[Question #9518] HIV Risk and Testing

31 months ago

Hello Doctors, I recently started dating this girl and had unprotected sex with her on the 23rd of Dec. This was the only time I had unprotected sex. But after the incident, she told me she had unprotected sex with an Egyptian around June before we dated. She fell sick few weeks later. She had taken a nasal COVID PCR and had tested positive. Later took a home test which was negative and the next PCR was positive again. Can HIV cause false positive in the covid PCR? How long after the exposure would the symptoms start? 4 days in and I have fallen sick. I have severe throat pain, fatigue, body aches and headaches etc. No fever or rashes as far as I know. Just a bit worried. I wanna know if I'm at high risk. What is the window period to test? I'm quite worried. I thought she'd be negative and jumped the gun. Her last test was in April and she was negative. My last test was in February and had tested negative. Am I at high risk here?

H. Hunter Handsfield, MD

31 months ago

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

Your partner would seem to be at low risk for STD, and certainly little or no chance she has HIV. Among other things, HIV is very rare in the large majority of sexually active women, and also rare in Egypt.

More to the point of your question, there are no medical conditions, medications, or anything else that have any effect on the reliability or timing of the HIV blood tests. And also no effect in the opposite direction: HIV does not result in false test results for any other infection, including Covid. Your partner clearly had Covid, with no reason to suspect she had HIV. As for your symptoms, they are typical for Covid and you should be tested for it. Your symptoms could go along with acute retroviral syndrome (ARS, i.e. an initial HIV infection), they also fit with almost any infectious disease -- and given your Covid exposure, that's far more likely.

You certainly are free to have an HIV test if the negative result would be reassuring. Even better, both you and your partner can be tested for HIV. If both negative, you will both know there was no risk for either of you. Perhaps you would find she also is worried about HIV, and might appreciate you raising the issue and suggesting you be tested. in the meantime, stay mellow: this is an exceedingly low risk situation in regard to HIV.

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

HHH, MD

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31 months ago

Thank you for responding Dr. Handsfield. Would the ARS symptoms appear 4-5 days after an exposure generally even if a person's immunity is at it's weakest? Also, she had COVID around June. This was few weeks after her encounter with the guy. Since there was no way to suspect Covid, I was correlating my symptoms with HIV. But I'm quite confused as to the timeframe of the ARS Symptoms as this is still the 5th or 6th day from exposure. I did feel feverish last night. Wouldn't me being uncircumcised make the risk a bit higher?

H. Hunter Handsfield, MD

31 months ago

The timing of these events wasn't clear from your original question; I assume the exposure, Covid, and your symptoms all were more recent.

ARS symptoms cannot start sooner than 8-10 days after exposure, regardless of the "strength" of the immune system. (And by the way, the notion that some people have "weak" immune systems is mostly an urban myth.)

Being uncircumcised roughly double the risk of HIV if exposed sexually -- but first you have to be exposed!! And the chance a partner like yours has HIV is near zero. And even a doubled risk doesn't mean much. If someone's risk of HIV is say one in a million, a doubled risk means one chance in 500,000. No big deal!

Do your best to accept and believe the reasoned, science based reassurance I'm trying to give. Isn't that why you're here???

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31 months ago

My apologies doctor. I might have phrased it incorrectly. Her exposure with the Egyptian was around the first week of June. She got sick around the third week of june. My exposure was on the 23rd of Dec and got sick on the 27th of Dec. Still sick which is why I thought it was ARS. Regardless, I have understood what you have said. Thank you for helping me understand doctor. What would be the window period if I were to test? I would be taking the antibody & p24 antigen test.

H. Hunter Handsfield, MD

31 months ago

You have nothing to apologize for. My assertive wording was intended to help you understand the very low risk involved here.

To repeat, there is no possibility of ARS starting only 4 days after catching HIV. As for testing, my strong advice is that the priority is for your partner to be tested. If her test is negative, it will be impossible you were exposed and no need for you to have an HIV test at all. If you do so, however (with or without her being tested), I would advise a lab-based AgAb ("4th generation") blood test about 3 weeks after the exposure, and again at 6 weeks. Three weeks will detect 80-90% of infections, 100% at 6 weeks.

Also you of course should be tested for covid, a more likely cause of your symptoms. But it equally well could be influenza, respiratory syncytial virus (RSV) (the news has been full of reports of both occurring epidemically at the present time), or just a bad cold.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Stay mellow in the meantime: you do not have HIV. (Perhaps it will also help you to know that in the 18 years of this and our previous forum, with thousands of questions from people worried about a possible HIV exposure, not one has yet reported they tested positive for HIV. You will not be the first. If and when it finally happens, undoubtedly it will be from a truly high risk exposure, like unprotected sex with a known infected partner, probably a gay man.)

Take care and stay safe.

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