[Question #321] HIV questions, so confused from conflicting information

35 months ago
I kissed a man who I feel is likely to have HIV.  I feel this way because he has slept with 30 women and does not care about using condoms because he cannot inpregnate due to a disease he has.  He gave me a cold sore and also performed oral on me and I believe he gave me genital herpes as well.  After my initial cold sore, I got very sick with flu symptoms and have been stressed out with anxiety since.  We did not engage in vaginal sex but the reason I am worried about HIV is because the day before we ate scolding pizza and we burned our mouths badly.  I would even go as far to say we could have had 2 degree burns on the top of our mouths.  When we were kissing, we were biting one another - it only happened once.  He even said, "Wow did that draw blood?" although I did not taste blood or see blood.  He bit me as well and again there could have been blood drawn but I did not see blood and I did not taste blood.    This was about 11 weeks ago.  I took the tests at 10 weeks.  I took blood tests for herpes and HIV and they were all negative.  I am understanding antibodies will likely show themselves in 14-16 weeks for herpes and 3 to 6 months for HIV.  Does this information sound correct to you?  Are burns portals to the blood stream?  I have read that contracting HSV2 makes people more susceptible to HIV.  Is this true?  If he were to give me the virus on my mouth a week before he performed oral on me, would this make me more likely to get HIV from him?  I have swollen lymphnodes and I am on amoxicillin for them, hoping that they are from strep throat.  I will be taking tests in the future to confirm my status but I want to ask you about the tests.  I took a HIV-1 RNA TMA Qualitiative test at 10 weeks and it was negative.  I took a 4th Generation Antibody test at 10 weeks and it was negative.How comfortable should I feel about these results?  None of the research I have done has made me feel like I can walk away from this situation saying that I am negative.
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago

My goodness, your post suggests that you are quite worried about the events you describe.  I hope that I can help you to relax over this.  From some of the things you say in your post, it seems that you are getting information that is out of date and in some instances, even wrong.  The fact that your partner has had over 30 sex partners slightly increases his risk of being HIV infected on a statistical basis but not much.  The likelihood that he has HIV is low- in the neighborhood of 1% or less unless he has had sex with other men or shared needles with infected persons.  Further, kissing ,even rough kissing with sores in both of your mouths is still not a risk for HIV. No one has EVER gotten HIV from this sort of exposure- not ever!   Finally, the tests you have had prove, without a doubt that you did not get HIV from the exposure you mention.  Both the HIV RNA test and the 4th generation test you mention provide definitive results at 4 weeks after exposure, thus you can be confident that you did not get HIV from the exposure you describe.

As for HSV- in the absence of lesions at the site of exposure and with a negative HSV antibody test 10 weeks after exposure, there is little realistic chance that you got herpes prom the receipt of oral sex you describe either.

My recommendation at this time is to move forward without further concern. I hope my comments will help you to do this.  EWH

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35 months ago
Thank you kindly for your response.

The CDC documented at least one case where HIV was transmitted through a bleeding mouth.  
http://www.cdc.gov/mmwr/preview/mmwrhtml/00048364.htm

Doesn't the 4th Generation Test check for antibodies?  Don't our immune systems develop antibodies at all different times, not just strictly 4 weeks?  I knew someone who has herpes and his antibodies did not show up for 9 weeks.  Terri Warren often mentions 14 weeks as a rule.

Can you tell me more  about the HIV-1 RNA Qualitative test?  It checks for the virus itself in your blood, but I have read that in some cases after 3 or 4 weeks the virus  can reach undetectable levels in the blood.  Do you have any information about its accuracy or viral load at 10 weeks in general?  Thank you for your time and I appreciate your input.  

Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago

The 4th generation tests test for both antibodies to HIV and the virus itself, in the form of the p24 antigen.  Once someone has HIV either one or the other of these test targets are present and detectable.  This is the reason that at 4 weeks results of 4th generation tests are described as definitive. 

The pace of antibody testing varies from person to person and test to test- no change in my assessment or recommendations.

The HIV RNA test is a PCR test.  After as little as two and certainly by 4 weeks all untreated persons with HIV will have positive tests.  I am not sure where you have gotten information about infected, untreated persons with undetectable HIV RNA tests at 3-4 weeks. This is not my experience or supported by the scientific literature.  EWH

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