[Question #2754] HIV exposure

43 months ago
Doctor(s)
  I really need your advice. 32 days ago I performed oral sex on a females clit for a short period, under 20 seconds. I also fingered her. Over this time I have developed what I would call symptoms. However, I'm not a doctor so I cannot say for certain. 
    recently ~day 25 I developed a sore throats. Not a bad sore throats but I would rate it a 3or4 on the annoyance scale. It comes and goes but it's there more than it's not. I also developed pain where my liver and spleen would be. That's mostly gone now. Day 29 I started to develop a cough, it's a dry cough and it's getting worse every day. I have some nausea but it's rare and only lasts for about 5-10 minutes at a time. I have no appetite but I think that's related to the severe anxiety I've been having. I woke up a few nights sweating way more than usual. I wouldn't call it a night sweat but it was enough to change my shirt. It was hot those nights. 
   I had an antibody test around day ten which was negative another antibody test at day 20/21, followed up by a rapid Alere Determine test at day 25. These were all negative. Day 32 I took another rapids 4th generation alere test which was negative. The clinic I took the test in said I was free of disease. I am married so I preceded to have sex with my wife ejaculating in her. After my sore throats got worse I got online and researched the test. I see some older posts where you have said 28 days is conclusive and more recent posts you say 6 weeks. 
   Question 1: COULD MY SYMPTOMS BE ARS RELATED 
     Question 2: if I was symptomatic would the test have reflected that? Even my dry cough which has only been around three days
      Question 3: why the change in conclusiveness for the tests? Also, have you seen any tests change from negative to positive after 32 days?
     Question 4: Is the Alere Determine a good test? It has mixed reviews. Its website says 99% sensitive and 99% specific after 28 days. Does that translate to accurate?
  Also, should I have my wife 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Welcome to the forum. Thanks for your question, and for reading other threads with questions similar to your own.

Oral sex is safe sex, with low risk for all STDs and virtually zero risk for some, including HIV, and cunnilingus is particularly low risk. There has never been a known case of HIV transmitted by oral-vaginal contact, in either direction. Same for hand-genital contact and fingering:  no measurable risk and no known cases. Further, HIV remains more rare in women (in the US and most industrialized countries) than you might think. It is statistically unlikely your partner had HIV -- but even if she did, no risk from thsi sort of event. Your symptoms also are not typical for ARS. Finally, the 4th generation blood tests -- including Alere Determine -- are very good and are nearly conclusive (98-99% reliability) by 4 weeks.

Those comments pretty well answer your specific quesitons, but to be explicit:

1) These are not typical ARS symptoms.  The timing is wrong (25 days is much too late --typically symptoms start within 2 weeks of exposure), and ARS rarely causes cough.

2) The blood test results reflect infection, not symptoms. However, almost everyone with ARS symptoms has a positive blood test. Your negative results prove HIV isn't hte cause of your symptoms, and are almost 100% conclusive you didn't catch HIV.

3) You are correct we used to say 4 weeks to conclusive results, and now say 6 weeks. However, 2-3 months ago we became aware of updated research on 4th generation test performance. On rare occasions, they can take up to 6 weeks to become positive. We always go with the best judgment from the available data -- which means our advice may change as new data become available.

4) Determine is a superb test. The figures quoted by the manufacturer are about right and translates to excellent accuracy. It is believed to be 100% sensitive any time 6 or more weeks after exposure. I have never seen or even heard stories of anyone turning positive after 30 days.

There is no reason for your wife to be tested. Have another test at 6+ weeks if it will make you feel better -- but I really dont' see a need. You weren't at risk and were not infected.

Let me know if anything isn't clear--

HHH, MD
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43 months ago
So my test is almost conclusive! My symptoms are not really symptoms for two reasons. The first reason being a 32 day test proves it's not also symptoms almost always coincide with a positive test. Cunnilingus is as safe as it gets. With all this information here it's a lot to take in.
   I'm so worried about my wife though. If for some tiny tiny chance, against all odds, I was infected what would the chance be I infected her. I'm sure my viral load would be HUGE
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
"Symptoms" means any abnormal body sensation that doesn't occur normally in healthy people. So of course you have had symptoms. However, your test results PROVE they are not due to a new HIV infection, and are 99% conclusive tht you don't have HIV at all. If you do have it, I agree your viral load could be very high. But you still shouldn't be seriously worried. Have another 4th gen blood test at the 6 week mark. It will be negative and you can move on without worry.

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43 months ago
Dr. HHH,
  I have a Few things I'd like to know before we part ways. I am going to test in another eight days for my final six week test. This is something I have to do for myself. Would taking another rapid Alere Determine test be alright? I ask this because it's the easiest and most accessible test for me. 
   What caused the change from four weeks to six weeks for the next generation? I know you said additional information became available, is it normal healthy people that tested late or are there underlying health issues with these people, like autoimmune disease?
   This sore throat and caugh are imbedding theirself in my "crawl" I can't shake the idea that this isnt just a normal run of the mill sore throat.  I'm assuming if it was something to worry about the pain would be really bad. Also, have you ever seen an ARS case without a fever?  I'm asking these questions to build up my confidence as I wait for my final test. 
     Is there anything at this point other than a reactive test that would concern you? If so what would that be. I am feeling a little weakness in the legs and a sore back. I'm pretty sure it's anxiety but I cannot be certain. 

          Farewell Doctor
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
I can't say much more about the window period for 4th gen tests. Based on all we know about the course of new HIV infections, the antibody response, and the biochemistry of the tests, 4th gen (Ag-Ab) tests should always be positive by 4 weeks, so I also was a little surprised by the review of known results. My guess is that some study participants may have misstated the dates of their exposures. But the data are what they are, and not many things are absolute in complex biological systems. Fortunately, it's a rare occurrence to take more than 4 weeks, under 1-2% of all people with new HIV. There is no reason to suspect any sort of underlying health issues that explain the rare aberrant results.

There is nothing you need worry about other than test results. Symptoms are never important in determining whether or not HIV might be present. Only the test results matter.

That completes the two follow-up comments and replies included with each question, and so concludes this thread. I hope the discussion has been helpful. Best wishes to you.

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43 months ago
Hello again,
   I bought another question. If I cannot attach it to this question please let me know and I will start a new thread. I know that you answered a bunch of questions in detail but I feel I need to ask a few more to get me through this mess until I can make my appointment next Tuesday with my GP. I understand that my "exposure"  is very low/no risk depending on who you ask. The problem I'm having is you said it was to late to have symptoms related to ARS. I did a little more research and it said symptoms can start as late as six weeks. I was at 4.5 weeks. The only reason I'm asking is after our last chat my sore throat became worse, I started to get very mild headaches, more abdominal pain and one night of the squirts. These symptoms occurred over three days and have been present the whole time since. 
  These "symptoms caused me to test again with a rapid Alere Determine again at day 39 and it was negative. My questions are why do some people say you can have ars symptoms as late as six weeks? Another question is you said most people with symptoms would test positive. Would this apply to symptoms that only started 2-3 days beforehand. Lastly, you said the Alere Determine is a wonderful test. I read online that it is not a very accurate test when it comes to the antigen detection.  My question is that if it does not test well in the antigen part is it still conclusive at six weeks? also why do most websites state 12 weeks is conclusive not 6 
 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Sorry, but I disagree with your research results and am inclined to doubt you found a scientifically valid resource that said symptoms can start as late as 6 weeks after exposure. Also, if your symptoms were due to ARS, you definitely would have had a positive blood test. I can't say why "some people" give misinformation on the internet. Sometimes it's intentional, sometimes just naive.

You do raise a very interesting point about the Determine® test and antigen detection, and we have discussed that problem on this forum. In effect, Determine® performed as if it were an antibody-only (third generation) test. However, the manufacturer quickly corrected the problem, and my understanding is that they recalled all test kits before it was fixed. At present Determine is once again a reliable Ag-Ab (4th generation) test. And in reply to your final question, almost all thrid generation, standalone antibody tests are nearly 100% conclusive at 6 weeks.

Please to your best to accept the reasoned, science-based reassurance I have tried to give. Perhaps it will also help you to know that in the 13 years I have been answering online questions about HIV risk and testing (starting April 2004), on this and the preceding MedHelp forum, with thousdands of question like yours, no questioner has ever turned out to have acquired HIV. Not one. You're not going to be the first. If and when that happens, I am confident it will be someone at legitimate high risk (e.g. a guy having sex with other men) and/or with typical symptoms, timing of symptoms, etc.

That completes the two follow-ups and replies included with each question, and so concludes this thread. Please do not be tempted to start a new thread with the same queations, or in the belief that some new thought would somehow change our assessment and advice. It won't. You can move on with complete confidence you don't have HIV.

I hope the discussion has been helfpul. Best wishes and stay safe.

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