[Question #7779] Several negative HIV tests since exposure- can I calm down?

52 months ago

Hi, I'm writing because on 12/28/20 and 1/6/21 I had unprotected sex with a woman. She told me she was clean but it began to amp up my hypochondria and OCD because after the first time I had a slight tear on my foreskin during sex because it was rough. Anyway I’ve had several HIV 4th gen tests ALL negative recently after exposure- One on 2/21 (47 days), another on 03/4 (57 days), and the most recent one I did was on 3/31 which was 12 weeks, 84 days exactly after the last exposure on 1/6. I also had an HIV RNA TMA test with the APTIMA assay at 57 days that came back Not Detected. Am I able to calm down now? I keep stressing about it thinking I haven’t seroconverted yet and that it’s somehow in my body despite all the negative tests.

I also keep thinking I may have to get tested at 6 months but I don’t have cancer or any immune issues, all doctors I’ve seen say I present very healthy (26 year old male), I never took PrEP or PEP etc. I just keep stressing thinking that my results are wrong since I had a little bacterial infection that I know I had and didn’t start treatment for via penicillin until 3/10 or so, and I also had a tetanus shot on 3/12 and thus I keep thinking those two things may have interfered with the result on 3/31 or that something skewed my RNA test. I think deep down I believe that I won’t suddenly test positive but I haven’t been able to banish the idea from my mind. I deeply appreciate any input, thank you!

H. Hunter Handsfield, MD

52 months ago

Welcome to the forum. Thank you for your confidence in our services.

The simple answer to the question (as you posed it in the title you chose) is yes, definitely: it is 100% certain you do not have HIV.

One of the most consistent themes on this forum -- which you can find in the answers to innumerable questions -- is that the current HIV blood tests are, collectively, among the most accurate diagnostic tests ever developed, for any medical condition. When dione sufficiently long after the last possible exposure, the results never are wrong -- and I mean truly never. No matter how high the risk at the time of exposure and no matter what symptoms one may have, negative results prove without doubt the person is not infected. Your first negative AgAb (4th generation) test 6+ weeks after the second exposure was all you needed to be confident you don't have HIV; all others were unnecessary. Even though some seemingly reliable sources still say testing should be continued out to 12 weeks, the science no longer supports a need to wait that long.

In addition, you had a very low risk exposure. I'll bet not 10 people in the US in the past 5 years has tested positive for HIV after a sexual exposure similar to yours, and iit could well be zero. If you had told me your HIV test was positive, my first reaction would be to ask you to 'fess up to a different exposure -- because the one described carried so little risk. A "tear" of the foreskin makes no difference: even among the most sexually active women, under one percent -- usually well under one in a thousand -- has HIV. And when a woman has HIV, the risk to her male partners is around 1 in 2,500 for each epsiode of unprotected vaginal sex. Finally, there are no medical conditions, drugs, vaccines, or anything else that have any effect on the reliability of the tests you had.

Perhaps you'll also like to hear that in the 15 years I and Dr. Hook have been moderating this and a previous forum, with thousands of questions from people worried about getting HIV, none has reported that they were infected. Not one. You certainly won't be the first. If and when that finally happens, certainly it will be from a truly high risk event (e.g. unprotected sex with a known infected partner, a male having unprotected anal sex with another male, and so on).

You describe yourself as OCD, and much of what you write shows you are aware that's likely the main issue here -- over-thinking the various "what if" and "could I be the exception" scenarios. Trust me: there are none.

Having said all that, perhaps it won't surprise you that I would also advise you get in the condom habit!

Anyway, please no more testing. Move on with no further worry about it.

Let me know if anything isn't clear! HHH, MD

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52 months ago

Thank you so much doctor, this is all extremely reassuring. It's absolutely my OCD that keeps making me think what you mention: the "what-if" and "am i the exception" scenarios are to a perfect T exactly what my mind keeps jumping to. As added info I did recently quit smoking tremendous amounts of marijuana recently and thus was having symptoms that made me think I had HIV like night sweats, swollen lymph nodes, stomach pain etc though no fever or fatigue. But I absolutely trust your input on this and if you say no further testing is necessary, I believe it. If anything I kept thinking that the HIV tests were weirdly mutable to other factors, making connections based on things in my body and that they interfered and made false-negative tests. But at this point I'll take your input and move on, and look into medication for my OCD.

As a last question out of curiosity: I received my first shot of the Pfizer Covid-19 vaccine on 4/7 and came up with a hairbrained idea: that my body/immune system would have reacted violently or severely to the vaccine if I DID happen to have HIV. Would that sort of thing be true? I only had a sore shoulder for one day.

Anyway thanks very much doctor!!

H. Hunter Handsfield, MD

52 months ago

Congratulations on starting on COVID- vaccinatoin. There are no known interactions between that vaccine (or any other) and HIV infection or HIV test reliability -- and from a scientific standpoint no reason to suspect it.

I'm glad you understand the underlying psychological issues!

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52 months ago

Thank you Dr. I'm aware this is my last possible reply before the thread is closed, so I'll use it to ask just a couple more questions:

1. My RNA test via aptima was reliable at the 57 day mark, yes? I know that test isn't necessarily used for explicit diagnosis, but I get the sense that it is reliable past a 28 day window period maximum. Nothing would have interfered with that, no? I've read it's a specialized test and that it can be trusted.

2. You or Dr. Hook haven't seen anyone tested neg at the 12 week mark via 4th gen later end up being positive, correct? If anything it's just been difficult to reckon with all the conflicting information saying 12 weeks/3 months or 6 months is necessary (my own primary doc said 6 months unfortunately) vs what you say about the science of 6+ weeks being reliable. Is 6 weeks/45 days the current 4th gen window period because of all the current studies done proving so? Are 99%/100% of truly reactive individuals known to be positive with a viral / antigen / antibody presence within that window period? Why do some sources say 3 or 6 months at this point? Is it because they haven't caught up to the science yet?

3. Is there any real difference between getting tested at 84 days vs 90 days? I can't help but think that there's some difference between those periods t but at this point it seems unlikely.

But again you say with all the questions people have asked about possibly having caught HIV, that none of them have reported actually being positive. So it must stand to reason that I am not some exception, as there have probably been many people in similar situations like mine who have come to this forum for advice, correct? And they've never ended up testing positive? If that's true, it seems to me like that kind of is a science in its own that would be on my side. I'm just a 127lb 26 yr old male with no real underlying conditions or anything, so I really want to believe that medically I am not some anomaly.

Anyway, thank you very much Dr. I came to this forum because I truly value a professional opinion and want to put my anxieties to rest and not have some necessity for another test be part of my future, as it's just creating more anxiety. But if this is the way the science works I will do my best to believe it. Thanks again for answering my questions and I appreciate the help of this forum.

52 months ago

Unfortunately I let my anxiety get the better of me and got another 4th gen test done along with an RNA PCR test. It seems like you’re right Dr and that it should come back negative, if anything it’s just for my own peace of mind. If it’s alright i’ll update with the results soon!

H. Hunter Handsfield, MD

52 months ago

I'm happy to answer these closing questions, but for the most part tjey are repeating the same questions as earlier in different words -- or the answers are obvious from those replies. The detail in your quesions implies, you're still seriously overthinking all this! It's time to let it go and put all this behind you.

1. Yes, 100% reliable. Once positive, the RNA tests never become negative; HIV RNA is detectable in the blood for life in almost eeryone with HIV.

2. I have no answer to your emotional reaction to various advice intervals for conclusive testing. I've told you what the science now supports and the large majority of authoratative resources advise. Most who advise longer than 6 weeks are just behind the times, sticking with old data with tests not much used anymore.

3. This quetion is logical nonsense. If testing is conclusive any time after 6 weeks, how could there be a difference between 11 weeks and 12 weeks?

4. The science indeed is on your side and you correctly interpret my previous reply. I told you our forum experience for only that reason, and already said you're not going to be the first exception.

Information alone never resolves anxiety in people with OCD, so there is no point in continued discussion. If you remain obsessed with fear of having HIV, professional councseling may be in order. I suggest it from compassion, not criticism.

That concludes this thread. Please don't return to inform us of the negative result of the unnecessary final test you have done, or with any other questions about this exposure and your HIV testing. But I do hope this discussion has been helpufl. Best wishes and stay safe.

HHH, MD

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