findings far more likely to be noted by an anxious person looking for signs or symptoms of disease.
4.  You can claim you are not anxious but I have to tell you, it certainly sounds as though you are from the tone of your posts.
5.  Finally, if you are so concerned, it escapes me entirely as to why you have not gone on and gotten tested again with a laboratory-based 4th generation combination HIV antigen/antibody test.  Testing will have no impact on whether you have infection but, in my opinion, it will almost certainly PROVE that you were not infected during the mysterious events you are unwilling to describe.  In the extraordinarily improbable instance that you were found to be infected, testing would allow you to seek the sort of therapy that has transformed HIV from a 100% lethal disease to a chronic illness which can readily be managed with good medical care.
 EWH

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47 months ago
Doctor,
I thank you for your reply and professional input. I am grateful for the service of Dr. Hansfield and now yours. I would not say that I argued with your colleague. We had an exchange of thoughts. Regarding my exposure, I was targeted and purposely drugged up after something was slipped in my benign beer and eventually I went to sleep unconscious for several hours. Upon waking up, it was communicated to me that I was molested during my unconscious state. 

Amnesiac and somewhat altered initially, it took me a while to seek PEP which was initiated about 48 hours after exposure. I am still concerned about HIV partly because I'm finding out that my 3-month negative gum swab test is questionable in light of the preceding PEP. There was a serious possibility of a false negative because PEP could potentially affect the body's production of HIV antibodies. What's your opinion? Reading your reply, I have a hard time deciphering that repeat "testing will have no impact on whether you have infection". 

I do realize that my symptoms could be nonspecific. However there are weird coincidences with the weight loss, rashes, sinus issues, and the recurrent ear pain/crackling/popping. I have new allergic rhinitis symptoms and the fact that allergies are worsened or caused by HIV does not escape me. 

HIV would alter my life immeasurably and this is not the voice of anxiety. 

Respectfully submitted. 
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
You and I will have to disagree on whether your are behaving in a manner which suggests anxiety.

Between the low risk for infection (IF you were exposed), your PEP, and your negative test, your risk for HIV now approaches less than 1 in 100,000 (far less than your risk of being hit by lightening).  MY final recommendation is that you test to prove to yourself that you are not infected.  Nothing more to say.
EWH
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47 months ago
Doctor,
Thank you for your reply and professional assessment. In the spirit of clarification, I didn't know that sodomy and other potential inflictions would be qualified as low risk. 
Respectfully submitted. 
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
Final answers.

You have not previously explained what activites put you at risk.  Receptive rectal intercourse does carry a somewhat higher risk for HIV acquisition than other sex acts.  When exposed to an infected partner, HIV transmission occurs about once in every 400 sex acts, on average (0.25%).  Whether you consider this high or low depends on your frame of reference.  That you took PEP and your recent negative test results dramatically further reduce the likelihood that you acquired HIV.  I am sorry for any trauma that you may have experienced but that does not change the FACT that, based on the data you have provided, the likelihood that you were infected by your exposure is miniscule.  You now need to figure out how to move forward.  I hope that our comments have been some help in that effort.  At this time, were you my patient I would encourage you to seek the help of a mental health professional who might assist you in moving forward from the trauma that you experienced. 

At this site we will have little to offer further. Thus the thread will be closed later today.  Further, please note that the forum does not permit repeated anxiety driven questions by the same users. This will have to be your last one; future new questions on this topic will be deleted without reply and without refund of your posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers; because experience shows that continued answers tends to simply prolong such anxieties, when the real answer normally should be professional counseling; and because such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand and wish you best.


EWH


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47 months ago
Thank you very much.