[Question #5640] HIV concern

22 months ago
Hello good afternoon

I am from Santo Domingo DR, 13 weeks ago I had a sex Encounter with a sex worker, protected vaginal sex but not oral, I was really worried because There are alot of HIV cases in this country, and I had 2 weeks ago flu like symptoms and diarrhea but a feces exam showed amoebiasis so I had me Tested and these are the results:

41 days post exposure RT pcr for hiv1 undetectable (from 40 to 1000000 copies)  and a antibody test negative (do not know What generation was) they draw blood from a vein and the result came the next day the pcr took 2 days

62 days another antibody test algo negative

86 days negative 

The time Between the symptoms and the last test was about 2 weeks. They gave a brochure that said: anti bodies can take up to 6-9 months to appear, 12weeks Is enough or Do I have to wait all That time for my test to be conclusive? 



H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Welcome to the forum. Thank you for your confidence in our services. Also congratulations for having safe sex.

All is well -- your test results are conclusive and show you did not catch HIV. It is true that HIV is a lot more common in your country than in most of North America or Europe, and I understand how symptoms a couple of weeks later could make you quite concerned. But the fact is that no matter how high the risk at the time of exposure and no matter how typical the symptoms might be for a new HIV infection, the test results overrule everyting else. The current HIV tests are among the most accurate diagnostic tests ever developed, for any medical condition, if enough time has passed since the last possible exposure. The combination of test results you had at 41 days probably was 100% proof you were not infected; it is not possible to have both a negative PCR and negative antibody (by any generation of test) at that time. And with additional negative antibody tests, the results are absolutely conclusive.

The information in the brochure you have is simply wrong. Even with the older (first and second generation) HIV antibody tests, it never takes more than 3 months for measurable antibody to appear. I would guess the information you were given simply hasn't been updated; or the agency or the writer has a serious misunderstanding of current HIV test performance. As for your symptoms, acute HIV generally doesn't cause diarrhea, and is especially unlikely in someone with another well-established cause of the diarrhea, such as amebiasis. And of course "flu like" symptoms (headache, muscle aches, etc) occur in hundreds of medical conditions other than HIV.

So all is well. You do not need any more HIV tests. And you can safely have sex with anyone without putting that person at risk for HIV.

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

HHH, MD
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22 months ago
Thank you very much Dr your words are very reassuring, some say Is 3 months (90 days) or 12 weeks (84 days) in medical terms Is There a difference? Also the antibody test was for hiv1 and 2 but the RT pcr only for HIV 1 and I dont if that Is important dont know if There have been cases of HIV 2 in This country and if I should be Tested for that 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Three months is old news, going back to the days of earlier (second generation) HIV antibody tests, now little used. But even if your test was an older one, in my advice above I was careful to say the combination of tests you had was conclusive. It is simply impossible to have HIV 40 days and have neither detectable virus nor antibody, of any generation test. (Or if not quite impossible, so rare as to be in the same category as the risk of being struck by a meteorie.)

HIV2 is not a realistic concern. It is rare outside the parts of Africa where it evolved. I also do not know details for the Dominican Republic, but there have been only a couple hundred cases total in the US, with most of those in people who were infected in Africa. However, the 3rd generation antibody tests (and the antibody compotnent of the 4th gen, i.e. antigen-antibody tests) detect HIV2 antibody within 6 weeks of exposure.

Don't overthink it! For sure you don't have HIV. There is no additional information you will think of that has any chance of changing my judgment and advice.
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22 months ago
Great Dr! Another thing I made a mis take the RT pcr was performed with the 62 day antibody test not 41, but for What you have told me i dont think it matters, I know Is my last question and I wanted to thanked you for this services, for What I have read you Are one of the greatest specialist in This ├írea so for you to take a little of your time to answer all kind of question Is awesome! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
As you ssupected, the revised timing makes no difference.

Thanks for the thanks, but I don't accept such a strong accoade. There are many, many experts who know more than I do about HIV risks, transmission, testing, and so on. Don't assume that just because someone has an online presence it makes him or her any more expert than others. In fact, on average those online probably are less expert than most in their fields. I'm pretty good at this, but not everybody is. Don't assume it when you're exploring health issue on the web.

That concludes this thread. I'm glad the discussion apparently has been helpful.
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