Probabilities...

[waiting874]

I suppose I should clarify my question to mean the probability of HIV+ status...39 days ago I had a one-time unprotected receptive and insertive oral sex without ejaculation with a HIV+ male (found out after). I also realized after I had a few canker sores, and he had an unusual amount of preseminal fluid. He told me it was a recent finding but that his viral count was low enough not to be on ART yet. Not sure whether to believe that or not. I then took a rapid AB blood test on days 15 and 17, and then a RNA Quant. test and another lab HIV-1/HIV-2 AB at day 18. All negative (the RNA result was <50 copies but I if I may not have had enough copies during the 'eclipse' period to be picked up in this test). I've read that some authorities view the RNA PCR test to be reliable at about 2-3 weeks (93%), but I've also read 9-11 days, 1-2 weeks, and even 7 days. I realize there just may not be enough data and studies out there to ascertain a RNA test result reliability at 18 days post-exposure (I understand that it is a viral load test not generally used to diagnose infection but in certain cases of high risk exposure it can be used) at the onset of infection and before ARS. Was also given one nPEP pill at day 18 (another issue). Anxiety is a major issue with me. Although I've read so much information online about the likelihood of transmission in this manner is somewhat small (the stats I've read have been alternative between 0.04 - 5%), but t's just all over map likely due to difficulty in isolating these specific behaviors, viral load factors, etc. I'm especially concerned that the risks could have been much much higher if it was during a high viral load period (I've read numbers such 1/30 - 1/300 for MTF transmission risk for example). I did another AB test at day 38, and it was negative. This week I was feeling a lot of fatigue, muscle aches, cold, but no fever, sore throat, white spots in mouth, or rash, and I'm better now. Can you help give some insight?

[waiting874]

Thank you..I"m sorry....I am just literally worrying myself sick during this waiting period and it is difficult to arrange a RNA test, so in the meantime I can't seem to focus on anything else.

[Edward W Hook, MD]

No you can repeat the PCR and antibody test at this time- if you got HIV, the test would be positve at any point beyond 28 days.  Sorry if I was unclear.  

The mouth ulcer does not change things.  

As for your efforts to "pin things down more", this is just guesswork and not helpful.  My advice is to get tested and stop playing these "what if" games.  EWH

[waiting874]

Repeat the PCR and AB test IN 4 more weeks? I'm at day 39 now.
So, much less than < 1/10,000 for that, even if theoretically possible due to a mouth ulcer? I really do not want to win the lottery on this one. If I could try to pin the numbers done a bit it would help me a lot. I know you're trying to be conservative and not give false reassurances. If assume risk at 1/10,000, and assume the RNA test reliability just one of the test) at day 18, or even the AB test at day 38, at say, 70%, the we would have (0.0001 x 0.3 = 0.0003) to get 0.003%, or less then 3/1000 of one percent? Correct? That's 99.997% I'm not positive...

[Edward W Hook, MD]

Welcome to the Forum. I will provide my assessment, then the reasoning behind it.  I suspect that you do not have HIV however, in my opinion, your test results do not prove it yet.  

You already know and have summarized most of the reasons that I have come to the conclusion I did however, let me summarize them in a (hopefully) organized fashion, acknowledging that we already know that your partner has HIV..

1.  The risk of this exposure is very, very low. There are no cases of HIV proven to have occurred as a result of receipt of oral sex (i.e. him on you) and just a few (less than 5 for sure) cases is which HIV MAY have been acquired through giving (i.e. performing) oral sex on an infected partner. In this situation, the mathematical risk for infection is less than 1 in 10,000.

2.  Your 35 day negative antibody test is strong evidence that you were not infected and would have detected over 95% or recent infections.

3.  Your viral load data support that you are not infected but do not prove it for all of the reasons that you mention.  The statements by the people who sell the test are stronger than I think they should be.  If negative at 4 weeks (42 days) and done in combination with an antibody test, this would be near conclusive (the reason that it is only near-conclusive is that you took a single dose of anti-retroviral medication at day 18- dumb- which would have no effect on infection but, in theory [although I doubt it] delay antibody positivity).  

My advice- at 4 weeks, repeat the PCR test and an antibody test, then believe the test results.  I anticipate they will be negative.  EWH