[Question #6677] Seeking correct info for regarding HIV

66 months ago

Good day Doctors,

On the 3rd of Jan, I met a random guy on the gay app and we met in a public washroom

He gave me a bj for 10 min, it was unprotected and rough

Also had a protected insertive anal sex for 10 min with sufficient lubricant

After then, I checked my cum in the condom without leaking

I asked him if he's STD free and he was like I don't know I got tested a year ago but it's gonna be fine we used condom

I started getting anxious becuase he didn't say he's STD free for sure

He didn't even seem to be aware of his status though

These are the tests I have got so far

18d: RNA RT-PCR AmpliPrep/COBAS TaqMan HIV-1 Test, v2.0 [Below 20 copis/mL]

28d: Abbott Architect Combo [Neg 0.09]

35d: Roche Combi PT [Neg] Chlamydia, Syphilis, Gonorrhea, Hepatitus B,C [All Neg]

45d: Abbott Architect Combo [Neg 0.05]

45d: Roche Combi PT [Neg]

*I've got two tests on the same day (45days) at two different labs to make sure 100%

1) Are those events I have had considered risky? Since it was msm and anal sex which CDC considers "High risk"

What if we say he was on the AHI period?

2) There might have been bleeding in his mouth during the receiving oral sex in any possible ways

Do you think it's still low risk?

3) I have had a few minor symptoms which I believe they might be from my anxiety

Is that possible to develope classic ARS symptoms after 7 weeks from the exposure?

I'm deperately seeking info reliable both sceintifically and medically

Thanks for your time. I really appreciate it.

H. Hunter Handsfield, MD

66 months ago

Welcome to the forum. Thanks for your confidence in our services.

I skipped over all the details of your exposure events because they are irrelevant. The modern HIV tests overrule all other factors. No matter how high the risk of HIV at the time of exposure (as I type this, I actually don't know any of those details) and no matter what symptoms typical of new HIV (again, I don't know), the test results tell the story. The HIV test results you report prove unequivocally you did not catch HIV during those events.

Now I have read the entire question. Guess what?

1) There is no strict definition of "risky". Compared with shaking hands with someone with HIV? Very risky. Compared with unprotected anal sex or injection of HIV infected blood? Very low risk. You were wise to use a condom in this situation. And in the future, I would suggest you discuss HIV status before exposure, not after -- and avoid unprotected sex with persons who don't know their status or haven't been tested recently. (That said, I don't know what "AHI period" means.)

2) As discussed above, the risk at the time of exposure doesn't matter. Your test results show you were not infected.

3) Same answer. The test results prove your symptoms are not due to HIV from the events described above. And no, it is not possible to have ARS 7 weeks after exposure. ARS symptoms start 10-20 days after acquring HIV, no later.

So there you go: these are the facts, "both sceintifically and medically ". You don't have HIV and can move on without worry. I hope these comments are helpful; let me know if anything isn't clear.

HHH, MD

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66 months ago

Dear Dr. Handsfield.

First of all, Sorry I meant AHI period as Acute HIV Infection period which person is super infectious during the first few weeks.

Thank you so much for giving me such reassuring facts.

Apparently, I have been researching studies of HIV way too much for the past few weeks,

So I ask you to clarify some details might be considered as "Myth" or "Unproved"

That's why I decided to be here instead of exploring random information (which I can't even judge if they are right or wrong) on the internet

So after this process, I can end up this ridiculous nightmare and finally move on.

I know I don't have HIV. I just want to know correct information for all my questions so please don't say it doesn't matter because you weren't infected.

I also would like to apologize first if my questions sound nonsense or crazy "scientifically and medically".

1) Some studies say, to detect HIV-2 antibody, the window period should be longer at least 12 weeks from the exposure to be 100% sure since 4th gen test detects antigens only for HIV-1 not HIV-2.

(It says Swedish government suggests that people who want to exclude HIV-2 infection should retest after 12 weeks although their guideline says it's conclusive at 6 weeks for the 4th gen test.)

I have seen Dr. Hook mentioned this "Most experts feel that antibody detection tests for HIV-2, as well as HIV-1 are conclusive at 8 weeks following exposure."

Also I reffered to this study https://academic.oup.com/cid/article/64/1/53/2194435 It says 4th gen test's 99% percentile is at 44.3 days but still I can see it's a study for HIV-1 judging from its title.

After all these, Do you feel I need to retest at any time after 8-12 weeks to 100% exclude HIV-2 as well?

2) What if I got co-infected with other viruses such as Hepatitis C or something?

Is that possible for co-infection to delay developing HIV antibodies?

I've seen there are some studies which claim that persons had no detective HIV antibody level over 12 months by immune blot because of co-infection.

Do you think 4th gen tests I have got might have been "false negative" because of co-infection?

Can it happen in any ways?

3) 2 days ago, I checked my blood sugar level with my father with the glucose meter.

After done that, I used an alcohol swab to swipe blood on my fingertip and put it on the desk.

I didn't notice but 1-2 min later, I saw my father was swiping his fingertip blood with the swab "I had already used"

I was literally freaked out but couldn't tell him anything.

I'm assuming he used the clean part of it but still it's really scary.

The alcohol swab I used says it contains ethanol 78.85%(v/v)

Let's assume I have HIV, Do you think there's any possibilities that my father might get infected from that route? (Like, if his fingertip blood touched my blood on the alcohol swab?)

Or it can't happen because my blood absorbed in the alcohol swab had not active HIV viruses because ethanol killed them?

I don't even know if ethanol can kill HIV virus or how quickly they become noninfectious in alcohol swab.

That's all my curiosity Doctor.

I'm not sure if I wrote all these questions right since English is not my mother tongue.

Thank you so much.

H. Hunter Handsfield, MD

66 months ago

1) We stand by our longstanding interpretation of the available data, which replicates the position of the CDC. The AgAb tests are conlcusive by 6 weeks (actually, 45 days) and usually positive (98%) by 4 weeks. Here is a link to the review article on HIV test performance on which our advice is based, and also the basis of CDC recommendations: https://www.ncbi.nlm.nih.gov/pubmed/29140890 I am unaware ot data that HIV2 testing needs to be as late as 12 weeks. In any case, HIV2 is exceedingly rare in the US and western Europe.

2) There are no infections or medical conditions, including HCV infection, known to alter the reliability of HIV testing at the recommended intervals. If for some reason antibody production were impaired or delayed, antigen would persist in blood, probably at higher levels than otherwise. The AgAb test would therefore remain positive.

3) I don't follow your reasoning here, but it sounds pretty outlandish -- a lot of unlikely probabilities combined. If for some reason you have doubt you did the fingerstick test correctly, you can always repeat it.

I agree with your own statement about too much online searching. Like many anxious persons, it seems you are being drawn to information that stokes your anxieties and missing the reassuring information also present. I suggest you give it a rest for a few weeks.

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66 months ago

Thanks for answering Doctor.

Somehow I don't feel like I got answers that I specifically wanted to know,

So I will make them short and simple.

These are my last follow up questions.

1) Is developing antibodies for HIV-2 slower than HIV-1?

2) What is the maximum window period to rule out HIV-2? (When can I exclude HIV-2 100% with what kind of test?)

3) Have you ever seen or heard of persons turned out to be HIV-2 positive after getting the AgAb tests negative at 45 days?

4) Why CDC made the statement that the maximum window period for the AgAb tests are 45 days although there is still rare probability people might get HIV-2? Do you think they disregard HIV-2 because it's too rare?

5) Judging from your answer you believe that the AgAb tests are conclusive by 6 weeks no matter what (including HIV-2 I mean)?

6) How accurate Oraquick advance HIV1/2 at 8 weeks is?

7) Is a drop of HIV positive blood absorbed in a 78.85% ethanol swab for 1-2min not infectious at all?

I will try my best to move on after this counselling Doctor.

Thank you very much.

H. Hunter Handsfield, MD

66 months ago

1) No.

2) 6-8 weeks. even though some resources say 12 weeks.

3) No, but I've never had a patient with HIV2, which is rare outside east central Africa.

4) I assume this is because HIV2 is so rare outside east Africa; and because the large majority of HIV2 infections would be dtectable by 45 days.

5) Yes.

6) The oral fluids test misses 1-2% of HIV infections no matter when testing is done. The blood tests are more reliable.

7) Probably not, but I'm sure no research has ever been done on this.

That concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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