[Question #2768] Indeterminate HIV

45 months ago
Incident: August 7th

I am a male I slept  with two escorts together in the city of Toronto.  Both were Asian, broken English.  

  Unprotected oral but protected vaginal sex.  No slippage. No breakage. Condoms replaced inbetween consistently.

There was insertion of finger in anus (received and given) also.  

Testing: August 9th

Went for full testing two days later.  Everything came  back clean.  

September 21st:

Full testing BUT  indeterminate HIV testing by antibody. Negative testing by RNA.  (Freaked out)

September 25th testing:

Point of care test was negative for HIV

Waiting on results of follow up RNA.  Results expected October 2nd. 

I was assured indeterminant Happens, but is rare.  I was assured I likely don't have HIV but to understand there is still a risk.  My exposure was low to medium risk in my estimation.  

Your thoughts about exposure.  I'm anxious and going crazy.  

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Welcome back to the forum and thanks for your confidence in our services.

It sounds like you are in the care of a knowledgeable physician; I agree exactly with the tests and advice you have had. Well, almost. I think he has overestimated your risk. In fact, this sort of exposure carried little if any risk for HIV. Heterosexually transmitted HIV is rare in eastern Canada, even when female sex workers are involved (from Asia or anywhere else), so it is statistically very unlikely your partners had HIV. And because condoms work and HIV is rarely if ever transmitted by oral sex. In other words, I disagree with your estimation of "low to medium risk". I'd call it low to nil.

You have been correctly informed that some HIV blood tests can give false positive or indeterminate results. Having had one negative RNA test, it is virtually impossible that the next one will be positive. I don't disagree with doing a second RNA test, but it's strictly fo reassurance. So stay mellow the next few days. You definitely can expect another negative result.

I hope this has been helpful. Let me know if anything isn't clear.


45 months ago
Thank you for the reassurance Dr. Handsfield. I'll post my results tomorrow when I get them.  

As an aside.  Obviously my anxiety has been off the charts the past two months.  I've been getting itchy also, which I believe may be stress related, but it is good to at least put it out there.  I think my mind may be playing tricks on me.

I've had kind of a persistent itch in my arm pits and scrotal skin.  No bumps, no lesions, no yeast I can see.  Nothing, at this point to indicate scabies or visible crabs.

As a precaution I had used permethrin cream 1% on groin area, body and armpits.  I used it three times over  span of 4 weeks (which may have caused further irritation). Then Cider Vinegar (because I'm an internet sucker) and then clotrimazole (with topical anti itch cream) on scrotum just in case.   

I can say that my scrotum is dryish, itchy... and I'm now using coconut oil, which seems to keep itch at bay. Armpits, though, remain persistently itchy.

On my last visit (when I just got my last RNA HIV test). The physician saw nothing of note on scrotum.... and the itch, I think, disappeared.  

Today it is back.  It's hard to tell if this is a symptom of anything - or just my anxiety about this whole bloody episode. When I'm distracted, i don't notice it. A tingle down there, then puts my mind on it - although I wake up in the middle of the night itchy....

Is anxiety related itching common as far as you know with people like me whom are stressed to the max over HIV and other STI infections?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
These symptoms do not suggest HIV. I'll bet nobody in the world ever had itching as the main or only symptom of a new HIV infection or STI. I don't recall ever seeing any patients in whom generalized itching was the main evidence of anxiety in people at risk for HIV/STI. But whenever someone suspects his or her own symptoms have an emotional or psychological origin, usually s/he is right.

There is no realistic chance your pending HIV RNA test will be positive. Sleep soundsly in confidence of a negative result.

45 months ago
Results came back negative, just as you said it would.   Thanks Dr!  

Given two negative RNA tests 7-8 weeks out and a negative point-of-care test, would you even recommend another at the 12 week period?

After answering, no worries about closing this thread.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Congratulations -- glad to hear it. (But of course not surprised!)

On one level, there is no need for further testing. However, you should follow your own doctor's advice, which might depend on which point-of-care test was done. If it was an oral fluids test, s/he might recommend a lab-based blood test as well (avoiding whichever test initially gave the indeterminate result). But no worries -- this would be optional, just icing on the cake and if done, will be negative.

Best wishes and stay safe.