Aa
9 months pregnant and terrified
Earlier this year I had a 4 month sexual relationship with a man who used to be an IV drug user. Mostly unprotected vaginal intercourse, and very brief one time anal. I know for a fact that he did get tested for HIV before our relationship, but can only go by his word that he is negative (I never saw the printed results). What would you consider my risk to be?
To get the point, the relationship did not work out and I am now in my 9th month of pregnancy. I have done hours and hours of research on the HIV testing window period, to the point where it is controlling most of my waking hours. (Once I get a definitive answer I plan on seeking counseling for possible OCD.) I am terrified I contracted HIV, and even more terrified it could be passed to my baby. All the conflicting ideas on window periods is literally driving me insane! I have tested negative at 5 weeks & at 3 months after the very last encounter.
The urgency for me is that I am due any day now and plan on breastfeeding my baby, I just want to make sure that I am indeed HIV negative, because I've read HIV can be transmitted from mother to child through breast milk.
On almost all the forums I have read, doctors consider the 3 month test to be both definitive and conclusive to some, yet recommend 6 month follow up testing to others. Like I said, I am going crazy over here. I need to know what to do now. I will not reach the 6 month mark until December.
Also, while doing research about this matter I've become more concerned about the possibility of delayed seroconversion due to co-infection of HIV and Hep C. Is this something I should worry about?
Thank you so much for your time.
To get the point, the relationship did not work out and I am now in my 9th month of pregnancy. I have done hours and hours of research on the HIV testing window period, to the point where it is controlling most of my waking hours. (Once I get a definitive answer I plan on seeking counseling for possible OCD.) I am terrified I contracted HIV, and even more terrified it could be passed to my baby. All the conflicting ideas on window periods is literally driving me insane! I have tested negative at 5 weeks & at 3 months after the very last encounter.
The urgency for me is that I am due any day now and plan on breastfeeding my baby, I just want to make sure that I am indeed HIV negative, because I've read HIV can be transmitted from mother to child through breast milk.
On almost all the forums I have read, doctors consider the 3 month test to be both definitive and conclusive to some, yet recommend 6 month follow up testing to others. Like I said, I am going crazy over here. I need to know what to do now. I will not reach the 6 month mark until December.
Also, while doing research about this matter I've become more concerned about the possibility of delayed seroconversion due to co-infection of HIV and Hep C. Is this something I should worry about?
Thank you so much for your time.
MEDICAL PROFESSIONAL
Welcome to the forum. The news is good: you do not have HIV and your baby is not at risk.
You had accurate replies on the community forum. Despite his past history, most likely your former partner did not have HIV. Even if he did, the chance you would be infected in a 4 month relationship is not high. The average transmission risk is once for every 1,000 episodes of unprotected vaginal intercourse -- so assuming you had sex even as many as 100 times, the odds were strongly in your favor.
And most important, the test results do not lie. Your negative result 5 weeks after the last exposure was very reassuring (or should have been) and the 3 months result is 100% certain. There is no evidence that any other medical condition alters the reliability of HIV test results, with the possible exception of terminal illnesses and conditions with profound immune deficiency. Viral hepatitis certainly does not do it.
Although a lot of misinformation can be found by searching the web, you can minimize it by limiting yourself to professionally run websites, e.g. by state or local governements, academic institutions, and several nonprofit agencies without a political perspective. Misinformation -- either intentional or simply naive -- is most common on sites with social, religious, or political slants. In any case, you can and should stop your searching. Your current results are definitive.
I hope this helps. Best wishes-- HHH, MD
You had accurate replies on the community forum. Despite his past history, most likely your former partner did not have HIV. Even if he did, the chance you would be infected in a 4 month relationship is not high. The average transmission risk is once for every 1,000 episodes of unprotected vaginal intercourse -- so assuming you had sex even as many as 100 times, the odds were strongly in your favor.
And most important, the test results do not lie. Your negative result 5 weeks after the last exposure was very reassuring (or should have been) and the 3 months result is 100% certain. There is no evidence that any other medical condition alters the reliability of HIV test results, with the possible exception of terminal illnesses and conditions with profound immune deficiency. Viral hepatitis certainly does not do it.
Although a lot of misinformation can be found by searching the web, you can minimize it by limiting yourself to professionally run websites, e.g. by state or local governements, academic institutions, and several nonprofit agencies without a political perspective. Misinformation -- either intentional or simply naive -- is most common on sites with social, religious, or political slants. In any case, you can and should stop your searching. Your current results are definitive.
I hope this helps. Best wishes-- HHH, MD
MEDICAL PROFESSIONAL
Everybody with HIV of more than 4 weeks duration has either a positive antibody test, PCR test, or both. It is impossible to have established HIV with both those tests being negative.
You don't have HIV. It does not matter what scenario you may read about or your mind may construct; that conclusion will not change. If you find yourself still worried, it is evidence or irrational obsession and suggests a potential need for professional counseling. I suggest it from compassion, not criticism. But this forum is not a substitute for that, so this thread is definitely over.
You don't have HIV. It does not matter what scenario you may read about or your mind may construct; that conclusion will not change. If you find yourself still worried, it is evidence or irrational obsession and suggests a potential need for professional counseling. I suggest it from compassion, not criticism. But this forum is not a substitute for that, so this thread is definitely over.
If you don't mind I have one more follow up question (last one, I PROMISE).
While waiting for the results of the PCR RNA test, I made the big mistake of researching test accuracy. This obviously took me to a pool of conflicting information.
I read that the PCR RNA test is very accurate in detecting ACUTE HIV infections, but is not accurate after 4 weeks, because viral loads will spike and then drop down and can become undetectable.
Is this true? Can viral loads become undetectable? Or will the PCR RNA test be accurate anytime after the 2 week "window period".
Thank you again Dr for you patience and reassurance. I am trying my best to put this all behind me, I don't know why it is so hard to just forget about.
While waiting for the results of the PCR RNA test, I made the big mistake of researching test accuracy. This obviously took me to a pool of conflicting information.
I read that the PCR RNA test is very accurate in detecting ACUTE HIV infections, but is not accurate after 4 weeks, because viral loads will spike and then drop down and can become undetectable.
Is this true? Can viral loads become undetectable? Or will the PCR RNA test be accurate anytime after the 2 week "window period".
Thank you again Dr for you patience and reassurance. I am trying my best to put this all behind me, I don't know why it is so hard to just forget about.
MEDICAL PROFESSIONAL
Yes, it does. Try to put all this out of mind. Best wishes for successful delivery and a healthy baby.
I got the results to the HIV RNA by PCR test today...... NEGATIVE!
Does this mean I am 100% completely, no way no how, infected with HIV?
Does this mean I am 100% completely, no way no how, infected with HIV?
MEDICAL PROFESSIONAL
No medical conditions have any significant effect on HIV test reliability, with the theoretical exception of illnesses with advanced immune system impairment, like terminal cancer -- and even these have few if any known cases. I'm unaware that pregnancy increases the frequency of false positive antibody tests, but for sure it has no such effect on PCR test results.
Feel free to report the test result -- but you can be very certain you have correctly predicted my response!
Feel free to report the test result -- but you can be very certain you have correctly predicted my response!
Thank you for your reassurance. I got the PCR test done today, it cost $300. A little costly, but I agree, the months of worry have definitely taken it's toll on my emotional state.
I've seen that pregnancy can cause false positives in antibody tests. Is this true for the RNA tests also?
I should be getting the test results early next week. I will check back and let you know the results, and hopefully you can give me a big "I TOLD YA SO!"
I've seen that pregnancy can cause false positives in antibody tests. Is this true for the RNA tests also?
I should be getting the test results early next week. I will check back and let you know the results, and hopefully you can give me a big "I TOLD YA SO!"
MEDICAL PROFESSIONAL
That reply should be viewed as highly reassuring; he agrees it is exceedingly unlikely you have HIV or that your baby is at risk. The alternate advice appears to be based primarily on test performance alone plus your emotional state. Mine also takes into account the low chance you were infected to begin with; given the nature of the exposure plus the test results, I would put the chance you have HIV at well under one in a million. Therefore, I stand by my reply above -- and my advice would be the same at a personal level, e.g. if you were my daughter or someone else close to me.
However, I do agree your emotional state is reasonable to consider in a final decision; and PCR testing for HIV is less expensive than it once was. You certainly could discuss these competing perspectives with your doctor.
Alternatively, if you are on speaking terms with your ex partner, why not tell him your concerns and ask him to be tested for HIV? If he tests negative, you would know for sure you were not exposed; that result would be just as reassuring as you having a negative PCR test.
However, I do agree your emotional state is reasonable to consider in a final decision; and PCR testing for HIV is less expensive than it once was. You certainly could discuss these competing perspectives with your doctor.
Alternatively, if you are on speaking terms with your ex partner, why not tell him your concerns and ask him to be tested for HIV? If he tests negative, you would know for sure you were not exposed; that result would be just as reassuring as you having a negative PCR test.
Before I asked this question here, I asked the same question to Dr. David Malebranche on webmd. I just got a response for him stating -
Hello,
I'm sorry to hear you are going though this, it sounds very stressful. First of all, Dan is correct and I think you can ease your mind if your HIV test was negative at 3 months. It is EXTREMELY RARE that someone would seroconvert to positive after being negative at 3 months post exposure.
That said, however, you are about to have a baby so I would recommend you do this:
- go back to your OB/GYN and ask them to do what's called an HIV RNA PCR test, or a viral load - if the main issue is that you and your doctors are scared that the regular HIV antibody test won't be accurate until 6 months, the best way to put the question to bed is get a viral load, which will absolutely show virus if you were, in fact, exposed. Then you don't have to think about timing of how long it takes to make antibodies, etc - you'll have a direct test that looks for copies of the virus.
And you don't have to apologize about the questions - you wouldn't be human if you weren't worried about your health, and more importantly, the health of your soon to be newborn. But demand your doctors order the viral load test instead of just saying that the antibody test is not conclusive yet and letting you struggle with your anxiety. If they still put up blocks, ask to speak to the medical director of the clinic, and go higher and explain the situation til you are satisfied they are running the appropriate tests to rule out any infection that the HIV antibody test may miss if this is a "window period."
Like we've said, I don't think you have HIV, but your situation is unique, and the viral load results will give you MUCH more certainty that you aren't putting your baby in harm's way. And if the viral load comes back positive (which I don't think it will), you can take meds and give meds to your baby to prevent transmission during childbirth IF it comes to that. But I don't think it will.
Please keep us updated on what happens and good luck to you. Hope this helps.
David
And I was finally breathing easy, any thoughts on that advise?
Hello,
I'm sorry to hear you are going though this, it sounds very stressful. First of all, Dan is correct and I think you can ease your mind if your HIV test was negative at 3 months. It is EXTREMELY RARE that someone would seroconvert to positive after being negative at 3 months post exposure.
That said, however, you are about to have a baby so I would recommend you do this:
- go back to your OB/GYN and ask them to do what's called an HIV RNA PCR test, or a viral load - if the main issue is that you and your doctors are scared that the regular HIV antibody test won't be accurate until 6 months, the best way to put the question to bed is get a viral load, which will absolutely show virus if you were, in fact, exposed. Then you don't have to think about timing of how long it takes to make antibodies, etc - you'll have a direct test that looks for copies of the virus.
And you don't have to apologize about the questions - you wouldn't be human if you weren't worried about your health, and more importantly, the health of your soon to be newborn. But demand your doctors order the viral load test instead of just saying that the antibody test is not conclusive yet and letting you struggle with your anxiety. If they still put up blocks, ask to speak to the medical director of the clinic, and go higher and explain the situation til you are satisfied they are running the appropriate tests to rule out any infection that the HIV antibody test may miss if this is a "window period."
Like we've said, I don't think you have HIV, but your situation is unique, and the viral load results will give you MUCH more certainty that you aren't putting your baby in harm's way. And if the viral load comes back positive (which I don't think it will), you can take meds and give meds to your baby to prevent transmission during childbirth IF it comes to that. But I don't think it will.
Please keep us updated on what happens and good luck to you. Hope this helps.
David
And I was finally breathing easy, any thoughts on that advise?
MEDICAL PROFESSIONAL
You're welcome. Glad to have helped.
You might consider discussing this (diplomatically) with your nurse midwife and/or doctor; most health professional appreciate being brought up to speed, even when it comes from their patients. You could print out this comment, if not the entire thread. They should understand that the standard HIV antibody tests now in routine use pick up 90% or more of new HIV infections by 4 weeks, nearly all by 6-8 weeks, and definitely all by 3 months. It's never necessary to wait 6 months, and for the most part useful (and reassuring) results are available within a month of the last exposure.
You might consider discussing this (diplomatically) with your nurse midwife and/or doctor; most health professional appreciate being brought up to speed, even when it comes from their patients. You could print out this comment, if not the entire thread. They should understand that the standard HIV antibody tests now in routine use pick up 90% or more of new HIV infections by 4 weeks, nearly all by 6-8 weeks, and definitely all by 3 months. It's never necessary to wait 6 months, and for the most part useful (and reassuring) results are available within a month of the last exposure.
Thank you so much for your detailed and quick response. I can't begin to explain how greatful I am to be able to speak to someone as well trained and experienced as yourself. I say this because I first went to my midwife and MD with my concern, and both refused testing until 6 months because "tests weren't accurate until then". I actually had to go to a same day clinic and pay out of pocket for my 3 month test. Let's just say I've had my fair share of dealing with medical professionals who don't know what they are talking about. So thank you again for your response and your dedication to getting the truth about HIV testing out there. You are saving me and countless other worried people from unwarranted anxiety and testing.
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