[Question #677] 2 yrs unprotected sex w/HIV+ woman (ATTN: Dr HHH/Dr Hook)

55 months ago
Glad 2 have found u well respected experts. I'll cut 2 chase. After 2 yrs unprotected vaginal sex, woman  was diagnosed w/HIV. Tests 2 date post last exposure: six rapids (days 3, 8, 10, 28, 42, 48), six 4th gens (days 10, 28, 35, 42, 55, 62), three HIV RNAs (days 12, 20, 35). "Overtested", but my head's in tailspin despite countless research, reviews of archives of ur previous forum, I need reassurance that I'm HIV free. Is it possible 2 have HIV w/theez tests? 34 yr old male, no anal, never sick, no symptoms. Could RNA test miss? Aptima claims 100% sensitive at 100 cp/ml. Tests thru labcorp and quest. Duos were Abbot Architect. Testing svc twice refused 2 take my $, adamant that 35 days w/RNA was  done deal and 2 drop issue. Dr. at 6 wks said stop coming (although he didn't know person of contact was confirmed positive). Thx, Doc.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
55 months ago
Welcome to Ask the Experts. Thanks for your confidence in our services.

It must have been a shocking surprise to learn your partner had HIV, and I certainly understand your desire to be completely certain you weren't infected. However, as you already recognize, you were seriously overtested. The various HIV blood tests, alone and especially in combination, are among the most accurate diagnostic tests ever developed, for any medical condition. As long as testing is done sufficiently long after the last possible exposure, the results always overrule all other factors, like exposure history and symptoms. (That interval is 2-6 weeks for most tests individually, and never more than 4 weeks for the combinations.) It does not matter how high the risk was at the time; your results PROVE you did not catch HIV.

I will also add that your risk may not have been all that high. Many HIV infected persons have low levels of the virus in their blood and genital secretions, and the lower the level, the lower the transmission risk. Even after sexual relationships many years in duration, many sex partners of infected persons remain uninfected. 

So all is well and I agree with the advice you have had from the testing service and your doctor. You don't have HIV and should not have any more testing. Do your best to separate your emotions about this from the infection risk. They aren't the same. Deal with the former as you need to, perhaps with counseling if you remain fearful and can't shake it. But truly you don't have HIV and can stop worrying about it.

I hope this has helped. Best wishes--  HHH, MD


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55 months ago
Awesome, Dr HHH! Happy 2 have gotten u on this. You're expertise is acknowledged by all. Hope ur well, enjoying life. Couple quik follow ups (excuse any redundance on my part): I know RNAs aren't the norm but me having 3 of them at said intervals, I'd imagine if I was infected, it would've caught it, especially above 100 copies, correct? I'm at 9 wks of tests, mentally spent. Ready 2 marry long term partner (not woman w/HIV). Can I go back 2 sex w/wife 2 be w/out fear of infecting her? No reason 2 worry anymore? I read an '06 thread where u told some1 to test out 2 three months, but obviously that's old news, correct? I respect u and ur career, so pleez understand, tho I can definitely take a no-nonsense reply. Once again, awesome 2 "meet" u!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
55 months ago
Correct re RNA testing. More important, if for some reason you had HIV RNA in your blood at below the detection level, it would only be because antibodies had cleared it from the blood -- i.e. the antibody tests would have to be positive. That's why the combination of antibody plus virus testing (RNA or p24 antigen) is 100% reliable any time more than 4 weeks after infection.

Testing as late as 3 months indeed is old news. Even those who still believe in 3 months understand it applies only when only antibody testing is done. It does not apply to any combination of antibody plus viral (p24, RNA) testing.

If I had been in your situation, I would have resumed unprotected sex with my wife after the negative 4th generation test at 28 days. All other test results really were superfluous. You certainly can resume your normal sexual practices now.

Thanks for the kinds words about our services.

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55 months ago
Thx, Dr HHH! BTW, the kind werdz were towards u. The svc should be happy 2 have u on board. I'll use my last follow up 4 that and 2 queries: I understand from ur famous "window period" thread that there's really no reason 4 CDC 2 reduce guidelines bcuz it'd cost millions in research, isn't justifiable from business standpoint. In ur experience, have u ever seen limitations in p24 portion of test's sensitivity hence missing infection? And it just sounds 2 guud 2 be tru that I'm free, what w/initial shock of learning of person's status. Do u come across often long term partners of HIV+ people who're uninfected? Thx 4 ur patience w/me, telling me I should've resumed relations a long time ago. Ur the best! (Nuthin against Dr. Hook. He's great 2)
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
55 months ago
I don't think business considrations have anything to do with CDC's guidelines for HIV testing and the window period. And there wouldn't be a significant cost to changing the recommendations. It's probably entirely an extra-conservative, take no chances approach common to many if not all government agencies. As I said above, many (maybe even most) long term sex partners of HIV infected people never catch the virus. So of course I have seen many such patients. Your situation is typical.

Thanks again for the thanks. Take care and stay safe.


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55 months ago
Bless yu for all the good yu do. It's been a long month and a half. Appreciate the time you've spent, here, Doc. Close thread as yu see fit, but once again, it's safe to resume relations with wife to be? Who are the cases they're covering for? Sick, terminally ill?  And specifically, have yu seen any limitations in the p24 component of the duo? Appreciate your extension of queries! Take care of yourself, your family, and those long term patients, as I guess yu are done practicing in house. Truly an honour to trade off ideas and gain reassurance from source such as yourself.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
55 months ago
I have not seen "limitations in the p24 component" of the duo test, but if there were such, the antibody would be positive so the test is always 100% reliable.

But both this and your other questions are re-asking things already answered -- all discussed above, re-read all my comments, I see no need to repeat myself.

Best wishes.

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