[Question #6954] HIV TESTING
63 months ago
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Hi,
I had unprotected anal intercourse (I was receptive) on Dec 28 and I started PEP (Truvada and Tivicay) on Dec 29 until Jan 1, so total 3 days worth of PEP. I was too scared. I tested using 4th generation (p24 antigen and antibody) on Jan 14, Jan 27, Feb 16, Mar 3 and Mar 30 and all came back negative. I also tested using 3rd generation (Antibody only - INSTi POINT OF CARE) on May 5 and came back negative. Do I need further HIV testing or my results are conclusive? I know CDC concluded that a 4th generation testing is conclusive at 42 days but I have taken PEP for 3 days I want to know if this affects CDC recommendation.
I had Hepatitis C when I was a child and I was cured from it. It went away by it self. RNA shows undetectable HEP C but show antibodies, does this interfere with the HIV testing timing e.g CDC recommendations. Some source from the internet recommend testing at 6 month if you have HEP C.
I hope you can give me conclusive answers and that I no longer need to worry about this and move on with my life. I have been having anxiety and it is starting to deteriorate my body rapidly.
Thank you,
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H. Hunter Handsfield, MD
63 months ago
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Welcome to the forum. Thanks for your question.
I'm happy to confirm exactly what you hope: You definitely "no longer need to worry about this and move on with [your] life." First, although the exposure itself was of course high risk, especially if you didn't ask about and don't know your partner's HIV status, the average risk for receptive anal sex with an infected partner is around 1 in a hundred. So the odds were in your favor from the start. Again assuming you don't know your partner's HIV status, PEP certainly made sense and I don't understand your decision to stop it after only 3 days. But that duration of treatment probably makes no difference in your risk of infection or reliablity of your test results.
Given those circumstances, the main issue becomes the reliability of the HIV test results you report. They are conclusive: it is not possible you have HIV (assuming no more recent exposure, of course).
As for HCV, you really weren't at risk. Anal sex between men indeed carries some chance. However, even then it's probably an issue only with overtly traumatic (bloody) anal sexual practices. And more important, with your anti HCV antibody, you are immune to a new infection.
You don't mention other STDs. If not yet done, I would recommend testing for rectal gonorrhea and chlamydia and having a syphilis blood test. If these are negative, you're definitely home free and can move on without worry.
My final thought is to remind you what you probably have told yourself a hundred times: next time, please have a condom handy and use it; and please get in the habit of discussing HIV status with partners before sex, and avoid further contact -- or at least anal sex -- with those who are positive (and not on treatment), don't know, or seem evasive about it.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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63 months ago
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Thank you for your reply.
Re PEP: , I was very scared from its side effects and I was very very anxious at that time so I decided to throw the medication in the garbage,,, stupid decision but odds turned out to be in my favor.
Re HCV antibodies: I am not sure if I understood correctly. Are you saying that HCV antibodies have zero affects on HIV 4 generation testing or HIV 3rd generation antibody testing? Do I need further HIV testing given I had 3 day PEP.
NOTE: The exposure took place in Ontario Canada and the it happened with a shemale trans. I don't know their HIV status.
Re other std s: I did test for other stds like gonorrhea (rectal swab , urine , urethra swab), chlamydia (rectal swab, urine and urethra swab), syphilis and trichomoniasis and all came back negative. I also had urinalysis done and came negative. However, I have been having on and off pain in the urethra (the part under the penis head and when applying pressure there its painful) and painful ejaculation (also the part under the penis head) since mid Feb and so far family doctor doesnt know reason. I was put on azithromycin 1gram single dose and then ciprofloxacin 7 days and then doxycycline 7 days but none worked. I had transrectal US and prostate size was within normal range. Is this an STD? If not what do you think it is? Note : I only had receptive anal and giving oral that's it and that was the only exposure since December.
Thanks
63 months ago
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Forgot to mention, I also applied hydrocortisone cream, fucidin and clotrimaderm cream on the penis head and part of urethra but still pain persists. Also because of this hiv situation and anxiety, I got a 6mm inguinal hernia but my surgeon is not convinced even though it shows on the ultrasound. Could the hernia be causing the penile pain?
Thank you
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H. Hunter Handsfield, MD
63 months ago
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HCV antibody has no effect on susceptibility to HIV if exposed, and no effects on HIV test performance. There are NO medications or medical conditions known to have either of these effects, despite all kinds of BS you can easily find online. Such things might affect symptoms and progression of HIV-related immune deficiency, but not susceptibility or test results.
With negative STD tests and no effect of all those antibiotics on your penile pain, you can be 100% certain it isn't due to an STD. The medications you appolied to your penis also make no difference. Referred pain from the hernia might be possible. As for your hernia, none of what you describe in regard to the sexual exposure, treatments, testing, or your emotional reaction to it all could possibly be the cause. My guess is your symptoms are primarily anxiety related, and diagnostic tests revealed a hernia by coincidence. It had to have been present previously. I'm confident your surgeon would agree.
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63 months ago
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Thank you again for your replies.
I hope my penile symptoms are anxiety related and to nothing else. My head keeps telling me it was from the exposure but tests reveal nothing.
I have been experiencing some night sweats, burning sensation in the back and feet and sometime weight loss , would you agree this is related to anxiety and not HIV? I am currently on Lexapro, could this be the side effects from this medication? Also , I have anal fissure for about month now and it's not healing well. I hope it's not anal ulcer caused by HIV.
Again test reveals no HIV but my head is telling me to keep retesting. If I havent taken the 3 day PEP, I would be a 100% sure I don't have HIV but , reading online PEP delays the window period and so thats why my head tells me to retest.
Thanks
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H. Hunter Handsfield, MD
63 months ago
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PEP for 3 days is not likely to alter the reliability of HIV testing or alter the window period. If there were any slight delay, it would be for a few days only; testing when you did is absolute proof you don't have HIV. No medications of any kind have any effect on the kinds of HIV test you had.
Do your best to accept and believe the reasoned, science based advice you have had here, and likely from your doctors as well. Keep a sober, analytic perspective. Stop testing for anything and stop trying to treat conditions that don't exist. Since you're on anti-depressant medication, you apparently have at least one doctor who understands anxiety, depression, stress, etc and their effect on symptoms. Follow his or her advice.
That concludes this thread. I hope the discussion has been helpful. Best wishes.
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