Exposure

[Awh2k]

Hello Doctor:

First, I would like to thank you all for your invaluable service to the community.  Providing in depth and current knowledge for those concerned regarding their risks for HIV.  So, I will start with my situation:

I am a homosexual male, I started dating another male in November of 2008.  I was HIV tested 10/25/2008- the result was subsequently negative.  During the course of the six weeks of dating this guy, we discussed HIV status, and he stated he was negative.  We slept together over the course of dating, and two of these times I did not use a condom.  I was topping. The final time was 12/8/2008, following this last time....two weeks pass and my sexual partner calls me to tell me he is HIV+,(I never had his semen in my body in anyway, nor do I remember blood on my penis following these incidents. So, I recieve a test following this news 12/26/2008, which was negative, my 6 week test on 1/19/2009 was subsequently negative as well.  I know you all say with 95% certainty, the 6 week test is accurate and you suggest follow up testing.  I would like to know:
1-How many follow-up tests do you suggest for my situation?  
2-And can my anxiety be relieved knowing my 6 week test was negative? I am a healthy male, no other health problems or drug abuse-all clear physical.  I have not had any febrille illness, just a cough- I do smoke, no lymph node swelling at any location on my body, or any other further symptoms- which I remember both of you saying symptoms are a horrible indication of ARS.

Again, thank you!

[Edward W Hook, MD]

Do you know if your partner was seroconverting at the time you were dating or was infected but did not tell you the truth? The reason I ask the question is that if he was seroconverting at the time you had sex with him your risk is somewhat higher than if he already had infection.  At the earliest stages of infection, the amounts of circulating virus are higher than at any other time a in the course of disease and thus, my concern regarding your risk would be higher in that situation.  On the other hand, if he had been infected for a while or, better yet, was infected and on therapy, your risk of infection would be somewhat lower.

Either way, I would suggest further testing for you. As you point out, at six weeks over 95% of persons who had become infected 6 or more weeks earlier would be detected, thus in is very likely that you did not get infected.  At the same time, because of your known exposure, I would recommend repeat testing at 8 and even 12 weeks to be completely sure.  At 8 weeks over 98% of persons infecte3d would be expected to have positive tests and at 12 weeks everyone would.

Finally, as for your anxiety (which is understandable and appropriate), I would suggest professional help and possibly anxiety-relieving medication (mild sedatives).  Your probability of infection is very, very low but given the circumstances and what may have been a breach of trust between you and your partner, counseling would be directed at helping your anxiety and restoring your trust in others.

Hope this helps.  EWH

[Awh2k]

Thank you very much Dr. Hook.  Your response made a world of difference.  I will be able to sleep somewhat better tonight, than over the past four weeks.