[Question #5642] HIV

22 months ago
Hello Dr. HHH,

6 years ago had vaginal intercourse with a CSW in the Caribbean where HIV is prevalent.   Used a condom, not sure if used properly due to alcohol.  Condom slipped down but always covered head of penis.  Did not break or tear from what I can recall.  Not sure if it was a latex, polyurethane or lamb skin material.

3-4 weeks after incident I came down with herpes zoster at age 29.  This made me very concerned about hiv.  Below are my testing results.

HIV-1 proviral DNA PCR - negative at 4,8,12 weeks (Roche Amplicor v1.5).
3rd generation EIA- negative at 4,8,12,13,26 and 52 weeks
Different 3rd generation EIA - negative at 26 weeks 
4th generation Ag/Ab test- negative at 3 years 
HIV-1 RNA viral load - not detected at 3 years after exposure.
Different 4th generation Ag/Ab - negative at 4 and 5 years
Had another antibody test done at 5 years after exposure - not sure which assay it was - negative.

Had T cell panel 4 years after exposure which had CD4 1002 (38%) and cd4:cd8 ratio of 1.72.

Now I understand this all looks conclusive for being hiv negative.  But then two weeks ago I got a second case of herpes zoster at age 35.  Everything I read says recurrent shingles at my age must mean HIV.  I would like to get your guidance and opinion.

Also does anyone here know how soon a person with hiv has an inverse cd4/cd8 ratio?  Is a CD4% of 38% concerning?  Is HIV-2 a possibility?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Welcome to the forum. Thanks for your question.

You needn't be at all worried about HIV. The HIV tests, including the ones you had, are among the most reliable diagnostic tests ever developed, for any medical condition. And you had several types of test, each by itself 100% reliable at the times you had them.Because the tests are so good, the results always overrule all other considerations. Even if you had a proved high risk exposure (e.g. unprotected sex wtih a known infected partner) or the most typical symptoms or signs of HIV or AIDS, the test results are what is important. Indeed, you have been sriously over tested. Every test done more than 6 weeks after the exposure proved you don't have HIV. And there certainly was no reason for T cell analysis. That test is useful only in known HIV infected persons -- no matter what the results, they have absoltuely nothing to do with HIV if the HIV test itself is negative. And no, HIV2 is not a possibility. (There have only been around 200 cases of HIV2 in the US, last I heard, most of them acquired in Africa and diagnosed here.)

As for your herpes zoster (shingles), that's common with or without HIV, and that includes your age and the occurrence of a second episode.If "everything you read" seems to point to HIV, it's because your anxieties are resulting in misinterpretation, or you're being drawn to sites that tend to exacerbate your anxities. That statement is simply flat untriue.  (My son had shngles at age 13. It didn't enter my mind to be concerned about HIV.) Having had two episodes, it would be reasonable to see a doctor both to have the updated version of the varicella zoster virus (VZV) vaccine, which will lower your risk of still more episodes. A general physical exam might also be warranted to make sure there isn't some sort of underlying immune deficiency (other than HIV) -- although in the large majority of people with recurrent zoster, no underlying health problem can be found.

Everything you say points to anxiety and obsession with HIV. For sure you don't have it, and I imagine other doctors have told you the same. If you continue to remain fearful despite this (and perhaps prior) reasoned, science-based reassurance, professional counseling might be in order. I suggest it from compassion, not criticism.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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22 months ago
Thank you for the reply.  Your reply was very reassuring.  Since I still get follow-up questions I’ll ask the following.  Looks like the 3rd and 4th generation tests I had also checked for HIV-2 antibodies.   Are these HIV-2 tests as sensitive and accurate as the standalone HIV-2 EIA one?  I’m assuming they are.  Is window period same for both HIV-1 and 2?


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Most lab based HIV tests are EIAs. That's the name of a testing technology, not any particular test. All these tests are equally accurate for both HIV1 and 2 antibody. The window periodi is irrelevant in your situation; it is the same for both viruses, i.e. 4-6 weeks -- this has no bearing on any of the tests done after that time.---
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22 months ago
My final post is regarding condom usage.

1.  If a latex condom is used INSIDE OUT but does NOT slip off or break, does this still protect from HIV?

2.  If a latex condom has a small tear on the part that covers the shaft of the penis, but the part of the condom that covers the head of the penis is intact, does that still protect from HIV?  I’m assuming it would as the virus cannot penetrate intact skin, but am not sure. 

I appreciate your time and knowledge Dr HHH.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
The purpose of follow-up comments is for clarification of the original question, not to ask entirely new questions. 1) Yes. Why not? 2) Yes, protection is complete as long as the penile opening and head are covered.

That concludes this thread. I hope the discussion has been helpful.
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