[Question #7231] Dr HHH or Dr Hook Please. HIV assment.

6 months ago
Risk: 42 year old heterosexual male unprotected insertive sex with female stripper in strip club in Miami FL.

Testing: Full STD panel and 4th gen test at 3 weeks. 8 weeks. 5 months. 6 months and a HIV RNA qualitative test at 7 months. All non reactive / negative

1. I know the test results above should be conclusive in all normal situations. I have been worried though that Miami is considered a high prevalence area for HIV. How does this affect test results?
2. I have read about a new strain of HIV discovered in Cuba that progresses to AIDS within 3 years. CRF19. Since we have such a large Cuban-American community here what are the chances of that strain being here and also would it be picked up by the tests I have taken?
3. If I were indeed rapidly progressing to HIV would antibody production be lowered by the rapid advance of the infection?
4. Is it possible for antibody to not be present at high enough levels in blood to be detected but high enough to clear p24 antigen? If so would the RNA test detect it?
5. My health has suffered a lot in the past 8 months. My girlfriend has as well to a degree. We have been in a monogamous  relationship for the past 15 years except for my recent indiscretion. We have condom protected sex but she sometimes gives me unprotected oral sex. I read its not possible to transmit through oral but now i wonder. Have I ruined her life?

Thank you for your patience. I know this sounds irrational but I am trying to understand what is happening with our health. If we are not infected I want to be able to let this go and move on. If we are infected as I suspect then I want to get diagnosed so we can get treatment and stay healthy and not die.
Edward W. Hook M.D.
Edward W. Hook M.D.
6 months ago

Welcome to our Forum and thanks for your question.  I'll be glad to comment and hope that you'll find my responses reassuring.  I'll go straight to your questions:

1.  Your test results are absolutely conclusive.  Prevalence of infection does not impact the performance of the test although is prevalence may impact the probability that a result is truly vs falsely positive.  In your case, I will also point out that the tests for HIV you had looked for HIV three different ways if any, looking for HIV protein (antigen), HIV antibodies, and HIV DNA.  Your results are incontrovertible and should be believed.

2.  From time to time rumors of new HIV "strains" appear on the internet.  These reports have little if any substance.   Your tests would have picked up ANY HIV infection you had.  I will acknowledge that there are some cases in which HIV can progress more rapidly than most cases but these strains of virus would be detected by the testing you have had.

3.  Rapid progression of disease would not impact antibody production by an infected person.

4.  No.  See my response number 1.

5.  You are not infected with HIV. You do not need more testing.  It is time for you to move forward.  If you cannot do it on your own, then I would suggest you seek the assistance of a trained counselor who can assist you.  FYI and of no relevance to your situation, HIV can very rarely be transmitted to a person performing oral sex on an infected person.  On average, this occurs less than once in every 10,000 acts of oral sex (i.e. more than  99.99% of the time the infection is NOT transmitted)

I hope you find my replies helpful.  The tone of your questions suggests that you are very worried about the possibility that you might have acquired HIV.   You did not.  I wonder if some of your concerns also reflect your guilt over your misstep.  That is a separate issue.  EWH

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5 months ago
Thank you Dr Hook.

I realize I may have developed an HIV phobia at this point. All of your well reasoned science based answers make perfect sense and yet i still find my brain trying to doubt. Its a strange place to be. I know that what you say is scientifically based and yet my brain says "what if" and all of the most unlikely scenarios seem to be more plausible than the science based truth. Which is odd for me because I believe in science. So I will ask another few questions then try and find a way to move past this.

1. What is the best course of action for a person suffering from an irrational fear of HIV to overcome it?

2. The strange symptoms in my body which were not there before this incident: constant dry mouth, white coated tongue, some oral ulcers, GI issues (stomach discomfort and loose stool for several weeks) loss of muscle mass, small scattered pink sores that come and go. Could they be attributed to anxiety and if so how likely is it that the constant worry and stress are able to cause such symptoms?

I know you cant diagnose over the internet but if its not HIV then something is causing it. If it is anxiety I never knew that the physical symptoms could be so powerful. Thank you again for taking the time to reply and have a good holiday weekend!
Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago
Thanks for your follow up and your insights into the issues at hand here. Our experiences on this forum suggest that an important first step in addressing unfounded fears of HIV is to absolutely stay off the Internet. All too much of what is found there is taken out of context, misinterpreted, out of date, or just plain urban myth. The second step which is helpful is to talk this through face-to-face with a trained counselor.  All too often guilt on some level contributes to these sorts of fears and working through ones guilt over encounters that they subsequently have come to regret is a further important step beyond hearing the facts and figures regarding HIV and HIV testing.

I suspect that some of the signs and symptoms that you have detected or a combination of hyper-awareness and detection of signs or symptoms which are normal and, in some cases, have been present for some time.  This is particularly true for discoloration of the tongue and subtle oral ulceration.  Other perceived signs or symptoms which may be due to some other cause.

Perhaps these responses are helpful. I hope so. EWH
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5 months ago
This will be last response and only to say thank you for your expert advise on this matter. Im sure its tiring to hear people constantly doubt the evidence based facts over and over. We do appreciate what you do though. I will do my best to stay off google and move past this. Thank you again Dr Hook.
Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago
Thank you.  I'm pleased that you found my comments helpful.  Take care, stay safe, please don't worry.  EWH
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