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HIV Prevention (Expert Forum)
Symptoms adding up - Is it HIV? (please read my whole history)
Answered by
University of Washington
Seattle - WA
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No questions will be accepted on the treatment of HIV/AIDS or its complications, viral load, and similar topics. If you have questions about a specific STD other than HIV/AIDS, please visit the STD Forum. Questions that do not pertain to the above topics will be removed from the forum.
If you have not done so, please review other threads in our archives for questions similar to yours and Dr. Handsfield's replies. Questions that duplicate other frequent ones, for which abundant replies exist, and that have little educational value for other forum users, will be DELETED WITHOUT RESPONSE. YOUR PAYMENT WILL NOT BE REFUNDED. The most common examples of such questions are those about low risk exposures to HIV, such as oral sex, condom- protected intercourse hand-to-genital exposure, and nonsexual contact with possibly infected blood or body fluids as well as symptoms of early HIV infection.
Symptoms adding up - Is it HIV? (please read my whole history)
by badlottery, Mar 25, 2007 12:00AM
Timeline
---------
- I gave unprotected oral to a man of unknown status, he came mostly on my stomach, but I stupidly followed through and got a fair amount in my mouth.
- I started nPEP (combivir/kaletra) 18 hours later. Tested negative at the doctors.
- 29 days after the event (1 day after nPEP ended) I started to get sick. Sore throat, fever, cough. I started really worrying about HIV at this point.
- 32 Days after the event (4 days after nPEP) I had an Oraquick test that came up negative.
- 38 Days after the event (10 days after nPEP) I got an ICMA ( immunochemiluminescent assay) - Negative, as well as a PCR DNA test - HIV - 1 Not detected. (I figure if I'm seroconverting, i should definitely have huge #'s of viral copies in my blood)
I start on Zithromax for possible bronchitis at this point. I start itching on my face neck and shoulders. I immediately think ARS rash.
Today 43 days later, and a day after my 5 day course of zithromax, my tongue is turning white. I've read that zithromax can cause thrush...
--------------------------------------------------------------------------
I'm going crazy here. I'm worried that the PCR, ELISA, and ICMA were false negatives due to nPEP. i'm worried that i'll be the first person to actually get HIV from a single oral encounter despite even going to the extremes of using nPEP.
Questions
-----
1 - Honestly, what do you think my risk is considering the tests?
2 - At what testing point can I rest easy? (PCR-wise, I know ELISA at 3 months should quell my nerves but how about PCR?).
Thank you very much
---------
- I gave unprotected oral to a man of unknown status, he came mostly on my stomach, but I stupidly followed through and got a fair amount in my mouth.
- I started nPEP (combivir/kaletra) 18 hours later. Tested negative at the doctors.
- 29 days after the event (1 day after nPEP ended) I started to get sick. Sore throat, fever, cough. I started really worrying about HIV at this point.
- 32 Days after the event (4 days after nPEP) I had an Oraquick test that came up negative.
- 38 Days after the event (10 days after nPEP) I got an ICMA ( immunochemiluminescent assay) - Negative, as well as a PCR DNA test - HIV - 1 Not detected. (I figure if I'm seroconverting, i should definitely have huge #'s of viral copies in my blood)
I start on Zithromax for possible bronchitis at this point. I start itching on my face neck and shoulders. I immediately think ARS rash.
Today 43 days later, and a day after my 5 day course of zithromax, my tongue is turning white. I've read that zithromax can cause thrush...
--------------------------------------------------------------------------
I'm going crazy here. I'm worried that the PCR, ELISA, and ICMA were false negatives due to nPEP. i'm worried that i'll be the first person to actually get HIV from a single oral encounter despite even going to the extremes of using nPEP.
Questions
-----
1 - Honestly, what do you think my risk is considering the tests?
2 - At what testing point can I rest easy? (PCR-wise, I know ELISA at 3 months should quell my nerves but how about PCR?).
Thank you very much
Doctor's Answer
by H. Hunter Handsfield, M.D., Mar 25, 2007 12:00AM
, Mar 25, 2007 12:00AM
I'm going to be very brief and go directly to your questions.
1) 'Honestly', I believe you have an extremely low risk of HIV from the exposure you describe, and I agree with the comments below about PEP: many (most?) providers would not have considered your exposure sufficiently high risk to prescribe PEP.
2) The chance you have HIV, having had PEP, clearly is zero or close to it. Your negative test results are reliable and to my knowledge, although few data exist on whether seroconversion might be delayed if PEP is taken and doesn't work. I just don't know, however. The provider who prescribed PEP is the one you should ask.
Put things in perspective: given the relatively low risk of the exposure, the negative tests, and taking PEP, your odds of dying tomorrow from some accident clearly are far higher than the chance you have HIV.
Good luck-- HHH, MD
1) 'Honestly', I believe you have an extremely low risk of HIV from the exposure you describe, and I agree with the comments below about PEP: many (most?) providers would not have considered your exposure sufficiently high risk to prescribe PEP.
2) The chance you have HIV, having had PEP, clearly is zero or close to it. Your negative test results are reliable and to my knowledge, although few data exist on whether seroconversion might be delayed if PEP is taken and doesn't work. I just don't know, however. The provider who prescribed PEP is the one you should ask.
Put things in perspective: given the relatively low risk of the exposure, the negative tests, and taking PEP, your odds of dying tomorrow from some accident clearly are far higher than the chance you have HIV.
Good luck-- HHH, MD
This did not warrant PEP. I think the MD gave it to you "just in case". The chances of acquiring HIV after an isolated exposure of performing oral sex is tremendously low. So low, that most people would not have tested (even fully aware of the person being HIV+).
I know of 2 good friends of mine who had HIV+ boyfriends. Both had performed unprotected oral sex (but..protected anal) on them for years, NEITHER acquired HIV.
Now, thinking realistically, ..if they were performing oral sex on their partners for years, ...and you did thi ONE time on someone who was HIV+, .....the chance you acquired HIV through this exposure is indeed tremendously LOW....so low, it surely did require PEP.
BTW,
Your MD that prescribed the PEP should have made you aware of the side effects of PEP (or so I hope he/she did). Such affects could include liver damage, diarrehea, intestinal bleeding, etc.
I say that NOT to frighten you, but more aware that the precautionary measures provided by your MD could be more detrimental than the actual risk factor involved.
Good Luck.
B.
But it came down to the choice of knowing i could have done something about it, and not. Had I not, and end up infected, I would forever regret that. 28 days of nausea and occasional diarrhea was worth it to me. My question is whether or not it worked.....
"..so low, it surely did NOT require PEP".
I do know what you are saying, "just in case".
I believe PEP is only functional 70-80% of the time.
To be honest, I believe you did NOT acquire HIV through this incident.
Your anecdotal story is comforting, as is the spanish study involving the magnetic couples only performing oral sex. But I can't help but think what if I had a cut or had irritated my tonsils or something that made me susceptible.
Thats why I'm concerned about the testing period
You don't need further testing. Instead, I suggest you talk to a doctor about your anxiety over this event, and consider seeing a therapist.
I won't have further comments. Please take any further discussion over to the HIV Support forum.
HHH, MD
I'll take a 12 week and a 3 month. But I'm not going to worry. I'll go to a doctor and get something for my possible thrush (likely caused by my antibiotic) and stop worrying 24-7.
Thank you all for your support.
Just a quick response to your last comment; if you get another test at 12 weeks, don't bother with the 3 month test, only because 12 weeks is 3 months. I know it is not easy sometimes, but stop panicing, you have taken almost every possible test offered as well as PEP for a single low-to-no risk event.
Ryan