[Question #2514] Follow-up with Risk on June 8,2017

45 months ago
I just wanted to ask a follow-up on a risk I had on June 8,2017 of this year. [Original question was "Is 22 days a Good Indicator?" Originally answered by Dr. Handsfield. Of course I don't mind who answers, your both phenomenal doctors from the research I have read on you both.

I had a sexual partner [we are both gay] and I was the receptive partner during anal sex. We used a condom and it broke. I didn't realize until 30-45 seconds.  The partner indicated he was on PrEP [not sure if he were telling the truth]. But he also said he was tested in March 2017 negative.

Fast forward..
I tested at 3 weeks with an Alere Determine Rapid HIV Ab/Ag test. [Which from the previous thread I understand that Alere Determine's HIV Ag portion of the test is not all that terribly accurate]. 

At 32 days I tested with a lab-based HIV 4th Generation HIV Ab/Ag test with Quest Labs. I also had an HIV RNA test done with Quest Labs performed simultaneously with the 4th Generation test. The RNA test was indicated as an Aptima HIV RNA test via Quest labs.
Both tests came back non-reactive and 'no evidence of RNA found in the blood sample provided to the lab' [as stated on the Quest lab results].

At 6 weeks, I did not want the costly venture of paying for another 4th Generation test nor an HIV RNA test completed, so I went and had a HIV Rapid Blood test [Antibody only] Unigold HIV Ab Rapid Test completed.  It too was negative

May I ask?
1. Am I in the clear?
2. Should I retest again at 8 weeks? 12 weeks?
3. I assume I am grossly over-testing, just need guidance.

I appreciate your time in this matter. 
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Welcome back to the Forum.  As I am on a plane at the moment I cannot review your earlier interaction with Dr. Handsfield (I can do that in follow-up if you wish) but from your description I am confident that he felt that the encounter you describe was rather low risk despite your unfortunate broken condom.  Irrespective however, your 32 day results effectively prove that you were not infected.  Nearly all recent HIV infections are detectable with 4th generation tests performed at 4 weeks and the very small proportion that are not would certainly be detected by a simultaneous viral RNA test.  The combination of those two results prove that you were not infected by your exposure 32 days earlier. and no further testing was required.  Your repeat test simply serves to confirm your 32 day result.  At this time there is really no reason for continuing concern and no reason for further testing related to the exposure that you describe, not at 8 weeks, not at 12.

I hope this comment is helpful.  Take care.  EWH 
45 months ago
Thank you Dr. Hook for your response.  
I appreciate the feedback.  Have a safe trip and thanks for your research, study, and effort in answering questions on this forum.

44 months ago
Just as a follow-up [for my own assurance] at 9.5 weeks:

I had syphilis testing done [negative]
A retest for HIV [negative]
Gonnohorea/Chlamydia [oral swab/urine]: [negative]

I do not believe I was vaccinated for Hep A/Hep B, but the woman doing the testing advised I get the vaccination.
Should I get tested first to see if I have been exposed to Hep A/ Hep B?

Thanks for the forum and  time answering.
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
Your tests now show you are in the clear.  No need for further testing, really!

 Your risk for hepatitis  and B is low however vaccination for these viruses it is recommended for everyone irrespective of sexual risk status. I agree with the recommendation. Not because of your exposure because it's a good idea.  EWH