[Question #8548] Rash question

43 months ago

I have a few more follow up questions:

1. My rash appeared about 6-7 weeks after the last encounter. I did my first finger prick test a week or two before the rash appeared. Could a blood test possibly detect antibodies before a rash? Or would they only be detectable after the onset of a rash?

Also, my rash was almost mostly localized to my shoulders, but I remember that I also felt a few pin pricks on my neck, one on my ear, and a couple on my back. I also felt like I had something in my eyes and a white bump also showed up in my throat. My normal keratosis pilaris on my arms seemed more exacerbated. Does this make it more likely to be an ARS rash? When does the ARS rash normally appear?

H. Hunter Handsfield, MD

43 months ago

Welcome back, but I'm sorry you found it necessary.

How carefully did you read and understand my replies in your previous thread? I gave a number of reasons why it is exceedingly unlikely you have HIV, and how your tests so far are nearly conclusive. Combining the low risk of your sexual exposure plus your negative test results so far, the chance you have HIV is zero for all practical purposes. Please re-read my previous replies -- you should find them very reassuring!

The more detailed description of the rash still does not suggest ARS and it clearly is not due to HIV. ARS symptoms, including rash, typically begin 8-10 days after exposure and always within 2 weeks. The "white bump" in the throat and exacerbation of your previous keratosis pilaris also aren't suggestive of ARS. HIV antibody is almost always detectable a month after acquisition of an HIV infection; therefore, as we discussed last time, your negative finger stick test was highly reliable.

We ended your previous thread with my advice that you have a conclusive HIV test, i.e. an antigen-antibody test (duo, combo test) when you reach 6 weeks after the sexual exposure. I will be happy to comment one last time if you get tested and would like to let me know the result. But I won't have any further comments or advice until then -- there's nothing more I can say beyond the expert, science-based assessment and advice I have already given. Do your best to believe and accept it.

Best wishes and try not to worry! HHH, MD

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43 months ago

Thanks for explaining the rash timeline and for addressing my questions. I realize that my test results are nearly conclusive, and that I should stop obsessing, but as you can imagine I have been terrified for three months, on top of trying to come to terms with the fact that someone I considered to be a trusted friend deceived me in the worst possible way. This was not a one night stand or a bout with a sex worker. I had unprotected sex multiple times with a bisexual man who I’m almost sure is hiv positive from August to October. While the majority of our encounters involved mostly oral and touching, which I understand is zero risk, we did have unprotected vag/penile sex at least four or five times for maybe five minutes each. He often avoided penetration and now I know why. I imagine that he would be on treatment but it is also possible that he is not, so that makes it harder not to worry. I agree that many of my symptoms could be caused by other illnesses, but I have never had a weird rash like that that made me feel kinda sick, which is why I wanted to ask about its timing. It does give me solace to know that a rash at 6-7 weeks would fall outside the normal time frame for ARS symptoms, and that there are other conditions that could have caused it. That small amount of solace will help me sleep a little better tonight and until I get a lab test. I value your expertise and will certainly take your advice to get the combo test, but I am still unable to be completely at ease knowing that my most recent test could be among the 2-5% false negative oraquick statistics. It also worries me that I have lost so much weight (126 pounds down to 112 as of today), that my tongue has been white for three months, and that I have serious gastrointestinal problems since my last encounter. I just don’t know what else it could be, but I have faith in your assessment. I too hope that I am not the first to have to report a positive test result in your forum. Thank you again for your time.

H. Hunter Handsfield, MD

43 months ago

No comment -- I have nothing to add -- but I look forward to hearing your negative test result. Forums are closed after 4 weeks, so be sure and return with the result before then. Stay as relaxed as you can in the meantime.---

42 months ago

I did another oraquick yesterday (about 4 months) past the last exposure and it was negative. (I had a negative finger prick test about 1 month afterwards, and two other negative oraquicks at 11 and 12 weeks). I know that you recommended a lab test for reassurance but given the encounters that I described, would it be ok to forgo a lab test as long as I continue to do an oraquick test monthly up to the six month point? I’m sorry to ask another question, but I would rather avoid doing the lab test if it’s not absolutely necessary for a few different reasons. What is the likelihood of turning positive at this point based on my testing history and exposures? Would it be unwise to rely on multiple oraquick tests?

I was wondering also what the available data says about the percentage of people who are on treatment for hiv that have undetectable viral levels? Are most people who take treatment undetectable? If someone has a low but detectable viral load, does that decrease the transmission risk? If a person has hiv, and they are aware of it, are they required to disclose their status if they have unprotected sex with someone? I feel that my partner should have disclosed or at least insisted on protection, and I feel that although we had consensual sex, it was a violation in some way since I was not informed of his status.

H. Hunter Handsfield, MD

42 months ago

There are NO home based tests that detect all HIV infections. If you feel you need a test with 100% assurance, you'll need to have a lab based test.

On the other hand, we have already discussed the exceedingly low chance you have HIV. Let's guess the possibility you have it is 1 in a million. (Even this probably is too high, but let's go with it.) If we consider the tests you have had as being 99% reliable, then the odds you have HIV become 1 in a hundred million. That is zero for all practical purposes. But only you can decide whether you need a test that by itself is 100% conclusive, regardless of the low risk of your exposure plus absence of typical HIV symptoms.

The percentage of people on anti-HIV treatment who have undectable viral loads depends on how closely they are followed and how expert their care. High quality care means viral load is measured; if not zero, the dose or type of ARV treatment are modified as needed meet that goal. In the US and other industrialized countries, probably the large majority of infected and treated persons therefore have undetectable levels. But that's not a guarantee, which is why care in partner selection and safer sex remain important. On the other hand, even a modest reduction in viral load -- but still detectable -- probably markedly reduces transmissibility of the virus.

Some states in the US or other countries may have laws that require disclosure of HIV status, but probably most don't have requirements about treatment or viral load. But such laws are unenforceable anyway, so basically symbolic: their main effect is to make some legislatures, mayors or governors feel better and make political points, with no realistic effect in prevention HIV transmission.

Ethically, should your partner have told you his HIV status? I believe so, yes. On the other hand, a valid case can be made that if on treatment with undetectable viral load, disclosure is not ethically required. Reasonable people could differ on this. Having said that, of course you can ask: experience suggests that even among people who are not inclined to disclose, most will ackowledge their infection status and treatment if asked directly.

That completes this thread. Let's make it your last about this exposure, your symptoms, and concerns along these lines -- OK? I do hope the discussions have been useful. Best wishes and stay safe.

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