Broken condom and viral test.

Hi doctors.

Ok well i am a 24 year old female and recently I had sex with a guy who tried to insert his penis without a condom. He put his tip in a bit but I immediately stopped him so he put on a condom. A few minutes later the condom broke but his penis was only inside for a few seconds before we stopped. I also think this guy has had sex with other men.

Well I was going to wait 3 long horrible months to test but I found out the UCSD has a research program where they give you a baseline a.b. test and also an "early test" that I believe looks for the virus in your blood and its free. Well they said you can test 7 days after possible exposure,  and give you the results in 2 weeks, so I was tested exactly 7 and a half days after and the results for were negative.

I was happy and started to move on but then I found info on the net that said those tests aren't that reliable that soon and are not as reliable as antibody testing. I freaked out. Is this true? Any expert advice would be great.

[H. Hunter Handsfield, M.D.]

Welcome to the forum and thanks for your question.  I'm flattered that you would think this forum would have as much expertise as the HIV/AIDS research team at a very prestigious institution like UCSD.  Most likely your doctors there are much more expert than I or Dr. Hook!

The general principle as they described it is correct: a negative direct test for the virus in the blood 7 days after exposure is very reliable evidence against a new hIV infection; and the combination of a negative viral test at 7-14 days and negative antibody test at ~4 weeks is 100% proof.  Even with the standard, non-research tests, such testing would have been entirely reliable at one month, with no need to wait 3 months for a definitive result.

You don't say whether the research involves a standard, tried-and-true test or a new one, or a combination of tests, that might work even better than the standard ones.  If I correctly understand, you enrolled in the research project -- yes?  If so, I'm sure they explained all this to you, and probably you signed a written consent form and a copy of it.  If so, I'm sure all the details are spelled out there.

All things considered, it is probable that even if the viral test done is new and experitmental, the negative result highly reliable.  But if this reply and re-reading the consent form leave any doubt, call the investigators.  You can be sure they will be glad to discuss any questions you may have.

Finally, I'll comment that you had a very low risk exposure, especially if your partner is not bisexual, an injection drug user, or otherwise at very high risk of HIV.  Even among very promiscuous heterosexual men in the US, under 1 in 1,000 has HIV.  If you had asked about testing ahead of time, I would have told you testing is optional in circumstances like yours.  But now that you have started, you should follow through on the testing schedule and the follow-up visits you agreed to.

I hope this has helped.  Best wishes--  HHH, MD

[H. Hunter Handsfield, M.D.]

There's a typo:  to be clear, I meant to wite "probably you signed a written consent form and *have* a copy of it...."  You could also print out a copy of this discussion and take it with you when you return to the research clinic for follow-up testing.  I'm pretty sure you'll find they agree with my comments.

PS:  If the research consent form lists my old friend Dr. Douglas Richman as one of the investigators, give my greetings if you see him.

[friendlysmile]

Thank you for your quick response doctor.

I'm not sure what the actual name of the test is, it is just called "The Early Test." They only told me that this test looks for copies of the virus which should be high in number by a week. A tester there also mentioned that its the same test used to screen donor blood.

It was only a 1 time visit in which they did the rapid antibody test as a baseline, then drew blood, and instructed me to check my results online or over the phone in 2 weeks. No further visits were required.

Since I was still worried that this might not be conclusive, I walked into an HIV clinic earlier today to do a rapid test (37 days post exposure) they gave me my results in 20 minutes which were negative.

I'm considering testing again a few weeks from now but this wait and HIV wonder is hell.

In your opnion doctor, how likely am I to have HIV?

[H. Hunter Handsfield, M.D.]

Thanks for the additional information.

Assuming you have had no possible exposures since the one described above, then you can be absolutely certain you do not have HIV.  A negative viral test at a week plus negative antibody at 5 weeks is 100% reliable.  You need no further testing.