[Question #5438] HIV COMBI Conclusive?

23 months ago
Hello Doctors 

In a nutshell i had anal sex with a sw on feb 8th and for the life of me cannot remember if the condom was intact at the end or not. on march 7 i had an HIV Test( 1&2ABS ,p24 using ELECTROCHEMILUMINESCENSE ASSAY) which came back negative. through my own fault i miscalculated the days and tested at 27 days post exposure. Recently i have contracted a throat infection and am on antibiotics,pain in the neck,and red pimples appearing on by back.I have not had fever or swollen lymph nodes since the encounter. Occasionally my body has the pins and needles feeling but i think that might be due to my heightened anxiety and stress.

Question 1:
Could you please advise whether a retest is necessary as as per the posts on medhelp you have said 4wks is conclusive for duo?

Question 2:
Could the symptoms i have said be related to HIV?

I look forward to your response.
Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
Welcome to our Forum. I'll be glad to comment.  The exposure you describe was relatively low risk since most commercial sex workers are not infected and even if your partner was infected, your risk from a single, insertive anal exposure would be about 1 infection in every 1000 sex acts.  Your negative test at 27 days strengthens the evidence that you were not infected with HIV at the time of that exposure.  

1.  Since we left MedHelp, more recent data have slightly changed when a combination HIV antigen/antibody test such as the one you were tested with can be considered definitive.  At 28 days (or 27 for that matter) over 99% of persons who have acquired HIV will have a positive combination test.  The final less than 1% of persons will develop a positive test at some point between 4 and 6 weeks after exposure.  This is quite rare and I have never seen such a case but it is described to occasionally happen. Thus for your test results to be completely conclusive, a final test should be done at some point more than 6 weeks after your exposure.  The likelihood that your test would be positive however is tiny.

2.  The signs of recently acquired HIV, the so-called Acute Retroviral Syndrome most typically occur 2-4 weeks after exposure and are comprised of high fever, a sore throat, muscle and joint aches and in a minority of persons, a rash or diarrhea.  Your recent illness, occurring more than 3 months after exposure is occurring too late to be the ARS and sounds much more like an every day viral sore throat than the ARS.  I would have no concerns that it might be due to HIV acquired in February.

I hope that this information is helpful to you.  EWH
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23 months ago
Thank you for you response doctor. 

When you say the likelihood of it turning positive now is tiny, how tiny would you say?
Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
I would estimate that the chance that you DO NOT have HIV is more than 99.99%.  EWH---
23 months ago
I do apologize I forgot to state that it was a brothel and not a sex worker..
23 months ago
Thank you Dr. Hook for your time and advise.

In Dubai,(where i live) most places that ofer std testing just do so for the money and have little to no experience in STD's and especially HIV. So thank you for the advise hopefully this will put my mind at ease..
Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
That makes no difference.  The people who work in brothels are considered sex workers.  You can stop worrying.

this is my 3rd response as part of this thread.  As per Forum guidelines, this will complete my responses.  there will be no further answers.  EWH
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