Apologies for the repeat I’ve question. This is with the follow for the receipt of unprotected oral from transgender from spa in UAE.

As it was cleared by you it is low risk activity and 4th generation test is conclusive at 45 days, still I have some worries May be it is from anxiety 

1) today is the 60 th day after the exposure   From 50 th day I am getting some eye twitching issues  I visited eye doctor and she said eye dryness and given some drops and vitamin D

2) I am also having some TMJ ISSUES which is better now 

3) The acne issue on face  is reduced (I don’t know weather it is a RASH it is with puss ) 

Is this symptom any thing related with the exposure I have Mentioned.

Also regarding Hiv Combo test 

1) some pub med literature  stating that there are case which proved that some second window period is there because some time some antigen are not able detect due to some rare strain of HIV ..

2) Also co infection with HCV affected the window period etc

3) Is diabetics or cholesterol Blood pressure medicines affect the window periods of 4th Generation tests

Can you please advise  above points ?

the below is the chronology of events  for your quick reference

1) Unprotected receipt of blow JoB trans person(Thai) uae

2)RNA PCR FOR HCV , Hiv  and Hep b on 11 th day Result is negative

3) 46 day hiv compo the result negative from 2 labs on same day ( index value is 0.08

At present I am at uae here stigma is too high and testing is very difficult.

Eye twitching may be a sign of anxiety and is not associated specifically with HIV- neither are TMJ symptoms.  Further, you have an alternate explanation for your rash and the rash associated with recently acquired HIV most typically occurs on the torso and is not pustular.  

Regarding the HIV testing:

There are no medications, other than medications designed specifically for treatment of HIV which impact the window period for HIV test.  Certainly medications for management of diabetes or elevated cholesterol have no effect.

I urge you to put your concerns aside.  Previously you acknowledged that you were probably overthinking your concerns.  That remains the case.  Please don't worry.  EWH

However, reference to the second Window period mentioned in the CDC  : Quick Reference Guide—Laboratory testing for the diagnosis of HIV infection: updated recommendations  PDF page number 25  which is stated as below 

". Rare cases of a “second window” during early seroconversion during which antigen/antibody combination tests transiently revert to nonreactive have been reported outside the United States with older versions of 4th generation tests than those that are FDA-approved.119-121 One case of a “second window” of 8 days’ duration was observed in a study of 28 patients in Africa and Thailand with acute, non-B subtype HIV infections identified by frequent RNA testing.122 Subsequent testing was conducted with immunoassays and viral load assays at frequent intervals. In this case, an FDA-approved 4th generation assay became reactive for antigen at day 9 after RNA detection, was subsequently nonreactive between days 17-25, and became reactive again at day 29 when antibody levels, detected by a 3rd generation assay, began to rise. Presumably, this phenomenon was due to the short interval when antibodies begin to appear during which antigen bound to antibody inhibits detection of either antigen or antibody by the assays. Experience with the FDA-approved 4th generation immunoassays is too limited to predict whether or how often transient seroreversion might occur in patients with subtype B infections."  This is  listed under the section "Limitations of the Evidence Supporting These Recommendations". Based on the clarifcation  I stopped further searching on the internet in this regard , Now it is feeling better

Any thing to worry? I thought 45 day test is conclusive .

You can be confident in your test results.  You did not acquire HIV of any sort from the exposure you describe and can move forward without concern.

This completes this thread which will be closed shortly.  EWH