[Question #9576] HIV

31 months ago

Hello Doctor,

My name is Taylor.

So I had two exposures last year. The first was November 27 and the second was December 12. The two exposures were exactly two weeks apart and I only used PEP after the second exposure, began using within hours after the exposure. I completed the 28 days of PEP on January 8 and on January 9 I went to the hospital. The physician there said to take a 4th gen test to test me for my first exposure but for my second exposure I would have to come in after two more weeks. I tested negative to which he said it is conclusive with regard to the first exposure. I asked him if the fact that I had just finished PEP a day before would affect the result of the test. He told me it wouldn’t affect the validity of the test for my first exposure. He explained to me that my first exposure was 6 weeks before the test date (November 27 - January 9) and had I been infected from the first exposure it would show by now. Also I started PEP two weeks after the first exposure so had I been infected the PEP would not be able to suppress the virus since it’s way past 72 hours since exposure. To summarize I had two exposures two weeks apart and only began PEP after the second exposure. I took a test a day after completing PEP marking 6 weeks from first exposure and 4 weeks since second exposure.

It’s not that I do not trust my physician, but I just wanted to get a second opinion. Did the negative result on Jan 9 clear me for my first exposure at least? I understand I still need to get tested for my second exposure but I just wanted to know how valid the test was with regard to the first exposure.

Sorry for bothering you with such a wordy and lengthy email. I hope you understand Doctor and appreciate your time and understanding. Thank you and I look forward to your reply.

Happy new years,

H. Hunter Handsfield, MD

31 months ago

Welcome to the forum. Thanks for your question.

My judgment might be more helpful if you would like to describe your two exposures. Although the test results are not affected by risk level at the time of exposure, they would help judge the situation.

If I correctly understand the timing of your exposures and PEP, I agree with your doctor, but neither his judgment nor mine are based on actual data. That is, no data exist on time to conclusive testing if someone starts PEP 2 weeks after an exposure and whether it might prolong the window period to conclusive testing for HIV. Probably not, but absent conclusive information, it isn't possible to be certain. But your most recent test is 98% conclusive for the second exposure and probably equally valid for the first. But to be 100% certain, have another AgAb test 6 weeks after the second exposure (December 12). That's only a little over a week away, so you don't have long to wait. Stay mellow in the meantime; you definitely can expect another negative result.

I hope this information is helpful. Let me know if anything isn't clear, or if you'd like my evaluation of your risk on the basis of the exposure details.

HHH, MD

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31 months ago

Hello Doctor,

Thanks so much for the reply. The first exposure was with an escort and it was unprotected. There were no other relevant factors such as signs of genital ulcers, STIs, etc. It was simply my wrongdoing and carelessness that it occurred. She did say that she tests regularly as it is required by her company, not that it detracts from the need for better responsibility on my part. The second exposure was a one night stand and turned out the partner lied to me and was a transsexual who had gone gender reassignment surgery. The second partner felt so bad for me from my shock and anxiety after finding out that she agreed to do as many 4th gen tests as I requested. So the morning of the exposure (Dec 12) she did a test and then she did two more tests on December 29 and January 12 (one month since exposure). All her tests were negative. She will do one final test at the end of this month (50 days from exposure) to assure that she was not HIV positive on the night of our exposure. Because she has been so supportive of the situation I am not as worried about her as I am about the first exposure. I’m worried that PEP may have impaired the validity of the January 9 test even though it was started 2 weeks after that first exposure. That being said, you mean to say that testing negative a day after ending PEP will give a 98% chance the next test (6 weeks from second exposure) will also be negative? If that is the case then I guess that’s assuring. Anyhow will that 6 weeks test be conclusive of my second exposure and by extension also my first? That 6 week test will mark 8 weeks from my first exposure and 6 weeks from my second. I read a lot of literature online but couldn’t seem to find anything definitive. Some websites said the 4th gen is conclusive at 28 days some said 45 whilst some said 50.

Also another question I had Doctor was what are the chances of contracting HIV from one exposure with a woman and what are the chances for gender reassigned woman?

Thank you Doctor

H. Hunter Handsfield, MD

31 months ago

Thanks for these clarifications. I've been on the forum answering other questions, so we're in nearly a real-time situation here. Most forum users shouldn't expect such immediate replies!

It is heartening to hear about the sensitive and caring responses you have had from the second partner. She sounds like a nice person! I agree you can be completely positive about that exposure; it is clear she doesn't have HIV and you were not at risk, no matter how risky the event might have seemed at the time. (You don't mention whether the exposure was neo-vaginal -- assuming she has had vaginal reconstruction -- anal or oral, or whether a condom was used. But clearly there was no HIV risk.)

And to be honest, I also see the first exposure as zero risk for all practical purposes. Your description of that partner is typical for escorts, i.e. expensive female sex workers by appointment. Most have similar attitudes toward sexual safety and in general are believed to have very low frequencies of HIV infection. Not only are they often frequently tested and regular condom users, but for the most part their clients are at low risk for HIV and other STIs -- men like you!

In theory, the AgAb (4th gen) HIV tests indeed are conclusive by 28 days, and we used to use that standard in our advice on the forum. However, a few years ago a comprehensive review documented that it rarely can take as long as 45 days, and an accompanying editorial from CDC agreed. At which time we revised our advice on the forum, although we generally round it off to 6 weeks. I imagine that most sources advising 50 days are just providing a safety buffer; I am aware of no data that supports that particular figure.

Anyway, based on your overall description, there is no realistic chance you have HIV. But feel free to have a final AgAb test next week if you'll sleep better with another negative result.

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31 months ago

Hi Doctor,

Thank you for your reassuring counsel. To clarify the second exposure, it was unprotected. We ended after there was some blood to which she lied and said it was her period. However like I said, in the morning she told me and felt so bad about the anxiety and shock she put me in that she has since agreed to do as many tests as I want. Like you said, the doctor at the hospital she has been testing at told her that the 4th gen tests are conclusive at 6 weeks, therefore she said she will do a test at six weeks from our exposure (Dec 12) to assure that on the day of our exposure she was HIV free. As I said before her redeeming attitude makes me not not as worried about her exposure as compared to the first exposure.

So just to recap Doctor, you don’t believe there is any real cause for concern with respect to HIV infection in my case? And a final test six weeks after second exposure (Dec 12) should be conclusive for both exposures? And should I do a PCR test or is the 4th gen equally conclusive at six weeks?

Thank you so much Doctor, I feel like you have lifted a heavy weight off my chest.

H. Hunter Handsfield, MD

31 months ago

I agree 100% with your recap statement. You're already home free in regard to HIV, from both exposures. The next and final test will confirm it. Do not have a PCR test; the AgAb test is sufficient.

That completes the two follow-up exchanges included with each question and so ends this thread. Thanks for the thanks. I'm glad to have helped.

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