[Question #9564] The Days Move Slow With Worry

31 months ago

Late Oct 2022 I met a gal. She recently left her husband because he had a girlfriend. She had been loyal to him for 25 yrs. Her last exposure to him was on Oct 4th. Before we became physical I asked her to get an hiv test. She got a test through stdcheck.com. I believe this test was a hiv 1&2 fourth gen ab /ant test. Result was negative. As were all the other Std tests. This was Nov 7th, (34 days post husband). She then took alere rapid test duo at 65 days post exposure to husband. It was negative. She also said in Nov her husband was tested for all stds and hiv. The results were negative. He showed them to her. Not sure if he takes biotin he body builds.

In total (in Dec) w/ this gal and I had vag sex 4 times. I used a condom every time. She gave me two unprotected bjs.

Concern: I just found out she takes a very high dose of biotin for her hair problems. A dose higher than was listed by one of you two doctors as not affecting the test. This past Friday she came down feeling sick (94 days post husband) & still is a bit. Her symptoms, tired, nasal, headaches, bad cough, bad congestion, chest pain, lost voice. Throat don’t really hurt but its irritated from coughing. No rash. Doc didn’t do flu test because at the time she didn’t have fever. Neg for covid. Diagnosed w/ bronchitis. Never seemed to have a fever but has taken ibuprofen for headaches at times. No real body aches. Slightly swollen glands in neck.

1. My last test rapid HIV 4th gen test was 62 days from receiving a unprotected bj from my previous partner. Did it cover HIV 1&2?

2. Because of all the biotin she takes daily could it have delayed Ars to 94 days post last risk with husband?

3. I believe I read tests after 6 to 8 wks aren’t affected by biotin is that true?

4. Does she need more testing. We aren’t on great terms.

5. Do I need HIV testing? (I do have hpv) and may have had wart our last encounter. Does hpv increase risk?

6. Do I need hcv test if so when?

31 months ago

One last question

6. Does her illness sound like ARS? (I believe I read coughing and congestion arent part of it, not sure)

Thanks,

Kev

Edward W. Hook M.D.

31 months ago

Welcome to our Forum. Thanks for your questions. FYI, happened to be on the Forum when your questions appeared so you are getting a response more quickly than is typical. If there are follow-up questions, responses will likely take longer. I'll be glad to comment.

By and large, I congratulate you on your approach to sexual health. Your discussions with your partner as well as the testing you both did will do much to keep you healthy. Your risk for STIs and HIV from the events you describe is quite small. I'll elaborate as I respond to your specific questions:

1. My last test rapid HIV 4th gen test was 62 days from receiving a unprotected bj from my previous partner. Did it cover HIV 1&2?

4th generation tests for HIV are totally conclusive at any time more than 6 weeks (42 days) following an exposure. Thus your last exposure to your prior partner was covered. In addition, I would add that there is no known risk for acquisition of HIV from receipt of unprotected oral sex in the unlikely event that your partner had HIV.

2. Because of all the biotin she takes daily could it have delayed Ars to 94 days post last risk with husband?

The concerns about biotin impacting HIV test results are largely theoretical and while the biotin might effect antibody detection in a 4th generation test, it would not be expected to impact detection of the p24 antigen. I would accept and believe your test results.

3. I believe I read tests after 6 to 8 wks aren’t affected by biotin is that true?

See my comments above. The biotin concerns relate to detection of HIV antibody.

4. Does she need more testing. We aren’t on great terms.

I see no need for further testing

5. Do I need HIV testing? (I do have hpv) and may have had wart our last encounter. Does hpv increase risk?

No. There is no realistic reason to worry that your possible HPV infection would modify your risk for HIV

6. Do I need hcv test if so when?

No. HPV is only very, very rarely transmitted through receptive rectal intercourse. Nothing you describe suggests any need for hepatitis C testing

I hope these responses are helpful. EWH

---

31 months ago

Doctor thank you for your quick response. My first follow-up questions are:

1. Does her illness (which I described earlier) sound like ARS? (I believe I read on the forum coughing and congestion are not really part of it)

2. Could her ARS be delayed to starting at 94 days because of biotin?

3. Would biotin still affect the antibody portion of the test? (Her second test was 65 days post exposure)

4. When are hiv-2 tests conclusive (since they are found via antibodies)?

5. When are rapid hcv tests conclusive?

Thanks for your time and expertise.

Kev

31 months ago

Lastly Doctor

6. I read in one of your posts where you said biotin might affect antigen testing as well. This was in question 7932. Has your opinion changed?

7. Can I resume unprotected sex with my wife? Dating is to scary.

Thanks,

Kev

Edward W. Hook M.D.

31 months ago

Straight to your follow-up questions:

1. No, this does not sound like the ARS. Cough and respiratory tract congestion or not typically part of the ARS. Furthermore the sore throat and high fever are typically part of the IRS and it does not sound like these were present.

2. No. While biotin is hypothesized to interfere with the test results, there is nothing to suggest it will delay the onset of the ARS

3. This concern is hypothetical. Given the time interval and results I urge you to believe them.

4. As I have already indicated, HIV-2 antibody tests are conclusive at six weeks. In addition, I would add that HIV-2 is extraordinarily rare in North America, with less than 50 cases being diagnosed each year, all of which occur in persons who have been to or are from India or west Africa.

5. You do not di testing for hepatitis C. If you choose to, test results would be conclusive 6 to 8 weeks following an exposure.

6. Yes. Data keep evolving. See my comment above.

7. Yes.

Hope this helps. EWH

---

31 months ago

Dr. Hook,

Thanks for your response. I have a few follow-ups.

As I said my partner takes a high dose of a biotin supplement every day.

She tested negative with and hiv 4th gen test / duo (std check.com) at 34 days (post risk with ex). I believe this was lab based.

She tested again hiv 4th a fourth gen test / duo (alere rapid) at 65 days (post risk with ex). It was negative.

Her ex was tested with the alere rapid duo supposedly some time in November or Early December.

Symptoms:

At 94 days she came down with a very bad cough and congestion, headaches and was tired . She tested negative for covid. She was not given a flu test. She said her body wasnt really sore. She did have a nasal voice and also lost her voice. According to her, the doctor didnt really examine her well. He said she had bronchitis. He gave her antibiotics. Which seemed to recolve her issues. She thinks maybe layngitis as well. Because of headaches she also took Advil. Because of this she doesnt think she ever had a high fever, but she was taking fever reducing meds. She did not have a rash. Lastly she said her throat really didnt hurt but was irritated from coughing and post nasal drip. She was sick for about 10 days.

New information: When tested on day 34 she also had an HIV RNA early detection test (HIV 1). The results were undetectable.

1. I read on another post that an HIV RNA test taken after 4 weeks is conclusive. It didnt require another test (4th gen) at 6 weeks. Hers was at 34 days. Please explain?

2. Does biotin affect HIV RNA tests?

3. Is there anyway the biotin could have delayed ARS to starting at 94 days?

4. Her symptoms have me worried. You said it doesnt sound like ARS. Could you explain why?

5. I asked this question before but didnt really understand your answer- Would biotin still affect the antibody portion of the alere rapid test at 65 days post exposure. Why or why not?

6. It sounds like latter after the potential risk it doesnt have an biotin affect. When is this time?

7. Should HIV-2 be a concern? if the biotin is still affecting antibodies at 65 days. ( i know the antigen is only for hiv-1)

8. Does she need more hiv testing?

9. Would she need more testing if she didnt have the HIV RNA test?

10. As I mentioned we used condoms for vaginal sex (4 times). I also received a bj twice unprotected. I do have hpv (maybe had a wart) do you feel I can just move forward and sleep unprotected with my partner?

11. HPV doesnt increase my risk during vaginal sex?

12. Does it mean anything that the antibiotic seemed to help her? (meaning it was bacterial and not viral)

I am having a hard time accepting that I can move on without worry and sleep with my regular partner unprotected.

Thank you very much for your time. It is a big help!

Kev

31 months ago

Lastly her rough voice ? no voice lasted for over a week. If that matters.

Edward W. Hook M.D.

31 months ago

I'm sorry that you are having troubling putting your concerns aside. Many of these questions are repetitive and the answers are not going to change. Please be aware that these will be the final replies to this set of questions. I presume you will not need to return to our Forum regarding this exposure. If you do, please realize that your question may be deleted without a response. Repetitive, anxiety driven questions offer little benefit to out clients.

1. I read on another post that an HIV RNA test taken after 4 weeks is conclusive. It didnt require another test (4th gen) at 6 weeks. Hers was at 34 days. Please explain?

Manufacturers state that there results are conclusive any time beyond 11 days and we have never seen a person have a subsequent test become positive after a negative HIV PCR at 11 days. Despite that, many experts recommend a final 4th generation test at 4-6 weeks out of an abundance of caution. I would accept and believe her test.

2. Does biotin affect HIV RNA tests?

Repetitive, see earlier response. No effect.

3. Is there anyway the biotin could have delayed ARS to starting at 94 days?

Repetitive- no

4. Her symptoms have me worried. You said it doesnt sound like ARS. Could you explain why?

Repetitive, see earlier response. Further, if her symptoms were due to HIV, her PCR test would have been positive.

5. I asked this question before but didnt really understand your answer- Would biotin still affect the antibody portion of the alere rapid test at 65 days post exposure. Why or why not?

Repetitive. As I said, HYPOTHETICALLY very high doses of biotin could interfere with the chemical reaction used to detect antibodies

6. It sounds like latter after the potential risk it doesnt have an biotin affect. When is this time?

Question is unclear. Biotin is cleared from the body in a few days

7. Should HIV-2 be a concern? if the biotin is still affecting antibodies at 65 days. ( i know the antigen is only for hiv-1)

Repetitive. as I said "HIV-2 is extraordinarily rare in North America, with less than 50 cases being diagnosed each year, all of which occur in persons who have been to or are from India or west Africa." There are fewer than 50 cases of HIV-2 detected in the U.S. each year.

8. Does she need more hiv testing?

No!!!!

9. Would she need more testing if she didnt have the HIV RNA test?

Yes

11. HPV doesnt increase my risk during vaginal sex?

Repetitive

12. Does it mean anything that the antibiotic seemed to help her? (meaning it was bacterial and not viral)

End of thread. Please calm yourself. If you cannot, I suggest you seek counseling, not more testing. I say this out of concern for your mental health, nothing more. EWH

---