Unprotected Transgender HIV 1 and HIV 2

[sfworriedman]

Hi Dr. Handsfield,

I'm a 30 year old male who engaged with a Male to female CSW transgender. After a lot of reading online I've found that 1/3 are expected to have HIV since its considered homosexual activity. 

My encounter was unprotected anal sex as the top. I'm an idiot for doing this  but t's done now and is what it is. I also French kissed the transgender and had receptive oral sex uncovered. The transgender is from New York so I'm concerned I may have caught HIV-2 as its rampant there. She looked filipino or Hawaiian but not completely sure. 

Now for the concerning part. I'm MARRIED and my wife and I were planning on having kids soon. 

Here is a summary if the testing I've had:

8 weeks post exposure - Negative HIV 1 RNA 
8 weeks post exposure - Negative  Rapid test

15 weeks post exposure - Negative ELISA and Negative Clearview HIV-1/ HIV-2 Rapid Test

Here are my particular concerns:

1.  I have elevated estrogens and Fatty Liver Disease. Additionally, I've been diagnosed with Gilberts syndrome.  It's my understanding that HIV-1 has been ruled out with the RNA but that only checks for HIV-1. Would my pre-existing conditions delay seroconversion for HIV-2 with the ELISA and rapid tests beyond 15 weeks?

2.  My main concern is HIV-2 because the RNA doesn't cover that. I've had a lot of testing. I don't want to infect my wife with HIV. I've read crazy stories online where people didn't test positive for years.  This however seems like dated information. 

3.  At what point can I have unprotected sex with my wife without infecting my wife? 

4.  What's the story with Hep C/HIV confection?  Will that delay seroconversion beyond 3 months?

5.  Is my testing conclusive for HIV-2?

Thanks for your help in advance. 

[Edward W Hook, MD]

You need to stay off the internet.  If you were an elite controller your test would still, be negative.  

This threa needs to end now.  EWH

[sfworriedman]

Thanks Dr. Hook,

Final questions and sorry for inundating you.  

I also read about Elite controllers and if i was one my HIV-1 RNA tests would not prove that I am not infected.  Now, I am gravely concerned that i still have HIV.  

Does the Antibody test i took at 15 weeks still rule out HIV?

[Edward W Hook, MD]

Stop worrying about the generation of test, etc.  As I told you, your tests prove that you did not get HIV from the exposure you described.  there is no need for abstinence related to the exposure that you have described.   EWH

[sfworriedman]

Sorry, last question is:

1- I don't know if the ELISA was a 3rd generation because my Doctor ordered it.   It was done i California at a major hospital...Any concern here as to the version of the test?  It just said HIV 1/2 ELISA

[sfworriedman]

Hi Dr. Hook,

Sorry, wasn't sure the reply got to you because of technical issues. Hence I sent it again.

Thank you for answering the specific questions.  

I have been abstinent since the incident with no further exposures while I was waiting for testing.

Based on that, will i infect my wife with HIV with a 15 week negative HIV ELISA with no additional exposures during the window?

The reason I ask is because we are going to start having unprotected sex to have children.  Some people say test out to 6 months...i just couldn't ever deal with me hurting anyone else.  Please let me know when you have a moment.

[sfworriedman]

Hi Dr. Hook,

Thank you for answering the specific questions.  

I have been abstinent since the incident with no further exposures while I was waiting for testing.

Based on that, will i infect my wife with HIV with a 15 week negative HIV ELISA with no additional exposures during the window?

The reason I ask is because we are going to start having unprotected sex to have children.  Some people say test out to 6 months...i just couldn't ever deal with me hurting anyone else.  Please let me know when you have a moment.

[Edward W Hook, MD]

Welcome to our Forum.  As you probably know, Dr. Handsfield and I share the forum.  You got me.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.

You are correct, the exposure you describe did put you at risk for HIV.  There is a risk that your transgender partner did have HIV although the infection rate is not the 33% you mention.   Your statement that HIV-2 is "rampant" in NY is also incorrect and suggests that you may be spending too much time on the internet where misinformation is truly "rampant". Fortunately, you did not get infected through the exposures you describe.  We can say this with confidence base on your test results.  The tests you have already gotten PROVE this.  I'll answer your specific questions below:

1.  I have elevated estrogens and Fatty Liver Disease. Additionally, I've been diagnosed with Gilberts syndrome.  It's my understanding that HIV-1 has been ruled out with the RNA but that only checks for HIV-1. Would my pre-existing conditions delay seroconversion for HIV-2 with the ELISA and rapid tests beyond 15 weeks?
Your elevated estrogen, fatty liver and Gilbert's disease do not change the validity of your test results.  You should believe them.  The HIV antibody tests you describe would detect HIV-2.  Some HIV RNA tests would also detect HIV-2 but only your lab can tell you the answer to whether or not the test you had would.

2.  My main concern is HIV-2 because the RNA doesn't cover that. I've had a lot of testing. I don't want to infect my wife with HIV. I've read crazy stories online where people didn't test positive for years.  This however seems like dated information.  
The on-line studies you mention are just what you say- crazy.  Current tests are accurate at any time more than 8 weeks after an exposure.  

3.  At what point can I have unprotected sex with my wife without infecting my wife?  
Your tests prove you did not get HIV from the exposure you describe.

4.  What's the story with Hep C/HIV confection?  Will that delay seroconversion beyond 3 months?
If your partner ha both infections, this would not change the timing or accuracy of detection by standard tests.

5.  Is my testing conclusive for HIV-2?
Yes.

You were fortunate.  In the future, I highly recommend that you ask partners if they are infected before you have sex with them and then use a condom.  

I hope my comments are helpful.  EWH