[Question #6557] Prednisone/Topical Steroid affect HIV test?

66 months ago

I just recently read steroids are immunosuppressive. My quick story is : I had unprotected vaginal sex with a female of unknown status, 8 months later I had jock itch and took cortisone 10 topical cream for about 4-6 weeks. I then took a generation 3 hiv test (came back negative) a month later I took a RNA PCR viral load test, it came back not detected (<20 copies). The rash got worse and I was put on prednisone taper . 80mg x 2days, 70mg x 2 days, 60mg x 2 days so forth and so on for a total of 12 days. This would have been 1 year AFTER my possible exposure. I was also given polysporin which is a topical steroid/antifungal cream for a bit. Then a month later I took a generation 4 ag/ab test (abbott architect) which came out non reactive/negative. I tested again 15 months after my possible exposure (about 6-8 weeks after stopping the prednisone) with another gen 4 (architect) and it came out non reactive/neg. then I tested about 17 months after my possible exposure with a generation 4 ag/ab (architect) and another viral load test pcr

Rna (roche cobas/taqman) which both came out non-reactive/negative/not detected.

My questions are:

1) Since I started the topical steroids AND prednisone so after after the "window period" would either of them be strong enough to delete/destroy existing hiv antivodies, or once I have them, they're there for life?

2) do topical steroids actually suppress the immune system or is it only oral/IV

3) if somehow it did destroy/suppress my immune system wouldn't I normally have detectable p24 ag AND a rather high/detectable viral load?

4) can I trust my results and move on, or should I take another test?

5) Also, about a month or so after the unprotected sex I noticed a spot on my hand which was dry, I thought it might have been coffee/caramel sauce so I licked my finger, rubbed it and relicked my finger. When I tasted it, it kinda tasted like blood. If it was indeed hiv infected blood how big of an exposure is it? The size of the spot was the size

Edward W. Hook M.D.

66 months ago

Welcome to the Forum. I'll be glad to address your questions. Let me start by assuring you that you have now PROVEN unequivocally that you were not infected with HIV through the encounter that you describe. Steroid medications, when take by mouth or injected but not topically, do have a mild immunosuppressive effect, slowing but typically not preventing the production of antibodies. Their effect does not last long after the steroids are no longer being taken and they have no effect on tests for antigens (such as the p24 antigen in 4th generation HIV tests) or viral RNA, both of which you indicate you have had and were negative. Further, their effect is present only during the period when the drugs are being taken, not weeks later. With this background, let me address your specific questions.

No, your topical steroids would have no effect on your test, even if you tested while using them. Health care providers like topical drugs precisely because they do NOT cause the sorts of side effects, including immunosuppression that we see when they are taken by mouth or injected. Further, once the antibodies are "turned on" by HIV they are then detectable for the rest of a person's life.

2) do topical steroids actually suppress the immune system or is it only oral/IV

Topical steroids act locally and do not suppress antibody production. See above.

3) if somehow it did destroy/suppress my immune system wouldn't I normally have detectable p24 ag AND a rather high/detectable viral load?

Yes

4) can I trust my results and move on, or should I take another test?

There is no need for further testing related to the encounter you describe above.

IF what you licked and ingested were blood (which I doubt) from an infected person (still more unlikely) there would be no risk of HIV. Ingestion of HIV contaminated material, even blood does not cause infection.

I hope this information is helpful. you are in the clear. EWH

---

66 months ago

Question 5 was cut off, I meant it was the size of a pencil eraser so kinda small. Thank you so much for your time Doctor! This really is a great service!

Edward W. Hook M.D.

66 months ago

Reposting my response to question 5. IF what you licked and ingested were blood (which I doubt) from an infected person (still more unlikely) there would be no risk of HIV. Ingestion of HIV contaminated material, even blood does not cause infection. This is true for a spot the size of a pencil eraser. EWH
---

66 months ago

Thanks for the reply!!!

66 months ago

Doctor one last question, what about the Prednisone I was taking a few weeks/months before the tests I took? Would they have any affect even though I started them about a year after my possible exposure?

Edward W. Hook M.D.

66 months ago

If you had acquired HIV your blood test would have been positive within a few weeks. If you had acquired HIV through your encounter of concern you would have developed a positive test which would not be influenced by taking oral prednisone a year later. You can have confidence in your test results.

I hope that the information I have provided is useful to you. Is per forum guidelines, because this is my third response, this thread will be closed shortly. Please don't worry. EWH

---

66 months ago

I apologize about that! Just wanted to thank you for your time and great service! Have a happy new year!

Edward W. Hook M.D.

66 months ago

Your Welcome. I'm pleased the Forum has been helpful to you. EWH
---