[Question #395] Trying to move on

34 months ago
Dear Doctors,

This is the 4th time in writing to you in the last 3 months. 
My history: I had one single exposure which consisted of oral sex received from a Thai CSW (a condom was used but I am not sure about its integrity). 

In my last query at the end of November I acted as if I was asking a question for a friend to know how conclusive are HIV 4th generation tests in a high risk situation; i sincerely regret having done this and I truly apologize for it! I have been suffering very much from this event due to the fact I have a lovely wife and an amazing child and I really regret my poor decision; I have been really afraid (I realize this is not rational) of getting HIV and then spreading it to my beloved ones. This "traumatic event" lead me to some behaviours that are not rational, not lucid and not normal for me. I am sorry for having abused of this really helpful service! I am doing a bit better now as I have spoken about this event with my family and I am seeing a therapist. 

When it comes to the medical aspects of this story, I have tested 3 times with a 4th generation test at 34, 84, 103 days (all negative results). What concerns me is the fact that I might have been exposed to a non-B  HIV-1 subtype as in Thailand the CRF01_AE is the most common form. I have read some recent scientific studies highlighting that some 4th generation tests are not very sensitive in detecting the antigen of non-B subtypes (http://www.ncbi.nlm.nih.gov/pubmed/25343245). I wanted to hear your opinion on the following: in the unlikely event of a delayed seroconversion, I am wondering if the test is capable of detecting the p24 for non B-subtypes? would the p24 levels be very high in case of delayed seroconversion? 

I am making an effort in staying away from internet and I hope this to be the last time I am asking you questions.

I wish you a prosperous 2016.
Respectfully,
L.
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago

Leonardo.  It is good to hear that you have begun to work with a therapist on your illogical continuing concern about HIV as a result of your error in judgment and to hear that you are trying to stay off of the internet.  That is progress and I am pleased to hear this.  At the same time, your question indicates that there is more work to be done.  The questions you ask are clearly internet fueled questions which I have answered in the past (more than once).  The answers will not change.  The exposure you described was of no appreciable risk for HIV and on November 20 you asked "Is a combo test at 4 and 12 weeks able to detect both HIV1 and HIV2 and all subtypes?" to which I answered "Yes".  This answer has not changed in the past 30 days.  Further, the idea of "delayed seroconversion" is another internet-fueled myth that plagues anxious [persons such as yourself.  There is no such thing as "delayed seroconversion" for persons who have not taken anti-HIV medications and are not otherwise immunosuppressed (and you are neither).   If such a thing did exist, as you point out, p24 antigen tests would be strongly positive.

Like you, I hope this will be the last time I need to repeat these responses to you,.  Good luck.  EWH



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34 months ago
Thanks Doctor,

you are right in stating that there is more work to be done. Never before in my life a wrong decision lead me to this suffering. I am struggling with the fact that tests cannot be 100% accurate (as many other things in life) and this leaves me with the irrational fear of infecting my family; finally,  this "mental state" makes it difficult for me to resume a normal sexual life with my wife. 

I hope that time will help. I certainly do not want to continue worrying and having more tests.

As a last question: do you have any comments on the article I shared? 

I thank you once more for the patience.
With kind regards
L.
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
I have no other comment regarding the article you mentioned. You are over interpreting things.  EWH
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