Hiv infection/Testing

I accidently posted this on the International board, but I wanted the opinion of one of the doctors in this forum.
Hello, doctors.  I am in my mid-forties and I performed unprotected oral sex on a woman who I met in a bar on July 10.  I do have some reason to believe that she is HIV positive.  Also, I have been extremely worried and nervous since the thought went into my head. My symptoms began about 3 1/2 weeks after.  I know that oral is considered very low risk, but my body suggests otherwise.  My symptoms have continued from that time.  I have had some good days, but most not so good.  First, I lost 8 pounds from July 24 (yearly physical) and August 15 (first ELISA test). Other symptoms include mild head ache for most of those days, white coated tongue - somtimes stinging and with bad taste, prickly/slightly itchy skin at times, what i call hot flashes, neuropathy symptoms - a good amount of burning and slight pain in feet and hands. Queasy stomach - mostly during weeks 4 through 7 or 8, Tired at times,but not wiped out, and a general feeling of not being well, as well as other symptoms.  Of late, I have felt an increasing number of pains, mainly in abdomen, particularly just inside of each hip.  I have had stinging pain in areas of lymph nodes - mostly neck and groin. Also, been getting more cold sores than I can remember.

I tested negative ELISA 37 days after exposure.  At 40 days, I had a negative PCR DNA.  at nine weeks, I tested negative ELISA and negative PCR RNA.  Would it be true that having no antibodies detected, the PCR would detect the hiv virus at 9 weeks?  How legit is PCR?   I'm getting tested at twelve weeks this week. Hope you can help me with your advice  Reported Report this

[Edward W Hook, MD]

Welcome to the Forum. I see that you have asked your questions on the HIV Community site as well as the HIV-International Expert site.  I hope that my comments, which will be in agreement with those you have already received, will help to comfort you.

Your risk for the exposure you describe is virtually zero and the test results that you have gotten since then further strengthen my confidence that you do not have HIV from the exposure you describe.  Let's break this down step by step.

1.  Your partner. You state you have reason to believe that she may have HIV. She may be in a higher risk group for HIV but even among such women, the majority do not have HIV.
2. Your exposure.  Even if your partner has HIV, the risk of getting HIV from performing oral sex on her is close to zero.  . The quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.
3.  Your tests.  At 5 weeks following exposure an ELISA for HIV will detect more than 95% of infections acquired 5 weeks earlier and even more if the person had experienced the ARS. At 9 weeks virtually all ELISA tests are positive. PCR tests, which we do not recommend because of false positive problems, would also almost certainly be positive one of the times you had them. Taken together, no matter who your partner is, you can be completely sure that you do not have HIV.  No way!

I am confident that your 12 week test this week will be negative.  You do not have HIV.  As for your symptoms, they may be due to something else, completely unrelated to the sexual encounter you describe or they could possibly be due to anxiety.  Sometimes after an exposure that, in retrospect, one wishes they had not had, persons tend to examine themselves and be far more attuned to genital sensations than in periods when they are not concerned.  This in turns leads to noticing what turn out to be normal sensations that might have been not noticed or ignored at other times.  Perhaps this was a contributor to your situation

I hope these comments are helpful. EWH  

[ATGR]

Thank you for your response.  Indeed, your assurance that I am not infected with HIV is comforting to say the seast.  You are correct about the anxiety.  I have a problem with anxiety and it was "off-the-hook."  I had blood drawn for my 12 week test today, and my PCP gave me a perscription for my anxiety.  Thanks again, and I wish you all the best!
God bless!!

[Edward W Hook, MD]

Glad to help. EWH

[ATGR]

I don,t know if I can follow up this question, but as  my lymph nodes in my neck have become swollen, I wish to ask anyway in fear of becoming positive after my 9 week negative.  With a negative ELISA at 9 weeks,  Would the PCR RNA at 9 weeks surely detect HIV.  Is it possible that the PCR RNA would not detect HIV even with a negative ELISA?  Is 9 weeks too late for a PCR DNA?  Please help because I'm really worried!  

[Edward W Hook, MD]

You do not have HIV.,  If you did, your ELISA and your PCR would both be positive.  You really need to look for other causes of your swollen lymph nodes if they worry you.  EWH

[ATGR]

Hi, doc!  My 12 1/2 week test is negative.  Is it at all possible that the virus could be hiding in my body, making it unable for my body to create antbodies, and making it difficult for the PCR RNA to detect the virus?  I do feel a lot better, but I'm still a bit concerned.

[Edward W Hook, MD]

No way. Be confident that you do not have HIV.  The risk was low to start with and your test results prove that you did not get HIV from this expsoure.  No reason for concern or for further testing.  EWH