Aa
Am I being resonable?
Thanks all for reading my question.
I had posted a question to doc that described my situation.
I had an hiv + partner. on 1/2/07 we were in bed just holding
each other when I bit his nipple just playing around and
drew blood into my mouth, I swallowed without thinking,
several minutes later rinsed with water. He is pos x 12 years and tends to be well controlled with meds.
We have no other risks, general good health. I went to the ER the following day out of fear and was prescribed a 28 day expanded 3 drug nPEP.
I followed up with my GP a couple weeks ago and she did not
seem concerned at all stating transmission would be "unsual"
she orded a blood test next week but did not tell me to
reschedule an appointment with her. I assume that she is
confident that I will not have the virus.
THat said, how could there be any risk at all of getting the virus via oral sex when you can even swallow HIV + blood and not become infected. I think some of the angst out here is because the rules seem to mutate as much as the darn virus does.
Anyway, I'm still freaked out and I really dont know what to do. The blood test is sitting in clinic for me to just come in. Do I go now? or should I wait for 6 weeks? THe blood test is the one that looks for the virus not the antibody test. Next week would be 5 weeks post exposure and one week after finishing PEP.
I had posted a question to doc that described my situation.
I had an hiv + partner. on 1/2/07 we were in bed just holding
each other when I bit his nipple just playing around and
drew blood into my mouth, I swallowed without thinking,
several minutes later rinsed with water. He is pos x 12 years and tends to be well controlled with meds.
We have no other risks, general good health. I went to the ER the following day out of fear and was prescribed a 28 day expanded 3 drug nPEP.
I followed up with my GP a couple weeks ago and she did not
seem concerned at all stating transmission would be "unsual"
she orded a blood test next week but did not tell me to
reschedule an appointment with her. I assume that she is
confident that I will not have the virus.
THat said, how could there be any risk at all of getting the virus via oral sex when you can even swallow HIV + blood and not become infected. I think some of the angst out here is because the rules seem to mutate as much as the darn virus does.
Anyway, I'm still freaked out and I really dont know what to do. The blood test is sitting in clinic for me to just come in. Do I go now? or should I wait for 6 weeks? THe blood test is the one that looks for the virus not the antibody test. Next week would be 5 weeks post exposure and one week after finishing PEP.
God thank you! I will get the anti- body at 6 weeks
(next monday). You've been a wealth of information.
I wish I found you and this board sooner so I didn't
have to stress out alone.
The jury is still out on PEP and the 'window period'. Of the few studies that have been done, most data have shown that there is little to no effect on the window period. HOWEVER, there have been two noticeable outliers:
1) In one animal study, a single monkey was documented to have late seroconversion.
2) In cases involving HCWs following occupational exposure to HIV, a few late (sometimes VERY late, 9+ months) seroconversion has been documented, but ONLY with co-infection with HCV.
But none of the studies have been conclusive yet, which is why testing is still recommended through 6 momnths.
In my scenario from my previous post, the "20 days post PEP" is the timeframe in which I would expect seroconversion illness to occur IF you had ultimately been infected. Why? Because post-PEP, the virus is starting out at very low levels and will replicate quickly. IF the body is already producing antibodies (and therefore keeping viral replication in check), I expect no seroconversion illness.
In ANY case, my assumption, based on data available, is that an antibody test should be very reliable by 6-7 weeks (42 - 49 days), which is roughly the same timeframe for people who do not take PEP.
If you'd like to read some of the cases, search for my previous post on the subject that starts "FYI:".
1) In one animal study, a single monkey was documented to have late seroconversion.
2) In cases involving HCWs following occupational exposure to HIV, a few late (sometimes VERY late, 9+ months) seroconversion has been documented, but ONLY with co-infection with HCV.
But none of the studies have been conclusive yet, which is why testing is still recommended through 6 momnths.
In my scenario from my previous post, the "20 days post PEP" is the timeframe in which I would expect seroconversion illness to occur IF you had ultimately been infected. Why? Because post-PEP, the virus is starting out at very low levels and will replicate quickly. IF the body is already producing antibodies (and therefore keeping viral replication in check), I expect no seroconversion illness.
In ANY case, my assumption, based on data available, is that an antibody test should be very reliable by 6-7 weeks (42 - 49 days), which is roughly the same timeframe for people who do not take PEP.
If you'd like to read some of the cases, search for my previous post on the subject that starts "FYI:".
both myself and my partner have been tested for
HEP B/C-negitive. My partner has treated with an HIV specialist for the last 12 years so all standard infections or other STD's have been ruled out. Besides, he did not get the virus from sexual activites, he recovered from a short drug addiction that occured 12+ years ago. Neither of us have been unsafe so I am not worried about co-infections.
Strata; are you saying that the antibodies would
show up 20 days post PEP (give or take)or would they
be present now if the exposure took place on 1/2/07?
Thanks for your help.. I know in my heart I am fine
All of my "symptoms" disappeared after completing
the PEP meds. If anyone ever has to do a 28 day PEP
they will learn a lesson to NEVER take chances again.
PEP does not PREVENT the body's own antibody response. The THEORY is that, if PEP suppresses virus replication to the extent that there is very little virus in the blood, the body might mount a detectable antibody response. However, the few studies in this area indicate there is generally little effect.
I'd be more inclined to believe that, during or shortly after PEP, an ANTIBODY test is more likely to be positive than a viral load test. This is because the body is still likely and able to respond to the presence of an antigen EVEN IF the level of antigen is too low for current medical tests to detect.
IF you were infected with HIV despite PEP, I'd assume that it would take roughly 20 days (3 weeks) after you discontinue PEP for ARS symptoms to appear, IF they appear at all. Within that 20 days (~48 days post exposure), a PCR/RNA (viral load) test is sure to be positive IF you were infected. I'd assume an antibody test to turn positive within the same period, if not slightly sooner.
For people recently infected with HIV who do NOT take PEP, a PCR/RNA would often be positive before the antibody test (although sometimes only by a few days).
I'd be more inclined to believe that, during or shortly after PEP, an ANTIBODY test is more likely to be positive than a viral load test. This is because the body is still likely and able to respond to the presence of an antigen EVEN IF the level of antigen is too low for current medical tests to detect.
IF you were infected with HIV despite PEP, I'd assume that it would take roughly 20 days (3 weeks) after you discontinue PEP for ARS symptoms to appear, IF they appear at all. Within that 20 days (~48 days post exposure), a PCR/RNA (viral load) test is sure to be positive IF you were infected. I'd assume an antibody test to turn positive within the same period, if not slightly sooner.
For people recently infected with HIV who do NOT take PEP, a PCR/RNA would often be positive before the antibody test (although sometimes only by a few days).
You should of took Pep for HEP b and C and tuberculosis.
Too late now. Get your boyfriend tested for those.
Cause you may have it too.
-DrLeigh
Too late now. Get your boyfriend tested for those.
Cause you may have it too.
-DrLeigh
I highly doubt that 'DrLeigh' is a doctor at all. His/her advice is quackery at best.
HCV is not sexually transmitted. Mucosal exposure to blood is also insufficient for transmission. HCV is often transmitted by shared needles among IV drug users.
I'm sure that your boyfriend would know if he were infected with HBV or HCV since these can present serious complication for HIV+ patients.
Tuberculosis is not a risk in the US. Besides, TB is EXTREMELY contagious IF the infected person is symptomatic. If your boyfriend were infected and symptomatic, you would be infected, too, since it is spread easily by casual contact. Being HIV+ does not put your boyfriend at increased risk for TB. Now, if he worked in the Peace Corp and had recently spent a lot of time in a refugee camp in the Third World, THEN TB MIGHT be a risk (most US citizens have been vaccinated).
HCV is not sexually transmitted. Mucosal exposure to blood is also insufficient for transmission. HCV is often transmitted by shared needles among IV drug users.
I'm sure that your boyfriend would know if he were infected with HBV or HCV since these can present serious complication for HIV+ patients.
Tuberculosis is not a risk in the US. Besides, TB is EXTREMELY contagious IF the infected person is symptomatic. If your boyfriend were infected and symptomatic, you would be infected, too, since it is spread easily by casual contact. Being HIV+ does not put your boyfriend at increased risk for TB. Now, if he worked in the Peace Corp and had recently spent a lot of time in a refugee camp in the Third World, THEN TB MIGHT be a risk (most US citizens have been vaccinated).
Thanks for the information.
I finished that living hell (PEP) last week and
I'll be going to my partners HIV specialist with
him this week to discuss the exposure.
My GP set up the "new just approved test" to
look for the virus, not an antibody test.
My assumption is it's the Gen RNA.
Assuming that PEP (possibly) delays seroconversion
and the antibody would be negitive due to
the meds, would the RNA also come out negitive
at 35 days? If I get a negitive RNA at 4 weeks or
so can I rest a bit easier? I will still f/u at
3/6 months but I have to have something to hold on
to and ease my mind.
My concern is that blood and possibly a bit of
tissue was at the back of my thoat, near the tonsil,
which has been inflamed since the incident. I've
read that the cells of the tonsil are the ones that
can get infected as well as the tissue under the
tounge. THe ER doc kept saying "you can get medication
into your blood stream via the mouth why couldn't you
get HIV through the mouth?" It freaked me out bad!
I know the board can't give medical advice but
I need to know if the RNA is a good choice 5 weeks
post exposure and 1 week post pep or if I should
sit in this hell hold for another 4 weeks.
Thank to all, this board is a lifesaver!
In answer to your "few milligrams" question, that would probably be smaller than a drop. A teaspoon would weigh about ~5 grams...
Basically, its the sort of volume if you have a small paper cut that is deep enough to draw blood and form a drop but doesn't bleed enough to actually flow away from the cut.
Hope that helps.
Take care and good luck.
Basically, its the sort of volume if you have a small paper cut that is deep enough to draw blood and form a drop but doesn't bleed enough to actually flow away from the cut.
Hope that helps.
Take care and good luck.
Your risk of infection is very small, due to the small amount of inoculum and the relative inefficiency of oral mucosal transmission.
That being said, since you are on PEP, you ought to test out through 6 months, as is the recommendation.
(Now, before everyone jumps on me, let me explain...)
There have been few studies on the effects of PEP on seroconversion. SOME theorize that PEP could delay seroconversion, as has been seen in one monkey (in an animal study) and in HCWs co-infected with HCV. Others, including Dr HHH, assume that PEP has little effect on seroconversion. Since there are so few studies, I think that those of us (myself included) who take PEP owe it to ourselves and others to be tested through 6 months so that doctors can see 1) whether PEP is effective and 2) if seroconversion is delayed.
The PCR (viral load) test was likely prescribed as a baseline. My HIV specialist (the one I'm seeing for PEP follow-up) ordered a PCR and ELISA at 2.5 weeks as a baseline. My doctor really couldn't give me a satisfactory answer as to why he wanted the PCR done. Seemed like a waste to me. I have a follow-up appointment at 6 weeks, and I'm assuming I'll be asked to come back at 3 months and 6 months.
If yourt GP doesn't schedule a follow-up for you, do yourself a favor and have a simple antibody test at 3 months. Your risk is very low, but it's too easy NOT to do, especially when you know your exposure was with an confirmed HIV+ partner.
That being said, since you are on PEP, you ought to test out through 6 months, as is the recommendation.
(Now, before everyone jumps on me, let me explain...)
There have been few studies on the effects of PEP on seroconversion. SOME theorize that PEP could delay seroconversion, as has been seen in one monkey (in an animal study) and in HCWs co-infected with HCV. Others, including Dr HHH, assume that PEP has little effect on seroconversion. Since there are so few studies, I think that those of us (myself included) who take PEP owe it to ourselves and others to be tested through 6 months so that doctors can see 1) whether PEP is effective and 2) if seroconversion is delayed.
The PCR (viral load) test was likely prescribed as a baseline. My HIV specialist (the one I'm seeing for PEP follow-up) ordered a PCR and ELISA at 2.5 weeks as a baseline. My doctor really couldn't give me a satisfactory answer as to why he wanted the PCR done. Seemed like a waste to me. I have a follow-up appointment at 6 weeks, and I'm assuming I'll be asked to come back at 3 months and 6 months.
If yourt GP doesn't schedule a follow-up for you, do yourself a favor and have a simple antibody test at 3 months. Your risk is very low, but it's too easy NOT to do, especially when you know your exposure was with an confirmed HIV+ partner.
If you are on a PEP regimen then a PCR test is not accurate. You have to understand that PEP drugs are the same drugs HIV+ people take. The point of the drugs is to slow down the replication of the virus. If you do this right after infection, it gives your body a chance to fight off the virus and beat it.
My point is that a PCR test while on PEP will not be accurate and will be a complete waste of time and money. Let's say you did get infected. A PCR test would show up negative because more than likely the viral load would be below detectable levels because the PEP is driving it down to those levels.
Lastly, all of this irrelevant. You absolutely did not get HIV from your exposure. I would bet my life on it. Saliva is a good inhibitor of HIV. Meaning HIV can not survive in saliva. Lastly, you have to understand that HIV is a very fragile virus and in order for you to get infected it has to have direct access to your blood stream. I can gaurantee you that if a little bit of blood got in your mouth and you swallowed it HIV would not survive. Large quantities of the virus has to come in contact with mucous membranes or your blood stream. Your partner did not have large quantities of the virus in his blood since he has been positive for 12+ years and has kept his viral load down. To be honest, you could have unprotected sex with him and it would be highly unlikely for you to get HIV, but no impossible. Magnetic couples have been documented to have unprotected sex for years and never pass on the virus.
Anyways, you have nothing to worry about. I personally think PEP is not neccessary and you should not be taking it. The only way to tell if you have HIV is through a standard antibody test, since PEP will not slow down the production of antibodies. On average people seroconvert at 22 days. If I was you I would get tested at 4 weeks and forget about this when you get your negative result.
My point is that a PCR test while on PEP will not be accurate and will be a complete waste of time and money. Let's say you did get infected. A PCR test would show up negative because more than likely the viral load would be below detectable levels because the PEP is driving it down to those levels.
Lastly, all of this irrelevant. You absolutely did not get HIV from your exposure. I would bet my life on it. Saliva is a good inhibitor of HIV. Meaning HIV can not survive in saliva. Lastly, you have to understand that HIV is a very fragile virus and in order for you to get infected it has to have direct access to your blood stream. I can gaurantee you that if a little bit of blood got in your mouth and you swallowed it HIV would not survive. Large quantities of the virus has to come in contact with mucous membranes or your blood stream. Your partner did not have large quantities of the virus in his blood since he has been positive for 12+ years and has kept his viral load down. To be honest, you could have unprotected sex with him and it would be highly unlikely for you to get HIV, but no impossible. Magnetic couples have been documented to have unprotected sex for years and never pass on the virus.
Anyways, you have nothing to worry about. I personally think PEP is not neccessary and you should not be taking it. The only way to tell if you have HIV is through a standard antibody test, since PEP will not slow down the production of antibodies. On average people seroconvert at 22 days. If I was you I would get tested at 4 weeks and forget about this when you get your negative result.
Worried16, the RNA is approved By the FDA it's a viral load test to be used in cases like Justone, that have been with a know pos person.www.Gen Probe RNA FDA San diego approved this is a viral load test.If i had to take a PCR test I would take the RNA, because it's FDA approved.I wouldn't take a DNA test only RNA.
You people are the best!
I think I'll need a head-shrinker after
this is over.
I went to the aids.med site and they
seem to be confident that swallowing
blood is very low or in some cases no
risk.
Still researching the PCR/DNA tests.
I wish I knew exactly what "a few milligrams"
was...a few drops???
I will do my test on Monday...
I think I'll need a head-shrinker after
this is over.
I went to the aids.med site and they
seem to be confident that swallowing
blood is very low or in some cases no
risk.
Still researching the PCR/DNA tests.
I wish I knew exactly what "a few milligrams"
was...a few drops???
I will do my test on Monday...
I agree with xhost....i second him on his comments and I do remember Dr. H saying that even if u drank 2-3 tablespoons of HIV infected blood ..it would be ok
Just,
I have read on more than one occasion that PEP should not, except in cases of co-infection with HCV, change the window period much at all. In other words, if you are going to develop antibodies to HIV, you will still do it, in the vast majority of cases, by the 6th week after exposure. Your doctor, of course, should be the primary guide as to what tests to take and when, and he or she will probably have you test out to 12 weeks or more, as is recommended after PEP is administered.
Your post prompted me to remember something that the Doc said to an earlier post in the moderated forum, which was, to paraphrase, that swallowing a few milligrams of HIV infected blood would not be much of a risk, as the route of possible transmission is not so efficient at letting the HIV virus find and infect the cells it likes to infect (combined with the fact that saliva based enzymes seem to do a number on the HIV virus).
Not sure that makes you feel better, but he did say it. Personally, I'd bet a lot of money that you are going to be just fine.
Take care of yourself,
xhost
justonce...i think it will be a DNA PCR test...it is a qualitative test that gives u a YES or NO answer...ie. YES HIV was found in blood...or NO HIV was not found....these test although are not approved are greater than 99% accurate at 28 days...
A RNA PCR test is a quantitative test that measures the HIV viral load in someone who is HIV +.....it is used to see the effect of medicines on them.
e.g someone is diagonised with HIV has a viral load of 1000000 and is given HIV medicines...and next month has a RNA PCR test and if the load is 1000, then this means the medicine was sucessfull in reducing the viral load.
A RNA PCR test is a quantitative test that measures the HIV viral load in someone who is HIV +.....it is used to see the effect of medicines on them.
e.g someone is diagonised with HIV has a viral load of 1000000 and is given HIV medicines...and next month has a RNA PCR test and if the load is 1000, then this means the medicine was sucessfull in reducing the viral load.
Justonce, if this test comes out neg, you will be A O'kay.But sill i don't think you had a risks.Just you may want to check out Aidsmeds.com also they will for sure tell you, you had NO RISKS and they will brake it down to ya.Peace.
Justonce, worried 16 is probably right to, because both these are viral load tests.And they will also give you a antibody test, because these aren't stand alone test,but they are accurant.Peace.
So if I go in Monday and get the blood test, and it
is indeed the DNA by PCR and it is negitive I should
be good to go???
or is there the 6 week anti-body to stress out about
in addition to that test.
God this sucks! Heck thing is..we weren't really
even having sex and I still have to go though
this! For all this worry and stress at least
it could have been sex.
Thanks for your help, you've been great.
is indeed the DNA by PCR and it is negitive I should
be good to go???
or is there the 6 week anti-body to stress out about
in addition to that test.
God this sucks! Heck thing is..we weren't really
even having sex and I still have to go though
this! For all this worry and stress at least
it could have been sex.
Thanks for your help, you've been great.
Justonce, your docter is probably going to give you the RNA test Gen Probe RNA FDA approved test, you can it up on the net. This test is for people like you if a doctor thinks you had a risks form a hiv pos person.This test can pick up early infections.I hope your partner is doing better with this i wish you luck, but i don't think you'll need it all. God Bless You Just.Peace.
justonce,
The test that ur GP is talking about is probably the DNA by PCR...i think 28 days after exposure should be fine...but still ask ur Dr.
The test that ur GP is talking about is probably the DNA by PCR...i think 28 days after exposure should be fine...but still ask ur Dr.
Doing Ok except for the side effects of PEP, or
conversion which ever it is. At this point I'd rather
just get a test and get the mental angst over.
This is really a tough head job. Anyway, I've
experienced a bad sore throat, back pain, eye pain
numbness in my hands and feet and a stiff neck.
No fever, no rash so I think I'm OK so far.
I haven't had any tests, My general practitioner just
wrote a script and stuck it in my file telling me to
come back a "couple weeks" after I finish the PEP meds.
I guess I could go anytime next week and get the blood work done. She ordered the test that "looks for the virus" not the anti-body. I really dont know what test she is talking about. She said it just came out.
Any idea how long I should wait after I stop the PEP to
do the test? The exposure was on 1/2/07.
conversion which ever it is. At this point I'd rather
just get a test and get the mental angst over.
This is really a tough head job. Anyway, I've
experienced a bad sore throat, back pain, eye pain
numbness in my hands and feet and a stiff neck.
No fever, no rash so I think I'm OK so far.
I haven't had any tests, My general practitioner just
wrote a script and stuck it in my file telling me to
come back a "couple weeks" after I finish the PEP meds.
I guess I could go anytime next week and get the blood work done. She ordered the test that "looks for the virus" not the anti-body. I really dont know what test she is talking about. She said it just came out.
Any idea how long I should wait after I stop the PEP to
do the test? The exposure was on 1/2/07.
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