Am I clear

[luckyornot]

Hi Dr.

I had sex with a CSW in South America and condom broke competely, was fully unprotected for 3-4 minutes maybe more. Did not know her status and she told me afterwards she has never been tested. Had baseline test 3 days after, negative. GP told me not to worry and gave 1 tab of azithromyincin and sent me along. 44 days after exposure, had symptoms of headache, chills, mild fever, really sore throat, maculopapular rash (confirmed by my GP) on face, neck, chest, back, upper arms and upper legs, mouth and genital sores. Sore throat for 5 days, rash lasted about 6 days and started to clear up. Lost weight due to sore throat and little apetite. I was away at work when all this happened and could not get tested (showed the Dr pictures I took of the rash when I got home).One Dr said my rash was an allergic reaction, another said it looked like a bacterial infection, but neither can be sure. I also checked for mono, which came back negative. So as of now there is no explanation for my illness that I went through.
Since returning home, I have all std's, chlamydia, VDRL, gonorrohea, Hep A,B &C, HSV1/2 checked during each HIV 1/2 test done which was at 10, 12 17 and 25 weeks post exposure, each one being negative. I know the test used at 12 and 17 weeks was the Abbott Architect Duo, not sure about the others.

I have seen that HIV type 2 and subtype F are common in the South American country that I had this exposure. Would the test have dectected subtype F and/or HIV 2, if I may have contracted this?
I am really stuck on this situation as there is no explanation as to what happened to me.
I was thinking about getting checked again, but this time asking my GP for maybe a VL test to see if there is something that may show up or maybe a CD4/8 count. Do you think this would be of any help? What would you suggest in this situation if I were your patient? Do you think I am in the clear for an hiv infection? Seems too much of a coincidence to me

[Edward W Hook, MD]

Welcome to our Forum.  If you were my patient, I would tell you that you can be sure that you did not get HIV from the exposure you describe and that the testing that you have had proves this.  I would not order further testing as it would be a waste of time and money.   Let me provide some background.

Most commercial sex workers do not have HIV. furthermore, most exposures to infected sex partners do not result in infection. The transmission rate for HIV through unprotected vaginal sex is less than 1 infection per 1000 sex acts.  

Your tests prove that you do not have HIV.  HIV antibody tests are definitive 8 weeks following exposure and combination tests like the Architect are definitive at 4 weeks. These tests would have detected HIV subtypes, including HIV subtype F.  Believe the tests.

Finally, you had a flu-like illness.  This is not an uncommon event an when such things have been studied less than 1% of flu-like illnesses in at risk persons are due to HIV.

Bottom line, it is time for you to stop worrying and move forward.  No more testing is needed.  You did not get HIV from the exposure you describe.  EWH

[Edward W Hook, MD]

There is little meaningful difference between 1 in 1000 and 1 in 2000. These well accepted figures are derrived from the many, many studies performed of risk for HIV over the years.  Some persons use one figure or the other, others state the risk as 1 in 1-2000.  

Again, the 3 month, official" recommendation by some. like our 8 week recommendation, is derrived from careful reading of the biomedical literature, including studies of time to seroconversion, our own experience and our conversations with other experts.  

EWH

[luckyornot]

Hi again;

I just wanted an answer to a couple more questions, if you would be so kind to answer.
Where does this infection rate of 1 in 1000,  or as I see from time to time on here, 1 in 2000 come from? What kind of study was ever done to come up with this number? and why does it change in the answers sometimes given from 1/1000 to 1/2000?
How can it be sure that 3 months is conclusive for everyone, when each persons body is different and some may take longer to respond ie. make antibodies to hiv infection? ( I read one persons story that she tested negative for hiv 10 weeks after her "illness" and finally turned positive 7 months after exposure.) I know you can't believe you read, and its only her story but I see no reason for her to lie about it. So how is 3 months considered conclusive if studies are based on when people think they were exposed, but might not of actually been the case.
Could you please answer my questions and that will be all from me.