So difficult to find reliable information

Hello Dr. (I will try to keep this concise),

I have a few questions for which I have not been able to find any reliable/researched answers for.

1. What are the statistics for high risk transmission of HIV ? - in other words female to male transmission, unprotected vaginal sex where both are 20-26 white affluent.
2. Window times - I know you have addressed this on a few occasions, and the question must be wearing you thin, however I read on the CDC website that you should have a test 3 months after exposure to be considered HIV free. You have mentioned 6-8 weeks is a very clear indicator if you haven't had high risk (male to male/sex worker) exposure. Is the CDC just being very cautious and addressing the 1 in 1 000 000 cases that may not show up until after 3 months, or is there a ligitimate risk that a possitive test would not show up after 7 weeks or so?
3. The rash - when reading anything about ARS symptoms, everyone comes across a symptom described as a rash - is there any details that can clarify some details on what this rash should consist of (ie. what it looks like, is it itchy etc.), or is it ambiguous like many things surrounding HIV symptoms ?
and finally, where can I find credited research on some of these issues. It is frustrating at times that there seems to be so little consensus on many of these issues (and a slue of other HIV questions ranging from 3rd world funding, to its prevalence in certain areas of the world). I notice that you have some research papers on HIV and I wonder where the community can find papers like this that use facts and research as opposed to much of the garbage found on discussion boards.
I didn’t do a great job of keeping it concise (no one ever does when they start with "I'll keep this short", however I have long admired your ability to cut to the point and answer questions succinctly, and I have so many questions for which I can not find any answers.

Thank you for your time, and then some,


23Guy  

[Edward W Hook, MD]

In general, the purpose of the Forum is to assist our clients in assessing their own risk and sorting out steps to deal with situations which may or may not require some sort of testing or intervention, not as a site for Q&A regarding HIV.  I presume the questions you are asking in some way are related to personal concerns so I will do my best to briefly answer them.  I will not however get into a dialog about HIV-related facts and their origins.  This epidemic has been going on now for nearly 30 years hand has be the subject of an enormous amount of scientific research.  This is the wrong place to try to summarize that.  So, with that as background, let's get to your questions:

1.  Your question has two parts.  What is the risk from unprotected vaginal sex and how does that risk change if the couple are 20-26 YO whites living in North America (I presume).  The risk for unprotected vaginal sex is 1 infection per 1000 exposures, on average.  This risk is in turn modified by the chance that a partner has HIV.  for 20-26 YO white, non-IV drug users in the U.S.  there is less than 1 person in a thousand who are infected.  Putting these together, a single act of unprotected intercourse with a white partner of the opposite sex has about a 1 in 1,000,000 chance of leading to HIV acquisition.

2.   The CDC is being conservative (they really can't "afford" to very be wrong). With currently available, 4th generation EIA tests antibodies to HIV are detectable in virtually all newly infected persons within 8 weeks.  As the DUO, antigen-antibody tests already available in much of the world become available in the U.S, this time will decrease.  I know of no expert who can find a normal person who has acquired HIV in whom antibodies were not detectable by the 8 week time point for over two years.  

3.  The rash is highly variable but tends to be generalized over much of the body.  More importantly however, like other so called symptoms of the ARS, rash symptoms are TOTALLY non-specific and when people experience "ARS symptoms" they are much more likely to have something else, usually some other, more typical virus infection.  When this has been studied in the US, less than 1% of persons seeking medical care for "ARS symptoms" are found to have HIV, the remainder having symptoms due to other processes. In contrast, over a given year, there is almost no one who has not had a viral illness, night sweats or both (sometimes on multiple occasions).  In addition, it is also important to realize that many persons who acquire HIV do not experience the ARS.  For a person to try to judge their HIV risk based on "ARS symptoms" is a waste of time.

Hope this helps.  EWH

[23guy]

Thank you Dr.,

As you presummed, this was a question specific to my own fears. I have dealt with a lot of anxiety, and have read so many conflicting articles and the General Practitioners I have dealt with seem to have very little knowledge on HIV and testing - so I was really looking for reassurance and facts. Thank you so much for your patience, all the doctors on this site provide a very valuable service,

D