HIV Transmission

Dear Dr.,
Although I have read your website many times, I have a few questions I didn't see the answer to. My exposure is the following: 4 weeks ago I performed oral sex w/ no ejaculation on a man who I don't know his status. 4 days later I developed (what my doctor called) a severe case of viral pharyngitis. I was tested for every STD (expect HIV b/c it was too early), and all came back negative. Here is my question:

1. Is it possible for HIV to invade my tonsils? Since it is a type of lymp tissue, and HIV does invade lymp tissue, would that make since why my tonils were the only symptom I had (no fever; on the throat culture, only normal respiratory flura was found).

2. B/c I didn't test positive for any type of bacterial infection, and my doc. concluded it was "viral", could this indicate possible HIV exposure?

3. Lastly, I order a pcr and antibody test at 4 weeks. Although it was expensive, waiting 13 weeks seemed unbearable. Even 6 weeks seems so long. However, the lab states that at 28 days past exposure my results are conclusive. Is this true, or do I still need testing beyond the pcr and elisa at 4 weeks?

Thank you so much. I know this exposure is very low risk, but after reading every website available on the internet, and the whole "white tonsil" problem, I'm scared out my mind. I really believe that some people put info out there to scare you. I would appreciate a doc. advice.

[H. Hunter Handsfield, M.D.]

The odds indeed are overwhelmingly against HIV and in favor of some garden-variety viral infection as the cause of your symptoms.  Compared with other causes, HIV is a RARE cause of "white tonsils" and other varieties of pharyngitis.  Further, 4 days definitely is much too soon for onset of HIV symptoms, and primary HIV infection almost always causes fever.  To your specific questions:

1) Yes, HIV invades lymphoid tissue.  But it generally does so without symptoms.

2) Your doc is right, but there is no particular reason to fear HIV as the cause.

3) I don't think you needed HIV testing at all, except for your mental health, i.e. the emotional relief from knowing you are negative. But the official advice from various agencies says to have another test 3 months after the exposure.

Consider the odds.  Let's say there is a 1% chance you were unlucky and chose a partner who has HIV.  Then add a 1 in 1000 risk you were infected if exposed (the real risk is much lower than that).  Then add a 1% chance that the antibody test plus PCR at 1 month both were falsely negative (that risk also is in fact much lower).  To assess the risk you have HIV, you multiply the odds:  0.01 x 0.001 x 0.01 = 0.0000001.  That's one chance in 10 million.  Since the actual risks of the individual events are lower, your actual risk is still less, maybe 1 in 100 million to 1 in a billion.  The chance you will die in the next week of some unexpected accident or illness is hundreds to thousands of times higher.

In other words, relax.  You don't have it.

I hope this helps.  Best wishes--  HHH, MD

[fearfire]

According to the lab (using 4th generation Elisa test), 16-23 days should be sufficient, but allow 4 weeks to be more certain. Some doctors suggest 2 weeks can detect most infections as the modern test detects p24 antigen as well. Hope this helps.

Good luck
B

[fearfire]

Oh, I forgot a point. Seems that PCR test at 4 weeks is a bit waste of money as it is used for early detection about 7-20 days. Standard screening test (3rd or 4th generation) at 4 weeks would be sufficient. If you want to do a PCR, do it earlier.

Best,
B