[Question #7676] Drs Hook & HHH - follow up #6713 and #7672 - final questions
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54 months ago
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Dear Drs, thank you so much for your support. in order to understand my own situation I would like to ask some final questions. The underlying risk situation: In India, a Thai masseuse and sex worker aged 40 rubbed her vagina against the top of my penis which came in contact with her vaginal opening twice for 1 second each. My penis top got wet and it felt as if it was surrounded by flesh, maybe her labia or the opening. - if she had a high viral load, how likely is it that this contact was enough to infect me?- if I (freshly infected with HIV) infect another female B through heterosexual intercourse C (probably between 4 and 20 days after my infection), does this mean that a 4th gen Combo test taken after C by myself has to be positive 100%? put differently: if i can infect someone else with my viral load right after infection, doesn't this necessarily have to show via my test? And if not, why so? If yes, wouldn't that mean that if I have a high viral load on day 4 already, a 4th gen test has to show this on day 5 already? On t he other hand, if a few people show positive 4 gen tests only between week 4 and 6, does this mean they were not infectious until then?
- If I infect my partner between 4 and 20 days after my own infection, what are the chances (in %) that my 4th gen test will be positive by 4 weeks, 5 weeks as well as 41 days after my infection?
- If i haven't had any ARS symptoms at all, but my partner had very typical ones shortly after our intercourse, is that even possible that we are infected?
- up to this very day, did you as well as your colleagues ever hear or see someone who had a negative 4th gen test at 4 weeks as well as 5 weeks, but then a positive one at 40 or 41 days or even later? i am sure that I had a negative 4th gen Duo test at 28 days and 35 days. The last negative 4th gen Duo test I had around 6 weeks but can't say for sure now if it was 40 days or 48 days.
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Edward W. Hook M.D.
54 months ago
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Welcome back to the forum although I’m sorry you felt the need. Your question above is restating the questions that you post in your series of questions yesterday. The answers will not change. As I told you yesterday, if you had gotten infected through your exposure to the masseuse and the infected another person, subsequent testing (after the 2nd partner who hypothetically became infected, your own tests would have been positive thereafter. Again, your own subsequent tests would have been positive and they have not been.
In addition, I note that the partner who experienced the flu like symptoms is not known to have acquired HIV and explained to you earlier that over 99% of at risk persons seeking care for flu symptoms turn out to have something other than HIV. I suggest you accept her symptoms as coincidental.
---Neither of us on the forum has seen or had a colleague who has had a patient with a negative test at 4 weeks become positive. Infections are detectable in over 99% of persons who acquire HIV at 4 weeks.
Please don’t worry, and please do not repeat yourself again. The answers will not change. I will leave this thread open and close your questions from yesterday so you can post your results which I am confident will be negative. EWH
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54 months ago
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Thank you very much for your patience and I'm really sorry for my behavior. I would actually count myself to the people who would be fine with test results, but in my case I feel there are too many weird coincidences that really make me mad, particularly when I think about the possibility that I might have very badly affected lives of my closest people through my own carelessness.
I think I would like to just pose one question for absolute clarification before I shut up and post my test results on Tuesday.
From what you said in your last comment it sounds like someone who got infected with hiv but doesn't yet show positive in 4th gen tests, is not able to infect anyone else. Is that correct?
That would mean that for these patients who test negative with duo tests until week 3 for example, do not have a high viral load or not even a normal load, therefore being unable to transmit the disease. Did I infer that correctly?
Thanks again Prof Hook for your help and patience!
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Edward W. Hook M.D.
54 months ago
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When one is looking for widespread, common symptoms which have many causes, overlapping coincidences are very common.
Your inference is correct, it is extraordinarily unusual for a person with a negative 4th generation test in the very earliest stages of infection to be able to transmit HIV. When persons have the high viral loads needed to make transmission likely, the virus is picked up as HIV antigen in the test.
EWH
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54 months ago
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Thank you very much again for your great academic support of my situation. I absolutely acknowledge that there is overwhelming scientific evidence right now that I am not infected.
1. The exposure might have been more or less a short and soft frottage or genital apposition where my glans was in touch with her vaginal lips or the vaginal opening twice and immediately exposed to air again. Which, as far as I have read in other comments of yours, might have deactivated the virus. Correct?
2. Furthermore, I have done three hiv duo tests at around 4, 5, and maximum one or two days short of 6 weeks. I also went to two different private diagnostic centers for these tests in one of India's megacities, so I can't really imagine that both centers switched off the antigen detection during 4th gen tests so that it would have been nothing but antibody tests eventually. This apparently happened to one other customer here in Ask The Experts, where you, mentioned that this might indeed be possible from a technical perspective. Did you ever hear or come across other such cases?
3. I also didn't have any typical flu-like ARS symptoms, which many or most infected patients might have, correct?
But 4. When I checked the homepage of one of these diagnostic centers yesterday it said that the Hiv duo tests do check for antibodies and antigens for HIV-1 but only for antibodies of HIV-2. So that would mean that they don't check for antigens of HIV2, is that correct and possible? So would that theoretically mean that I might have gotten infected by HIV2 which seems to be prevalent in India (and possibly Thailand) , but antibodies were not present and detected by the 4th gen test at around 6 weeks?
5. I would have one last question before I appreciatively acknowledge that my two follow up replies are used and I will only post my results next Tuesday then. Would it be possible for you to review my first question #6713 and tell me at what exact date I posted the question and and when exactly I wrote my last reply to Dr HHH where I mention that I did another test at apparently 48 days? This would help me immensely to recalculate at what day after exposure I really did the last 4th gen duo test. Unfortunately, at my end I can only see that #6713 was posted "11 months ago".
Again, Thank you so much for your help, Prof Hook, I can't tell you how thankful I am for your time and patience with utterly distressed people like me. As I said, if I were the only one potentially affected in my situation , I would quietly wait for the results and not stress that much. I will let you know about the test results on Tuesday and promise hereby that I will not put myself in such a deeply problematic situation ever again.
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Edward W. Hook M.D.
54 months ago
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Final responses. You are once again being repetitive. Although I will keep the thread open so you can post your results, should you post further questions, the thread will be closed immediately without response.
1. Frottage does not put you at risk for acquisition of HIV
2. No
3. The proportion of persons who experience the ARS is not precisely clear however the syndrome does likely occur in more than half of persons who acquire HIV
4. Correct, 4th generation HIV tests test only for HIV-2antibodies. A negative test indicates that antibiotics to HIV-2 were not detected.
5. After 30 days our system can no longer provide precise dates.
EWH
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54 months ago
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I bow my head. You were indeed right, the test is negative and I completely trust it. End of story. However, on a general note, I have to say that I find both your and Dr HHH advice slightly problematic with regard to contexts where Hiv2 is more prevalent like in my case - India. I get it that it's still just a small percentage of all Hiv infections in such regions and that Hiv2 is more difficult to transmit, but I doubt a 4th gen test that doesn't look for Hiv2 antigens is conclusive by 6 weeks. As far as I understand it would take up to minimum 8 weeks until antibodies are conclusively detected, since, as you stated yourself several times, they may take longer than 6 weeks. So for that reason it sounds like 4th gen tests should be under certain circumstances described as conclusive by at least 8 weeks. And that should be communicated to people who find themselves in such a situation. I repeatedly came across threads of people from/in India who did not get a clear response from your side with regard to their questions about Hiv2 4th gen test conclusivity. If I am wrong here I'd appreciate it if you could enlighten me where I am mistaken.
Nevertheless, I am truly truly thankful for your willingness to share your expertise online and I hope you will continue this consultation for many more years!
All the best to both of you, and no offense meant!
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Edward W. Hook M.D.
54 months ago
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I'm glad you are now comfortable that you are not infected.
Regarding HIV-2, I agree with you that there is less known about HIV-2 than for HIV-1 however, I am confident that persons with HIV-2 would have developed detectable antibodies to their infections by 6 weeks following infection and disagree with your assessment that this process might take longer. We may need to disagree on this.
This ends this thread. Take care. EWH