[Question #8263] HIV risk

47 months ago

I’d like some clarification on where to go from here. In July I had a risky encounter from msm. I was the receptive partner. I was really intoxicated and from what I remember a condom was used the entire time. Anxiety took over and went in on day 13 for a 4th gen test which was negative. I went into a point of care clinic at 6 weeks and took a finger prick test which I think was oraquick advanced and that was negative. Later just a day from 9 weeks I took an oraquick rapid test which was also negative. The encounter took place in the Midwest where there roughly 63 reported cases of hiv annually. I questioned the person a few times on their hiv and std status and repeatedly said he was negative. So my question is do I need to repeat testing or are my two negative rapid results enough to say I’m not infected with hiv.

H. Hunter Handsfield, MD

47 months ago

Welcome to the forum. Thanks for your question; I'm happy to help.

Assuming the event wasn't condom protected, this was a high risk exposure. I'll get to your specific questions shortly, but one potentially very reassuring approach is to contact your partner, if able, and ask about his HIV status. If recently tested and negative, the risk was zero for all practical purposes; same thing if infected and on effective HIV treatment. If either of these is uncertain, you could ask him to be (re)tested at this time: if negative, you'll know for sure there was no risk. Of course I understand that this may not be practical.

Even without that, you can be nearly 100% certain you weren't infected. The initial test at 2 weeks didn't mean much -- it was way too early. However, your negative rapid tests at 6 and 9 weeks tests are very reassuring. That said, they aren't conclusive: they would detect somewhere around 95% of HIV infections. For a conclusive result, you really should have a lab-based HIV antigen-antibody (AgAb, "duo", "4th generation") blood test. Based on all you have said -- the low rate of new HIV infections in your geographic area plus your negative test results so far -- the chance you have HIV is extremely low, maybe one chance in a million. But why take even that chance? Have the conclusive test you need.

You also should be tested for other common STDs, if not yet done: a rectal swab for gonorrhea and chlamydia, and a syphilis blood test. The chance of any of these is a lot higher than for HIV -- still low, but it is definitely reasonable to be tested.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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