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Concerned above HIV CRF A/E and oral sex
Dr., I have some serious concerns that I hope you can help clarify for me, or perhaps put my mind at ease.
I recently had an encounter with a woman while traveling in Thailand. She was NOT a sex worker, just a Thai woman I began talking with because she had lived in the US for a time. We both briefly performed unprotected oral sex and manual stimulation on each other, but did not have intercourse. After this, I felt guilty and asked her about her sexual history, she assured me she not normally promiscuous (nor am I) and had been tested each of the past two years (perhaps as part of work physical, I wasn’t sure). But as I didn't know her well, I had concerns.
Fearing the worst, I had myself tested for Gonorrhea, Chlamydia, and Syphilis, all of which were negative. I also read the most people develop antibodies after 25 days, so on day 26 I had the HIV Rapid Blood test (in the US) which was negative. I was feeling better until I read about CRF A/E, which is supposedly prevalent in Thailand and:
a. May not seroconvert until 115 days
b. Is possibly more easily transmitted by heterosexual/oral sex via something called mucosal transfer.
I told my regular doctor all this, and she told me I have nothing to worry about, and refused to give me a HIV PCR test stating my odds for a false negative were significantly greater than having anything.
I was planning to get another HIV Rapid Blood test in two weeks (will be 12 weeks then), but am concerned over the CRF A/E seroconversion timeframe and other issues because:
1. I do not know if the 115 day stated timeframe is accurate, which would mean this test wouldn't be conclusive. Or, as some have suggested the current tests are more sensitive and a negative test after 4 or 8-12 weeks would be conclusive?
2. Does the CDC window not account for CRF A/E because it is not common outside of Asia?
3. Does this subtype transfer more easily through heterosexual or oral sex?
Please help.
I recently had an encounter with a woman while traveling in Thailand. She was NOT a sex worker, just a Thai woman I began talking with because she had lived in the US for a time. We both briefly performed unprotected oral sex and manual stimulation on each other, but did not have intercourse. After this, I felt guilty and asked her about her sexual history, she assured me she not normally promiscuous (nor am I) and had been tested each of the past two years (perhaps as part of work physical, I wasn’t sure). But as I didn't know her well, I had concerns.
Fearing the worst, I had myself tested for Gonorrhea, Chlamydia, and Syphilis, all of which were negative. I also read the most people develop antibodies after 25 days, so on day 26 I had the HIV Rapid Blood test (in the US) which was negative. I was feeling better until I read about CRF A/E, which is supposedly prevalent in Thailand and:
a. May not seroconvert until 115 days
b. Is possibly more easily transmitted by heterosexual/oral sex via something called mucosal transfer.
I told my regular doctor all this, and she told me I have nothing to worry about, and refused to give me a HIV PCR test stating my odds for a false negative were significantly greater than having anything.
I was planning to get another HIV Rapid Blood test in two weeks (will be 12 weeks then), but am concerned over the CRF A/E seroconversion timeframe and other issues because:
1. I do not know if the 115 day stated timeframe is accurate, which would mean this test wouldn't be conclusive. Or, as some have suggested the current tests are more sensitive and a negative test after 4 or 8-12 weeks would be conclusive?
2. Does the CDC window not account for CRF A/E because it is not common outside of Asia?
3. Does this subtype transfer more easily through heterosexual or oral sex?
Please help.
MEDICAL PROFESSIONAL
You have a wise doctor. I agree 100% with "...she told me I have nothing to worry about, and refused to give me a HIV PCR test stating my odds for a false negative were significantly greater than having anything." You don't need any additional testing.
Let's calculate the odds you have HIV. Let's assume a 1 in 1,000 chance your partner had HIV. (It might be even lower than that, but I'm erring on the conservative side.) Also consider that oral sex, in either direction, has an average transmission rate of 1 in 10,000, if your partner in fact had HIV. (It's actually less than that, I'm being conservative here as well.) From those figures alone, the chance you caught HIV was 0.001 x 0.0001 = 0.0000001. That's one in 10 million!
If you want to take it further, let's add the chance that a test at about 4 weeks would miss a new HIV infection, whether due to inherent test performance or infection with a strain that is less easily detected with current tests, such as the recombinant (CRF) virus problem (A/E). That's around a 10% chance. Your negative test result drops the chance you actually have HIV to about 1 in 100 million.
Now one more figure to put this risk into context: If you live in the US, the National Safety Council data show a 1 in 1,756 chance that you'll be dead of an accident within the next 12 months. That, my friend, is 57,000 times higher than the chance you have HIV.
To your specific questions:
1) I don't know the data on seroconversion time with CRF A/E strains. I doubt definitive data are available. But for the reasons above, it doesn't matter.
2) Maybe; I don't know.
3) I am unaware of data on differential transmission efficiency. But any differences between particular HIV strains generally are minor.
Bottom lines: For practical purposes your risk of HIV from this exposure was zero and you didn't need HIV testing to begin with. You don't need any more testing. Follow your doctor's advice. Finally, stay safe -- and don't forget your seat belt!
Regards-- HHH, MD
Let's calculate the odds you have HIV. Let's assume a 1 in 1,000 chance your partner had HIV. (It might be even lower than that, but I'm erring on the conservative side.) Also consider that oral sex, in either direction, has an average transmission rate of 1 in 10,000, if your partner in fact had HIV. (It's actually less than that, I'm being conservative here as well.) From those figures alone, the chance you caught HIV was 0.001 x 0.0001 = 0.0000001. That's one in 10 million!
If you want to take it further, let's add the chance that a test at about 4 weeks would miss a new HIV infection, whether due to inherent test performance or infection with a strain that is less easily detected with current tests, such as the recombinant (CRF) virus problem (A/E). That's around a 10% chance. Your negative test result drops the chance you actually have HIV to about 1 in 100 million.
Now one more figure to put this risk into context: If you live in the US, the National Safety Council data show a 1 in 1,756 chance that you'll be dead of an accident within the next 12 months. That, my friend, is 57,000 times higher than the chance you have HIV.
To your specific questions:
1) I don't know the data on seroconversion time with CRF A/E strains. I doubt definitive data are available. But for the reasons above, it doesn't matter.
2) Maybe; I don't know.
3) I am unaware of data on differential transmission efficiency. But any differences between particular HIV strains generally are minor.
Bottom lines: For practical purposes your risk of HIV from this exposure was zero and you didn't need HIV testing to begin with. You don't need any more testing. Follow your doctor's advice. Finally, stay safe -- and don't forget your seat belt!
Regards-- HHH, MD
Yes the reference given on En Wikepedia is to UNAIDS report. En Wikepedia has used the information in the report NOT correctly as the report described different window periods for different HIV strains for BED assays. These assays are used to calculate the interval since acquiring HIV. BED assays SHOULD NOT be used for routine HIV screening. I researched all this as I was myself concerned after reading this on En Wikepedia.
I will write to En Wikepedia to correct the information.
You also mentioned Avert web site, they have NOT mentioned about longer window period for CRF:AE, but they suggested that CRF:AE and Subtype C may be easily transmitted. BUT they also mentioned that it was not a conclusive information.
Hence the information about the longer window period for HIV CRF:AE strain has been wrongly presented on En Wikepedia as the report they gave reference to (UNAIDS) is about BED assays and NOT about the routine HIV screening assays.
And yes there are at least two rapid HIV tests I know which do detect CRF:AE. Both are recognised for sale in EU including the UK and one is also recognised for sale in Canada. Both are NOT for self testing.
I think we should not discuss it more here in this forum.
Thanks.
I will write to En Wikepedia to correct the information.
You also mentioned Avert web site, they have NOT mentioned about longer window period for CRF:AE, but they suggested that CRF:AE and Subtype C may be easily transmitted. BUT they also mentioned that it was not a conclusive information.
Hence the information about the longer window period for HIV CRF:AE strain has been wrongly presented on En Wikepedia as the report they gave reference to (UNAIDS) is about BED assays and NOT about the routine HIV screening assays.
And yes there are at least two rapid HIV tests I know which do detect CRF:AE. Both are recognised for sale in EU including the UK and one is also recognised for sale in Canada. Both are NOT for self testing.
I think we should not discuss it more here in this forum.
Thanks.
Thanks to all who took the time to read this and respond - Happy Holidays to all.
First and foremost quit reading about CRF A/E
You have been told by your Dr and Dr. Handsfield that you dont need to be worring over HIV
Life is to fast already so dont waste time looking into hiv and MOVE ON and enjoy life
You have been told by your Dr and Dr. Handsfield that you dont need to be worring over HIV
Life is to fast already so dont waste time looking into hiv and MOVE ON and enjoy life
MEDICAL PROFESSIONAL
There are no data that prove increased or decreased transmission efficiency by one HIV type or another, only soft data based on people's impressions. And what if it's true? Enhanced risk is relative and it would not affect the analysis of your risk. If you assume twice the risk of transmission with such a strain, the likelihood you have rises to 1 in 50 million instead of 100 million. Absolutely meaningless.
Accept the reassurance and stop searching the web for bad news -- which is all you'll find, nothing good.
Accept the reassurance and stop searching the web for bad news -- which is all you'll find, nothing good.
For those of you reading this thread and may have similar concerns about CRF01:AE, what Swat_Valley is referring to is these lines on the 2005 Athens UNAIDS reference report referenced by Wikipedia:
"With regard to the laboratory assay, there are a number of factors to consider, including the time from infection to detectable antibody response occurring, and the time from then until a strong antibody response occurs (called the 'window period'). This window period may differ by subtype (with mid-point estimates ranging from 115 days for subtype E in Thailand to 181 days for subtype C in Zimbabwe).
Swat_Valley (or the Dr.) reading this it would seem that the window period referred to here is NOT the window period to from infection to antibody detection but a different window period after detectable antibodies are present until a strong antibody response. Correct?
"With regard to the laboratory assay, there are a number of factors to consider, including the time from infection to detectable antibody response occurring, and the time from then until a strong antibody response occurs (called the 'window period'). This window period may differ by subtype (with mid-point estimates ranging from 115 days for subtype E in Thailand to 181 days for subtype C in Zimbabwe).
Swat_Valley (or the Dr.) reading this it would seem that the window period referred to here is NOT the window period to from infection to antibody detection but a different window period after detectable antibodies are present until a strong antibody response. Correct?
Swat_valley - thank you for your input. I had read this both on Wikipedia and in several others places such as avert.org. It is very confusing as it makes it hard to know what to believe.
Doctor H, my main concern has been the CRF A/E and what I read about easier transmission and seroconversion - I don't think I would have been as worried under these circumstances had this happened in the US. Thank you for your reassurance, and I will try to heed your advice not to worry.
Doctor H, my main concern has been the CRF A/E and what I read about easier transmission and seroconversion - I don't think I would have been as worried under these circumstances had this happened in the US. Thank you for your reassurance, and I will try to heed your advice not to worry.
MEDICAL PROFESSIONAL
I don't know about the rapid tests and recombinant HIV strains.
I am sure Dr will answer your question, but if you had read this 115 days window period for CRF01:AE on En wikepedia, then please let us know, as I have researched this info and found that this 115 days window period mentioned on En wikepedia for this HIV strain is NOT correct as the reference they have given indicates that the information is NOT about routine HIV screening tests, but for specific HIV tests used to calculate the time since infection (these tests should not be used for HIV screening).
Thanks.
Thanks.
Sorry - one last question. Does the HIV Rapid Blood test detect CRF A/E? Or does that require a different test?
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