qucik question

[21allgood]

I had sex with a prostitute back on 5/1.  We reused the condom and I am not sure if I put it on it on the same way both times.  There was alot of alcohol involved so I cannot recollect much.  She said she was HIV Neg but I went ahead and at 20 days did an HIV - 1 RNA Qualitative and it came back non reactive.  I also did an HIV 4th generation test and it too came back Non reactive.  Should I consider getting retested at 6 weeks or later to confirm that I am negative.  

Also, the RNA qualitative says they recommend considering HIV-2 nucleic acid testing if clinically indicated.  I do not this that applies here as I was negative, would you agree?

Last, I have been on Levaquin for 7 days at the time of these tests, will it skew the test at all.

Much thanks for your advice/answers.

[21allgood]

You replies are very helpful and I am sorry for the anxiety driven fear and yes the guilt.  I am sure that you see a lot of this reaction and for that I apologize.  Thank you for your help, you have made it very clear on what I should do and you will not hear anymore anxiety questions from me.  Thank you so much for your time and have a good day.

[Edward W Hook, MD]

You are over reacting.  I suspect this is because of your own fear and guilt over cheating on the person you are in a relationship.  I cannot help that and that will not change my assessment of advice.  Further, asking "have you ever" questions is silly as well.  

As a final answer to your anxiety-driven questions I have the following final responses:

Yes, I have seen persons with negative PCRs soon after exposure become positive at a later date.  Each case is different and that does not change the FACT that, based on the information you provided, you are almost certainly not infected with HIV.  You will now worry about what I mean by "almost" so let me provide a similar statement- it is also almost certain that you are not going to be struck by lightning today.

The likelihood that you are infected is far less than 1%.

It should be obvious to you that if I recommended that you not worry and move forward, that I would also say that there is no reason related to the exposure you described to avoid unprotected sex with the partner you cheated on.  

Looking for ARS is a waste of time. Should it occur, it would be obvious and many people who acquire HIV do not experience the ARS.  Your mild symptoms do not suggest ARS.  

I hope these replies are helpful.  I will have nothing more to say. EWH

[21allgood]

Thank you Dr, I had a couple of additional questions.

You mention that if you were me given my low risk and test results that you would not worry and not look to retest.  You said that while my tests were strong evidence I did not get infected, they are not absolutely sure and that to be absolutely sure I can retest the 4th generation test at 4 weeks.

The fact that the tests I took could be inaccurate has caused me some anxiety.  Have you seen patients that have done the PCR RNA test and the 4th generation and then 8 days later get different results?  I was excited when I got these results that they did not find the virus, the antigen or antibodies at 20 days.  I realize the antibodies may not yet be present but the fact no virus or antigen was encouraging.  

You do say that it is very, very unlikely that I acquired HIV, which is very encouraging, can you put a percentage on this?

I am in a relationship, would you recommend unprotected sex with my partner whom I have been with for many years?

If the tests at 20 days were negative does that mean I could still yet experience ARS related symptoms?  Because I have skin blemishes, red spots forming around my neck mostly on my left side, raised but more like pimples.  Nothing on my chest or back, no fever, glands seem fine, mild diarrhea but may be due to new anxiety.  Just trying to ease my anxiety.

Please let me know your thoughts in regards to my concerns and my questions.  Thank you for both for your help!   To have experts here like you both is a god send and I hope you both have a wonderful Memorial Day!

[Edward W Hook, MD]

As I told you above, we do not recommend PCR for HIV diagnosis despite what those who profit by selling it tell you.  It does appear to become positive before 4th generation tests but only by a few days.  On the other hand, it is more expensive, it gives more false positve results, and the time course over which it becomes positve is not nearly as well studied as for the 4th generation tests which, as I also told you, give definitive results at 4 weeks (28 days).  Your results are not yet definitive but are strong evidence that you were not infected as the majority of persons who acquired HIV would be positive at 20 days. Given the improbability of infection in the first place, your negative tests make it very, very unlikely that you acquired HIV.

Shooting nerve pain of the sort you describe is not a sign of ARS or recently acquired HIV.  and yes, ARS symptoms do tend to occur together.

Levaquin would have no affect on ARS, including the rash of ARS.  it would not affect test results either.  EWH

[21allgood]

Also, I know levaquin is good at clearing up skin issues, would the levaquin have slowed a rash outbreak?  I have a single red zit like blemish on my right neck and a single one on my left, no real other skin issues.  Would the Levaquin hold skin rashes at bay or any other symptoms of ARS?

Thank you

[21allgood]

Also my second attempt was condom protected but not sure it went on the same way as first time.  

[21allgood]

Thank you for your advise.  They told me that the RNA test based on my 20 day test from exposure is 95-99% accurate, is that not true?  I will take your advise and not worry but will probably go ahead and retest at 4 weeks.  By 4 weeks do you mean 28 days and that will be 100% accurate?  Thus far the only symptoms I have are shooting nerve pain mainly in my abdomen and legs/feet.  No fever, no sore throat or glandular issues.  I did have alot of anxiety with stomach issues but after receiving this great news, or so I thought, that has all gone away.  The nerve pain concerns me due to having herpes 2 which was confirmed and that I had shingles many years ago.  Does the nerve pain indicate any sign of ARS?
I have read that ARS symptoms usually occur all together, is that true?  

Thank you and I will let you know my results.

[Edward W Hook, MD]

Welcome to the Forum. the exposure you describe was very, very low risk.  Most CSWs do not have HIV and your partner told you she had been tested recently- most people do tell the truth.  Further your initial exposure was condom protected- whether the second one was is not clear but may have been as well. since then you have had both an HIV PCR (which we do not recommend for HIV diagnosis) and h 4th generation test (which we do recommend).  There are no good scientific data regarding when PCR tests are definitive (despite what those who sell them say) and 4th generation tests provide definitive answers at 4 weeks following exposure.  Thus your tests are strong but not absolutely sure evidence that you were not infected.  If I were you, given your low risk of infection and your test results, I would not worry further and would not feel the need to test further.  If you want to be totally sure however, repeat the 4th generation test 4 weeks after your exposure.

Taking levofloxacin (levaquin) will not affect your test results.

I hope this comment is helpful. EWH