[Question #9111] HIV risk assessment and test

36 months ago

Hello doctors, it is a pleasure to greet you. About 3 months ago I had an encounter with a scort, everything was with condoms from start to finish, oral and vaginal sex. After that I panicked thinking that I could have been infected, I asked the girl if she had HIV and she told me that she doesn't, but it's someone I barely knew and I don't know if it's really true. Given my situation of stress and anxiety, I had muscle pain, specifically in my arms, and from time to time I had petechiae on my arms. I haven't had a fever or lymph nodes, with the exception that I got covid a month after my exposure and I had a body ache and a headache for 3 days (I guess that's because my whole family was sick on those days and one of them took the test that tested positive). So far I have had hiv tests done on days 19, 29, 40, 47, and 70 of fourth generation ag/ab by elisa and chemiluminescence methods with extraction of blood from a vein, all with NEGATIVE results. According to everything I have read, it is conclusive, but I need an assessment. In my case, do you think I should repeat the test after 90 days? Would you recommend a follow-up at 6 months to be completely sure? Since I have read cases of late conversion and that worries me, although I must say that my health is fine, I do not present anything at the moment and I have never had serious problems that cause immunosuppression. but I would like to be completely sure as I have started a new relationship and plan to get married and have children, so it is important to me. Based on my exposure, would you recommend that I go for a medical evaluation with an infectious disease specialist? or can I consider my results conclusive and forget about it completely? Sorry for my English (I am not a speaker of the language) thanks

H. Hunter Handsfield, MD

36 months ago

Welcome to the forum. I'm happy to help.

It is 100% certain you do not have HIV; no more testing is needed. You have come to the correct conclusion based on your own reading; your test results are conclusive. There is no such thing -- there has never been a single proved case worldwide -- in which the HIV AgAb test was negative more than 6 weeks after catching HIV. The only (rare) exceptions are when anti-HIV drugs are taken to prevent infection: if preventive treatment doesn't work, the clock on testing begins after the last dose of drug rather than the time of exposure. These tests are so reliable that they always overrule symptoms, exposure history, or anything else: even if you had the most classical symptoms of a new HIV infection (you do not) or had the highest risk exposure imaginable (which of course you did not), you can rely on the test results. I will add that you had a zero risk exposure for HIV, for all practical purposes.

So as I said, there is no need for you to have another test at 90 days (or any other time) and you certainly do not need any sort of medical evaluation on account, with an ID specialist or anyone else.

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

HHH, MD

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36 months ago

Thank you very much Dr. Handsfield, for me it is very important to have the opinion of an expert like you. the truth is that i have read a lot about hiv and based on my results i am already coming out of that stage of stress and anxiety, the only thing that gave me doubts was about those cases of late seroconversion, i know that they are very specific cases and that nowadays with these ag/ab tests they are rarer, but they make my mind play against me. Thank you very much for your prompt response. I think no more of the matter and will follow your advice. you have a good day!!!.

H. Hunter Handsfield, MD

36 months ago

Thanks for the thanks -- I'm glad to have helped.

The term "seroconversion" preferably is applied only to development of detectable antibody, and is not the proper terminology for the AgAb tests. If for some reason antibody development or detection (seroconversion) were delayed, the antigen component of the test would still be positive. As I said above, to my knowledge there has never been a scientifically validated case of the AgAb tests taking longer than 45 days to become positive -- with the exception of treatment with anti-HIV drugs, as discussed above.

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36 months ago

I understand, and as a last point to conclude, in the case of elite controllers who suppress viral load, will the ag/ab test still be positive in the first 45 days, or should we wait longer? Thanks

H. Hunter Handsfield, MD

36 months ago

Yes. Elite controllers have positive AgAb tests. They may have negative on RNA test results because of low viral load, but even that usually is positive.

As I wrote above, "there has never been a single proved case worldwide -- in which the HIV AgAb test was negative more than 6 weeks after catching HIV". To be more precise, if you like, 45 days -- but for sure no need to test any later than that.

That completes the two follow-up exchanges included with each question and so ends this thread. Best wishes, stay safe, and don't lose any sleep over this: you can trust your multiple test results!

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