[Question #815] unprotected sex and test results.

51 months ago
Hello doctor h hunter handsfield,

i am male 25 years old and i am very much confused right now. i had very high risk exposure, unprotected vaginal sex with a unknown person(not CSW) who later found to be hiv positive i dont know when and unaware of her viral load. since that day i was in hell and cannot live my normal life. this incident took place 14 weeks ago. 
 
i have each and every symptoms till now in irregular manner.here are the details of my symptoms till now and test results.

Symptoms: day 8: mouth ulcer
day 15: sore throat and little fever(for 4 days and sore throat for 10 days).
day 20: feeling of swollen lymph nodes in my neck and later everywhere.
day 40: on and off back acne and face acne.
day 60:on and off acne or warts near my groan area(near thigh)
on 13th week and till now i have, new mouth ulcer, runny nose, sneezing, lymph nodes etc.

test results(4th generation)
day28: negative
day56:negative
day 83:negative

1) my major concern is that, i am immunosuppressed and taking methotraxate for 15 years(30mg/ week). will it affect my hiv result at all.
2) can i be 110% sure and rule out hiv completely or i need another testing?
3) i have read that in some rare cases the test result are not valid until an year. is it true? because i have read about those 25 cases who are immunosuppressed and they do not show up on test until a year.
4) does anything in this world(methotraxate or any other drug) will change my result or something is missed(either hiv 2 or any other strain) and is not showing on my test.
5) can i continue unprotected sex with my regular partner now?

please advice.


Edward W. Hook M.D.
Edward W. Hook M.D.
51 months ago

Welcome to the Forum.  I'll be pleased to provide some guidance. the short version of my reply however is that you can be completely comfortable that you did not acquire HIV from the exposure that you describe 12 weeks ago. there is no reason for continuing concern or for additional testing related to this exposure..

I few comments before I answer your questions.  Your exposure was certainly higher than average risk in that you know that your partner was infected with HIV.  Your risk for infection was, on average, about 1 in 1000 or 1/10th of 1% following the single exposure you describe if she was not on therapy.  Now with your test results you can be confident that you were not infected.  Remember that the 4th generation tests detect both antibodies and the virus (in the form of p24 antigen), so even if your antibody production was delayed or hampered by methotrexate, the virus would have been there and led to a positive test within the recommended time frame.  That you have multiple negative tests well beyond when virus would have appeared, is proof that you were not infected.  If the symptoms you describe were due to HIV, your test would have been positive. 

For your specific questions:

1) my major concern is that, i am immunosuppressed and taking methotraxate for 15 years(30mg/ week). will it affect my hiv result at all.
See above.  the immunosuppressive effect of the dose of methotrexate you have taken is small.  Further, as mentioned above, if you were immunosuppressed, this would not result is less virus but, if anything, more than usual, assuring that the tests you had would detect infection if present.
 
2) can i be 110% sure and rule out hiv completely or i need another testing?
No need for more testing.

3) i have read that in some rare cases the test result are not valid until an year. is it true? because i have read about those 25 cases who are immunosuppressed and they do not show up on test until a year.
See above.  I do not know of the report you mention but suspect it reflects the results of older tests.  At this time, you should believe your test result.

4) does anything in this world(methotraxate or any other drug) will change my result or something is missed(either hiv 2 or any other strain) and is not showing on my test.
No, believe your test result

5) can i continue unprotected sex with my regular partner now?
Yes.

I hope these comments are helpful. EWH
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51 months ago
Thank you very much for your reassurance. The people which i am reffering to is in the link below.

Because of this i am getting nervous and cannot believe my result. 

Now my questions are that. 
1) i am having ongoing symptoms now also. That is, 14 weeks past exposure. That is more concerning to me. Ulcers and cold. Can it happen due to imminosuppression that it delays the symptoms?

2) does methotraxate have any effect on developing antibodies ? 

3) are my symptoms worth worrying?

4) i am very much afraid after reading that link? Is it worth worrying?

5)now at last and once again, though i believe my results but you undestand my anxiety. Can i be 100% sure and confident that after multiple test there is no chance of infection?


Edward W. Hook M.D.
Edward W. Hook M.D.
51 months ago

The paper that you refer to is more than five years old and the circumstances reported do not reflect your situation.

1) i am having ongoing symptoms now also. That is, 14 weeks past exposure. That is more concerning to me. Ulcers and cold. Can it happen due to imminosuppression that it delays the symptoms?
This is far too late for symptoms of the ARS and too early for symptoms of advanced HIV. They are due to something other than HIV and are most likely enhanced by your anxiety.

2) does methotraxate have any effect on developing antibodies ? 
In theory methotrexate may modestly temper antibody production but does not halt antibody production entirely.  FURTHER, as I have told you, even if there were a problem with your antibody production, your test for p24 antigen would be positive.

3) are my symptoms worth worrying?
Not for HIV- see above

4) i am very much afraid after reading that link? Is it worth worrying?
No, the cases described are old and do not reflect your situation.

I repeat, your tests are conclusive and should not be believed.  You are not the 1 in 1000 people who would get HIV following the sort of exposure you have described.  EWH
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51 months ago
I think that you mean should be believed and not should not be believed. 

1) is there any condition in which p24 cannot be detected?

2) should i rule out the 6 months test without considering the slimmest chance of being hiv?

3) you are correct that i am very anxious and my question is that this series of symptoms sounds suggestive of hiv in any sense to you?

4) am i hiv negative? Please answer this one.
Edward W. Hook M.D.
Edward W. Hook M.D.
51 months ago

Sorry about the typo.  Yes, I did mean SHOULD BE BELIEVED.  the remainder of your questions are repetitive.  Asking the same questions using slightly different words will not change the answers.  I will answer your repetitive questions below- then, since this is my third response to your questions, as indicated in the Forum guidelines, the thread will be closed and if you must ask more questions, you will need to pay again (I cannot think of why you would repeat these questions again).

1) is there any condition in which p24 cannot be detected?
Either p24 or antibody would be detected in all infected persons who were not treated at all times beyond 4 weeks;

2) should i rule out the 6 months test without considering the slimmest chance of being hiv?
A 6 month test is a waste of time and money.  You have proof that you are not infected.  There is no need for additional testing.

3) you are correct that i am very anxious and my question is that this series of symptoms sounds suggestive of hiv in any sense to you?
As I said, your symptoms are NOT suggestive of HIV.

4) am i hiv negative? Please answer this one.
Yes, believe your test results

This thread will be closed later this evening.  EWH
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51 months ago
Thank you very much doctor. you are doing a great job by helping many anxious and confused people like me.  Thank you for your support and correct advice. you guys are great.