Older does not mean Wiser

Hello Dr.;

I am a big fan of yours and this forum.  This may be partly because of your opinion of the window period and test results, perhaps.  The following story is true, believe it or not.

I am a 53 old male, and my girlfriend at the time, was the same age.  We had unprotected vaginal sex 8-10 times this last March, along with oral both ways.  As things were getting more involved, I insisted she get tested, and sure enough it came back positive for HIV and negative for STDs.  Subsequently, she is under good medical care with a specialist.  Her viral load came back at 8700 copies, by the way.  The good news, if any, is that perhaps a few lives have been saved, including mine.

At 46 days (6.5 weeks) post-exposure, I tested negative on the Elisa.  This was sent to LabCorp testing.  Since my exposure was high risk, my doctor allowed me to have a qualitative and quantitative PCR, which both were negative/undetectable at 60 days post.

Now, after reading several of the postings, it appears that you deal with many low risk encounters, so my question is, have you had a lot of experience with documented high risk situations, like mine?  It is now 5 months post, and from what I have read and been told, it should be conclusive that I am negative based on the timing of the tests taken.  Do you concur?  I remember seeing postings in the past, where you stated you never heard of a 6 week negative that turned positive before.  I am praying you are right.

To be sure, I am planning on a retest at 6 months (next month) but wanted your insight.  Thanks again.

[H. Hunter Handsfield, M.D.]

Not only have I never had a case, I have never heard a story from any of my many colleagues (who have much greater experience than I do) having a patient who was HIV negative 6 weeks after exposure and positive later.  Unless, of course, there were new exposures in the meantime.

Statistically, your odds of getting infected with 8 episodes of unprotected sex, with an HIV infected woman on care and with a relatively low viral load, were no more than 1 chance in several hundred, maybe a couple thousand.  But to be absolutely sure, if your last test was 6.5 weeks after exposure, you should have a final test.  Testing at least 3 months out is definitely recommended for someone who definitely was exposed to a known postitive person.  But the odds are overwhelming that a final test will be negative.

I'm sure someone will question why this advice is different than the other advice I have often given about 6 weeks being sufficient.  I'm not going to repeat what has been said so many times.  Don't ask!  Instead, go back and search for discussions using keywords "time to positive HIV test" and "HIV diagnosis".

Good luck--  HHH, MD

[skerdstraght68]

doc, you need to have "before you ask please see, "time to positive HIV test" " under your user name on the left.

Does each act carry the same risk, Ie 1/1000 or does the group of acts lower the number.  I mean if you had sex 1000 times and didnt get HIV it's not like the 1000th time carries 1/1 odds.

[skerdstraght68]

There is a remarkable moderator on aidsmeds.com named Ann who is positive and her BF is neg.  They had an active sex life for a year and half before she was diagnosed with HIV.  He is still negative to this day.  I'm sure you'll be fine.

[anotherdummy]

They had unprotected sex during this time?  and he was not infected???

[anotherdummy]

I am far from an expert, but I would feel the doctor's words should be a sigh of relief for you.  

I'm praying for you too.

[anotherdummy]

I don't think she was on care as she did not know she was positive....or did I read it wrong?

[shouldaknownbetter]

Thanks, Dr.
That is some relief; although having that PCR Test at 60 days come in negative; should close the case, right?? The staggered timing of both these tests confirm each other, I believe.
Thoughts anyone?

[anotherdummy]

I dont know how porn actors can live like this.

[oceans3]

please tell me WHY...if she was receiving "care" did she not inform you she is HIV positive when you had unprotected intercourse??? she had 8-10 chances to inform you.

[Kibbles'nbits]

Dumbo-

I read it the same way. From what I read, I don't think she was on care until after she was diagnosed so I believe that might make an impact on the doctor's answer

[shouldaknownbetter]

I think we may be mixing up comments that someone made about Ann with my girlfriend, whom had no clue she was positive until she got tested in early April.  She currently now is under care with a specialist after the diagnosis, with a low viral load.  Sorry.

[shouldaknownbetter]

One more clarification; she is with a specialist,but is not medicated.  The viral load was the initial load right after her diagnosis.  She has been given no meds.  Thanks.

[skerdstraght68]

Ann is a moderator on aidsmeds.com.  You should go there and talk to her.  Her situation is identical to yours.  Once your out of this you're going to need to practice safe sex and she would be the one to help you out.

[oceans3]

okay...i see it now. i totally misunderstood and glad (well, not glad but you know...) that she truely did not know when you two had sex. this must be devastating for you both. you sound as if you have a good head on your shoulders. the dr. is confident you are well so hopefully that will put your mind at ease some. let us know how things go if you will??

[shouldaknownbetter]

Thanks, all..

Wondering if the Doc missed the fact that I had a PCR test 2 weeks after the Elisa.  It was very justified at the time.
It actually validates the Elisa, and vice versa.  Hoping this is conclusive, as it should be...

[shouldaknownbetter]

Wanted to let everyone know, that I just tested negative on Elisa at 6 months.  Thanks to Dr. HH, and his guidance and advice.  I am a huge fan and kudos to your CDC guideline publication.  You did advise the use of PCR in a high risk exposure situation such as mine, as a diagnostic option.  Thank you again, Dr.