HIV - Prevention Expert Forum
Additional Thoughts...
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This forum is limited to prevention of HIV and to safe sex in general. All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Additional Thoughts...

Dear Dr. HHH, I posted a question and it was kindly and well-answered by Dr. H, but I also wanted to see if you had additional input, due to my likely overactive anxiety about the overall risks.  (see this link for the question:
http://www.medhelp.org/posts/HIV---Prevention/Probabilities/show/1938647

I read a wonderfully interesting reply of your about the probabilities of infection (you estimated the chance of a Vegas CSW of being positive at 1/1000, estimated the per-act risk of unprotected vag. intercourse and went from there .. http://www.medhelp.org/posts/HIV---Prevention/Accuracy-of-5-Week-HIV-and-STD-Test/show/932651 )
I've read that while it is very hard to estimate the per contact risk transmission of receptive oral sex without ejaculation (including accounting for viral load, oral lesions, etc.), I've seen it's about 1/2,500 and the risk described as 'very low' or 'very, very low'. However, assuming that I had some mouth ulcers at the time, there was copius preseminal fluid, and the fact he was positive, it is not a non-zero possibility...can you give your thoughts if you don't mind? I imagine a 1-day course of PEP wouldn't affect the AB testing window period as well, so my 38-day negative AB test, along with my 18-day negative RNA test should give more reassurance? Thank you so much.
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There is really no point in asking for additional input from either me or Dr. Hook, once the other has responded.  We never significantly disagree with one another and our advice is generally identical -- even if our writing styles are somewhat different.

I will just say that the test results you posted in your other thread are 100% conclusive:  you didn't catch HIV.  I agree that a single day of PEP drugs doesn't change anything.  Since it is certain you were not infected, it is a pointless waste of time (yours and mine) and emotional energy (yours) to worry about what the odds of infection may have been.  The bottom line is that you didn't catch HIV and should do your best to stop obsessing about it.

Regards--  HHH, MD
4 Comments
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Thank so much for your reply and time, I am very grateful for your expert  opinion (and as a winner of the ASTDA Lifetime Achievement Award) , and your replies to others with unreasonable anxiety and fear show great patience and compassion. At the risk of appearing to excessively post 'yes, but' or 'are you sure?' could you please help me understand the reasoning to help me move on? Was it the time between tests? The low risk? I see and hear so much conflicting information on different tests and timelines.

I realize there may be no need to post further negative test results, but a 7 weeks (51 days) rapid AB test (Clearview Stat-Pak) was also negative.

To recap: low risk exposure: 1-time unprotective receptive oral with HIV+ partner (I may have had oral sores)
Negative Tests: Uni-Gold AB, at 15,17, and 38 days; unknown (not sure if lab or not) AB test (not sure what it was) at 18 days. RNA PCR Quant. <48 at 18 days. neg. Clearview at 51 days.

I've seen conflicting info. on the reliability/sensitivity of Clearview (2nd gen) in early conversion (not as sensitive as 3rd EIA/Ag test, and not much better than WB ~5 days earlier so tends to miss early/AHI. What about the various 'official' (depending on who says it) window periods? Is it just covering liability for the very rare people?  I do thank you for your time and do not want to waste it, and would like to move on.
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Avatar_n_tn
I forgot to add possible symptoms: Days 31-36: chills, fatigue, body aches, but no fever, rashes, or sore throat.
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239123_tn?1267651214
Here is a thread with discussion of HIV testing window periods, which in turn contains links to other discussions.  They should answer your remaining questions.

http://www.medhelp.org/posts/show/1704700

You do not have HIV, and test results always overrule symptoms and exposure history. Your negative test results prove something other than HIV is the cause of any and all symptoms you may develop.

Thanks for the kind words, but that will end this thread.  I have no further comments or advice.  Do your best to accept the overwhelming scientific evidence and the repeated, reasoned, science-based reassurance you have had from multiple sources.
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This Forum's Experts
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H. Hunter Handsfield, M.D.Blank
University of Washington
Seattle, WA
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Edward W Hook, MDBlank
University of Alabama at Birmingham
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MedHelp Health Answers
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