[Question #599] Test again?

42 months ago
Hello Doctors,
  I am a 38 year old straight male who is asking about a situation that happened many years ago. 

Back in 2004, I rekindled a romance with a former girlfriend that I had been in a long term relationship with. The reunion lasted about a month, in which we had unprotected vaginal Intercourse twice. 
Shortly after I began a relationship with another girl which lasted until we ended things in 2012, and have I not been sexually active since.

In 2014, on a night out I came across an AHF mobile HIV testing site. I decided to test since I had never been tested. The test they used was an INSTI 60 second antibody test which came out negative. I didn't give it another thought until I came across an article a few days ago saying INSTI got FDA approval for use to detect HIV 2.

I'm curious if I should test again? I know HIV 2 is rare in the U.S, however when I got involved with my ex all those years ago she had just come back from a 3 month trip through Europe, and to be honest I'm not sure if she was sexually active while there. 

So I'm wondering if the INSTI antibody test was enough, or if I should test again with one that test for HIV 2 also? 

 Thankyou
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Welcome to the forum. Thanks for your confidence in our services.

First, congratulations on getting HIV tested. The standard recommendation is that every adult in the US be tested for HIV at least once, regardless of risks. Your risk was exceedingly low (probably zero) from the exposures described, but still good you did it. Always better safe than sorry.

That the INSTI was only recently approved for HIV 2 probably makes no difference. I believe it is the same test as before, i.e. your negative result was valid for HIV 2 as well as HIV 1. That is, it isn't the test that has changed, just the data submitted to FDA to document test performance. But in addition, you are correct that HIV 2 is vanishingly rare in the US. Virtually all of the handful of cases that have occurred were in people who acquired their infections in the parts of West Africa where HIV 2 is endemic (Cameroon, for example), or in their regular sex partners. It is almost equally rare in western Europe. The chance partners like yours had HIV of either type, but especially HIV 2, is extremely low.

So on both scores -- essentially zero risk for HIV 2 and the negative test -- you needn't worry further about it.

I hope this has been helpful. Let me know if anything isn't clear.

HHH, MD

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42 months ago
Thank you for your reply Doctor,
  I think I understand your reply pretty well.
From what I interpret you're saying that I don't need further testing because even though the FDA just recently approved it for HIV 2, the test I took was valid for HIV 1 and 2, and on top of that I wasn't really at risk for HIV 2 anyway.

I also forgot to mention that I'm uncircumcised and was wondering if that changes your assessment in any way? I'm assuming it doesn't as I tested negative, but I thought I would ask anyway. 
 
Thank you again!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
You correctly understand everything.

Lack of circumcision roughly doubles the risk of acquiring HIV if exposed. If we take a rough guess that the chance you caught HIV started at say one chance in 2 million (probably not far off), then being uncircumcised would have raised the risk to 1 in a million. And as you say, since you're negative, the risk at the time of exposure is irrelevant anyway.

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