[Question #3666] HIV testing and other factors

34 months ago
Hi Doctors,

Unfortunately, it is difficult to find reliable information online, and my PCP is not well versed with updated HIV guidelines, so I figured I'd ask the true experts.

~9 weeks ago, I had a brief exposure (no more than 10 seconds of unprotected vaginal sex), then finished with protected intercourse. She was not a sex worker, and this occurred in suburban/rural PA. I had an HIV RNA test done at 18 days, HIV DUO tests done at 44 and 56 days (all negative). I understand that both DUO's are considered conclusive, but unfortunately I've read some things online that have made me question my results.

I've seen information that claims HEP C is common among HIV + persons, and can delay seroconversion of the HIV virus. I'm not even sure if my exposure could result in a HEP C infection, but I've read that it's possible.

1. Am I even at risk for HEP C, and if I happened to acquire it, would an acute infection cause complications to my HIV testing?

2. Does body weight and or muscle mass affect the HIV testing window period?

3. Would you recommend any further testing or screening based on this information?

This has all caused some excessive anxiety, and I'd like to know if I can put this all behind me

Thanks
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
 Welcome o our forum and thanks for your question. I'll be glad to provide some information. Before I do let me tell you that the Internet is a bad place to be looking for HIV and STI related information.  Much of what can be found there is out of date, taken out of context, or just plain wrong. Many incorrect statements are quite prominent on the Internet.   Some of your questions reflect some of the misinformation which is all too common on the Internet. 

 Your risk of HIV from the exposure you describe is very very low. Very few women ( less than a fraction of 1%) of women in the United States have HIV. Even among commercial sex workers the infection is quite rare and your partner was not a commercial sex worker.    Your test results, both the RNA and combination antigen/antibody DUO) tests are conclusive and there is no reliable information to suggest that if you were you or your partner had hepatitis C, that this would meaningfully alter the accuracy of your tests.    I certainly would not worry further about HIV related to this exposure. 

1.   Hepatitis C is relatively common among persons with HIV, particularly those who use IV drugs. Even so most persons with HIV do not have hepatitis C.    Further, and relevant to your question, hepatitis C is very very rarely transmitted through vaginal sexual intercourse.   The risk of hepatitis C transmission during receptive reptile intercourse is a bit higher but still very low. 

2.    There are no data to suggest that body weight or muscle mass significantly affect the HIv window period.

3.  There is no reason for further HIV testing related to the exposure you describe. You risk for any STI from this single exposure is low and I presume that you may have tested for more traditional STI's like Gonorrhea or Chlamydia.  If not, out of an abundance of caution I would suggest you do.   These infections are far far more likely than HIV.

I  hope this information is helpful to you.   EWH
---
33 months ago
Hi Doc,

Thanks for you prompt reply. I haven't been tested for more common STD's, as the only thing I can think about is the grave possibility of having HIV. I do have a couple follow up questions

1. Just out of curiosity, even if I didn't have the tests done at 44 and 56 days, was my RNA test at 18 days considered 100% conclusive?

2. Do you suggest any HEP C testing? And if so, what is the window period?

3. By saying there is no significant affect due to body weight and/or muscle mass, I'm assuming that 8 weeks would be more than enough time even if it caused a slight delay?

4. I am also nearing a committed relationship, and was wondering if it would be safe to have unprotected intercourse without fear that I could possibly have HIV

Thanks
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
1.   Yes, a negative HIV RNA test at 19 days is conclusive. 
2.   Unless you use IV drugs there is no need for a hepatitis C test. As I mentioned, above hepatitis C is virtually never transmitted through vaginal sex. 
3.  Correct.
4.   Given your situation I still think testing for more common bacterial STI's is a good idea. Otherwise, I see no reason to related to the encounter you describe to worry about unprotected sex with your significant other. 

 I hope these comments are helpful. Take care.  EWH
---
33 months ago
The reason I ask about the HCV/HIV coinfection is because I saw multiple responses from Dr. Bob on thebody.com stating that coinfection can delay HIV antibodies. I believe reports of cases like this were from the late 90's - early 00's, and I can only assume the reason was that tests were less effective back then. I am going to see my PCP for a physical later this month, and coincidentally, he ordered me a panel of STD testing which happens to include HIV and HEP C testing along with the more common STIs. The thought of testing again does make me anxious, as the thought of my HIV test turning positive puts me on edge. 

1. Should I wait until the 12th week to take this series of tests, or can I take it any time from now on?

2. Is there a possibility of my HIV test coming back positive, or am I just being irrational?

3. I have been struggling with this for quite some time now. If I continue to doubt my test results and have these fears, what type of professional help should I seek? I am hesitant to see a therapist due to their lack of knowledge on the topic of HIV testing

Thank you for your replies doctor
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
Your follow-up question is a bit repetitive.  I said (twice) above that hepatitis C is not meaningfully transmitted through vaginal intercourse.  The answer is not going to change.  The prevalence of sexually acquired hepatitis C amongst heterosexuals is a small fraction of 1%.  I am not sure of the date of the post from Dr. Bob that you are describing and in general we agree on our advice to individual clients.  For men with male sexual partners who practice receptive rectal intercourse there is a small risk for hepatitis C- that does not pertain to you.  Regarding your specific questions, my final answers (the Forum provides up to a total of three responses to any question) are:

1. Should I wait until the 12th week to take this series of tests, or can I take it any time from now on?
Not sure what tests you are referring to.  There is no need for further HIV testing.  If you are wondering about other STIs, you can test at this time and results will be reliable.

2. Is there a possibility of my HIV test coming back positive, or am I just being irrational?
No possibility at all in relationship to the exposure you have mentioned.  You have  three negative tests using two different testing methods at times when it is well established that the results are reliable. 

3. I have been struggling with this for quite some time now. If I continue to doubt my test results and have these fears, what type of professional help should I seek? I am hesitant to see a therapist due to their lack of knowledge on the topic of HIV testing
I am not suggesting counseling to help you understand the tests, I am suggesting counseling to help you sort out why you are having so much trouble accepting negative test results at a time when experts on this site, at the CDC, and at the WHO all agree, your results are definitive.  this is not about test performance, it is about your inability to accept your results as definitive and move forward.

I hope these final comments are helpful. Take care  EWH


---