HIV Ag/Ab DUO test at 25 days

Dear Doctor,

I am a 35 year old white male. I recently had a terrible experience in west Africa (where im working) which is still worrying me considerably. I am a recovering alcoholic and during a brief lapse I went for a night of drinking in Kinshasa and then picked up a streetwalker. We used a condom for vaginal sex but at some point the condom slipped off and i didnt notice until after I ejaculated. After I withdrew I also noticed she was on her period and there was a good deal of blood on my penis. I panicked and washed. I then asked her her HIV status and she said she was 'not sick' and that she had been tested in November, but I have no proof of this.

I have had no symptoms to speak of except for a brief respiratory infection 2 weeks after the event. No discharge from the penis etc. I had the opportunity of taking a HIV 1/2 Ab/Ag DUO test (Abott Architect) at 25 days post exposure during a brief trip outside africa. The result was negative. I was not able to wait until 28 day mark as I had to fly back to africa for work the same day as my test. There are no facilities here which offer a DUO test that I know of. Its now about one month post exposure. I also seeked the help of an addiction specialist for my alcoholism on the same day as the test and I am currently on disulfiram and have stayed sober since the event. This has not been easy considering my anxiety.

a) What is your opinion of the accuracy of the DUO test result at 25 days considering my very high risk exposure?
b) What further testing would you reccommend?
c) Would it be required for me to ask this girl to be tested for HIV?

Im sure you can tell that I am very concerned and deeply regretfull. This would NEVER have happened if I was not drinking. It is bad enough for me to have 'fallen of the wagon' but to have risked my life in such a way has completely consumed my life.

I hope you can help.

Thanks

[Edward W Hook, MD]

Welcome to the Forum.  You are correct, unprotected sex with a commercial sex worker in West Africa is a relatively risky exposure.  That she was menstruating does not particularly increase risk for infection sense among infected persons there is substantial HIV present in genital secretions.  I'll go straight to your questions.

1.  There are no day-by-day figures as to the accuracy of DUO (or any other kind of ) tests however results at 28 days are highly reliable. thus at 28 days I would guess that your results are about 95% accurate.   Your results definitively prove that your respiratory infection was unrelated to HIV- if it had been your test would have been positive.

2.  If you have access to DUO tests get another at 28 days or beyond.  If you don't, you can be completely sure with a standard HIV antibody test at 8 weeks following the exposure you described.

3.  If she were tested at this time and found to be negative, you could be sure that you are not at risk for HIV from the exposure you described.

4.  Both the DUO and other standard HIV antibody test would reliably detect both HIV-1 and HIV-2 infections, thus you can have confidence that testing would not miss another infection.

I hope these comments are helpful. With a negative test at 25 days it is most unlikely that you were infected by the contact you describe.   Good luck with your pursuit of sobriety as well.  EWH

[ScaredinAfrica]

I forgot to ask the following question also:

d) What are the implications for me of HIV 2 prevalance in west africa? The test I took includes HIV 2 but im not sure that the Ag part of the test is designed to detect HIV 2. So im concerned the test may not be as sensitive to HIV 2 as it is to HIV 1.

Thanks again.

[ScaredinAfrica]

Doctor,

Thanks for your detailed answer. Given that there was still a small chance I was infected anxiety drove me to find the girl and ask her to get tested. We went together in the night to the clinic ER where she gave the blood but the lab was closed so the results were not available until the next morning. She picked them up by herself (while I was working) and showed them to me later that night - negative for HIV 1 and 2. Strangely the clinic also gave her the rapid test strip used which I thought should be disposed of. She said they give it for people who are making visa applications. Part of me is suspicious that in west africa negative test results maybe "can be bought" (although I havent heard of this practice) and that I should have gone with her to pick up the results, but maybe thats just an extension of my current anxieties. She even offered to go back to the clinic with me and verify the results are true but then i started thinking they would just lie to me at the clinic if they had been paid. I don’t know why im thinking like this as she has been nothing but cooperative, and was even keen to see my recent test results, maybe im still in shock.

Also, I have been vaccinated for Hep B so im not worried about that but when should I take a VDRL test and are there any other STD's I should be worried about?

Thanks again. You have been very helpful during what has been a real ordeal for me.

[Edward W Hook, MD]

Glad I could help.  It is now time for you to put your concerns behind you. If you do not develop a lesion on your penis in the next 3 weeks, syphilis is not a concern either.  If your anxiety forces you to seek testing, doing so at about 1 month following your contact will provide the reassurance you need.  EWH

[ScaredinAfrica]

OK, thanks (im assuming the testing you refer to is the syphilis testing)

As i will have no further posts let me wish you a happy new year now.

[Edward W Hook, MD]

Correct about the syphilis statement.  Glad we could help. Take care and stay safe.  EWH