[Question #2936] 4th Generation HIV Test @ 16 day after Exposure

42 months ago

Hi Doc,

My wife of 19 years was recently diagnosed with HIV after blood splash incident at work with one of her patient. Am I at risk to have performed vaginal oral sex on her (brushed my teeth 30mn before)? The reported viral load was around 10000 couple of days after the oral sex. I tested 16 days after the exposure with 4th generation Ab/Ag with LabCorp that came back negative? Is that reliable? Should I expect a similar result @ 16 weeks. Just tested this morning and waiting for the next result. Extremely anxious with shooting pain in neck/shoulder over 3 month followed by arm and leg pain & tingling. I've also noticed small white spot on my skin (underarm and stomach) but not sure it they've always been there since I never paid attention to until recently. 

Please help me understand the risk. I've not being felling well the past 12 weeks - no fever, sore throat and etc... just general Gerd and anxiety issues.

Thanks,

MM

42 months ago
Forgot to mention we've been having protected sex since March of this year to avoid getting pregnant. I've also had a negative 4th generation back in February  just as routine test for low WBC.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Welcome to the forum. Thank you for your question and your confidence in our services.

I'm sorry to hear of your wife's unfortunate, unlucky, and unusual situation. I will address your questions, and you should find my comments reassuring. However, my main advice is that you need to develop a relationship with your own doctor about this, ideally one who understands HIV and its prevention. Most likely it can be the doctor/clinic providing care for your wife's HIV infection. They will be able to advise the two of you, as a couple, on how to protect you from infection. Your protection can and will be 100% complete. 

HIV has never been known to be transmitted by cunnilingus (oral vaginal sex), so there would have been little if any risk even with a high viral load. With her relatively low viral load of 10,000 when you were exposed, for practical purposes your risk was zero from that exposure. Your 16 day blood test is about 80-90% reliable. However it is 100% reliable in proving your symptoms are not HIV:  all people with HIV symptoms have positive antigen-antibody (4th generation) HIV blood tests. Also, it never takes longer than 6 weeks for a positive result with these tests. You don't need testing beyond 6 weeks and certainly not at 16 weeks. Finally, your shmptoms are not typical for a new HIV infection. See your doctor if they continue or still concern you, but don't worry about HIV as the cause. (They are typical for the physical manifestations of anxiety -- which of course would be entirely normal in this situation. Everybody in these circumstancdes is naturally anxious!)

Finally, once your wife's viral load is completely controlled with HIV drugs (anti-retroviral thereapy, ART), you will not be at risk at all, even with unprotected vaginal intercourse. Her doctors may advise, and you and your wife may choose, to also use condoms, but probably that will be optional. They may also recommend periodic HIV testing for reassurance. But in the long run, all will be well for you and her. But definitely follow up with your own doctor, or perhaps best, you're wife's HIV provider.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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42 months ago

Thanks for the reassurance doc! The 4th generation test @ 16 weeks came in today and was non-reactive as you had said in your email. I can now focus on my wife and our kids.

As for my wife’s situation, thanks for the kind words. This is a very unusual situation and we have tried repeatedly to understand the source of the infection along with the hospital infectious disease doctor who initially reassured us this was a false positive giving the risk of the exposure and our life style. Unfortunately, after several round of testing and it was confirmed that in fact it is a true positive. To make matter worse, his analysis speculates that the nature of the infection could not have been from that exposure and as a result the patient (source) was never contacted and tested for HIV by the hospital and Workers comp was denied which we’re trying to get our lawyer to appeal.

She is currently under the care of Margaret Fischl team @ UM HIV/Aids research and was put on HAART immediately. Her viral load is now undetectable within 3 weeks and the expectation is that she would be OK...Praising the Lord. However, they do believe this is a recent infection due the CD4/CD8 ratio and viral load fluctuation prior to her starting HAART. Also she repeatedly tested negative in the past and breastfed our child thru Sept 2016 who recently tested negative by UM pediatric team (worse 4 day wait of our life).

The incident with my wife occurred on June 13th and while she was pulling an IV out of one of her patient, she felt a drop in her eye (saliva or blood not sure) and quickly ran to the nurse post station to wash it out but didn’t notice any blood. She also checked the patient chart and didn’t see anything unusual, therefore never reported the incident. A week later she had an unusual sinus and eye pressure and was prescribed some antibiotics but never developed any fever or any other symptoms but claimed she wasn’t feeling herself. She later told me about the incident and with the lingering sinus and eye pressure, I immediately urged her to report it to employee health which she did the next day on July 12th.  She was tested for several STDs and HIV came back reactive. Besides this incident, the only exposure she could have had was a dental procedure done while she was still breastfeeding and a pap smear and routine dental cleaning done early this year. The Pap smear did reveal she was with and was prescribed Mifeprex per our request. She later had a cold with mouth sores around March and also had two episodes of yeast infection. I myself routinely tested negative for HIV back in Feb due to low WBC count which I’ve never done in almost 20 years. We’re still unable to get our mind around this whole situation.

 This is extremely hard on us and we’re taking it one day at a time with a lot of gilt as to what we could have done differently. Sometime we do ask ourselves if this is real as she had false positive RPR in the past while pregnant. However, we’re working with good doctors and strongly hope every will be OK.

Do I need any further testing at this point post 16 weeks? The doctor told me I should test twice a year, any thoughts…  How about the kids? Should they be tested occasionally as well? Please advise.

 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Thanks for all the details. I'm very glad to hear your wife is in world class care. I can't say much about the exposure and source of infection, except that the apparent occupational exposure is a much better bet than her dental procedure. And given the uncertainty about the source, I think you should be tested yet again, perhaps including RNA/DNA testing in addition to repeating the antigen-antibody (4th generation) test. Your wife's doctor or anyone else in the U of Miami team will be able to address this, probably with more expertise than I have personally.

All this assumes your wife has not otherwise been at risk, sexually or by injection drug use. Of course you're in a much better position than I am to judge the likelihood your wife has had such risk, and I'm not making any accusations, just stating the obvious. You don't say anything about it, but I'm sure this must have come up for discussion.  

There is no realistic chance of HIV transmission in the household and your kids are not at risk, and I do not believe most HIV/AIDS experts would recommend testing. But this too is something for you and/or your wife to discuss with her doctors.

I've been happy to answer these questions, and per forum standards, there can be one more round of Q&A. But please do not rely on this or any other online forum as your main source of information and advice going forward. As implied above, the Fischl team has far more expertise and experience in managing HIV infected people and their families than I or Dr. Hook do. (We are dominantly STD experts. Beyond risk assessment and testing after potential exposures, we are not in-depth HIV/AIDS experts.)

Best wishes to you and your wife.
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42 months ago

Thank you for the feedback Dr.! You and Dr. Hook are doing an amazing job and can’t imagine how many life you’re impacting. Truly appreciated…

My apologies but the reason I didn’t mention any sexual or drug injection risk is that there are non-existent. My wife and I have been in a 100% committed relationship for almost 19 years, no alcohol, cigarette, drug or any substance abuse. Any sexual risk (if there’s any with protected sex) would have been from me 20 years ago before we started dating and I’m the only guy she has ever been with. There’s absolutely no doubt in my mind how faithful we’re to each other and that’s what makes this situation so difficult to digest. Now that I can remember we both tested negative for all STDs including HIV and substance abuse back in 2013 for our life insurance application.

As far as other risks if there are in fact potential risks for HIV transmission would have been surgeries – I had 4 surgeries in the last 15 years - 2 endoscopy, 1 colonoscopy and a dental surgery late 2015. As for my wife, she had 2 surgeries -  a C-section and then an episiotomy in 2015.

The UM team focus is usually on the patient and their advise to me was to get tested 28 day post exposure with the 4th Gen ag/ab to confirm I’m negative.  Per my wife’s doctor occupational exposure is rare but real and for that reason they always advise people to report every incident as soon as possible no matter the type of exposure.

I did talk to my family doctor about the RNA/DNA test and he believes my anxiety is getting the best of me that I should maybe consider therapy. He’s saying that at 17 weeks, the 4th Gen ag/ab test is conclusive per the CDC guideline and the RNA/DNA is typically use to confirm any undeterminate 4th Gen. He believes that I’m hypochondriac as early this year, against both he and the GI advise regarding my low WBC which has been the same for almost 13 years (which both of them always believe is normal), I saw a hematologist who ordered several test including HIV back in February of this year to rule out any stomach cancer which has always being my concern due to previous H pylori infection back in 2002 and chronic gastritis.

  1. CBC, SMA-7, and LFTs

  2. Vitamin B12 and folic acid level

  3. Serum protein electrophoresis and serum immunofixation

  4. Thyroid profile

  5. ANA and rheumatoid factor

  6.  HIV screen

  7. Viral hepatitis profile

  8. Flow cytometry   

The tests were extremely expensive, however, all came back normal and including the cd4 and cd4/cd8 ratio which were within normal range as well. Per the hematologist final report, my low WBC is not infection induced is in normal range for my ethnicity group and nothing else was recommended except occasional follow-up.  

Now I’m thinking I could have been infected thru one of these procedures I’ve done in the past and then gave my wife this disease. Is realistic for the 4th gen to be false negative after all these years if in fact I’m positive? My PCP thinks I’m being irrational and did give me a script for both 4th gen ag/ab and PCR RNA to be done next January 2018 with the instruction that the PCR RNA is to be done only if the 4th Gen is reactive. He also thinks the results to my unnecessary test above are best indicator that I’m not HIV positive and I didn’t unknowingly infect my wife. My wife situation, although rare is unfortunate and could have been from anything (cut, needle, blood splash, etc.…) giving the fact she works in a hospital setting.   I keep thinking we’re living a nightmare. Can the RNA/DNA yield a positive result 5-6 months post-exposure giving the fact that the 4th Gen is negative? Isn’t the 4th gen conclusive at 28 days? I’m a ball of nerve right now and can’t stop thinking about the possibility of both of us having the disease. I’m scared for our kids.

So far I tested  3 times. What the chances that still could turn positive?  Please help 

07/28  - Day 16  Rapid  antibody Test  - Negative

07/08 - Day 16  4th Gen Ab/ag Labcorp - Negative 

 11/07 - 17 Weeks  4th Gen ab/ag QuestLabs  - Negative

Thanks
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
I'm truly sorry, but these issues go beyond what this or any online forum can do. I will simply say that the HIV tests you had are among the most accurate diagnostic tests ever developed, for any medical condition; and your results prove you do not have HIV. Also, no kids of HIV infected people ever are infected in the home:  it simply does not happen. However, as I said above, you need to discuss all this with the UM team providing your wife's care -- or find your own HIV expert doctor, perhaps with their help. It also is very obvious you are having great difficulty in adjusting to the new reality in your family. That is entirely understandable. However, you are more frightened than necessary or reasonable. 

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