need help high risk exposure

i had unprotected sex with my partner many times (+- 10) without knowing he was hiv+ . we were together for 5 months since october 2007.
i tested negative in dec 2006 and in dec 2007,
we did not have anal sex,
we did have unprotected oral and vaginal sex no eyaculation though,
the last test was 33 days after the last high risk exposure (vaginal unprotected sex)  and was negative , ( axsym abbott MEIA)
i´m so scared, i´m living a nightmare .......
i just want to know what are the odds......'  will i seroconvert in time?
how long should i keep living this nightmare to be safe
how long should i get tested again to be sure
thanks

[Teak]

You keep having unprotected sex and putting yourself at risk you will end up positive. You will need to test 3 months post your last unprotected sex. Always use condoms and water base lube.

[helpme649]

thanks for your comment
i did not know that he was positive until 2 weeks ago. like i said 33 days past since last exposure because we are not together anymore  
if i just would have known ....i wouldn´t be living this hell
what are the odds? what do you know about cases like mine? , because i read a lot of cases but everyone had just 1 o 2 encounters but i did lived with this person hiv + and had sex as frecuent as any couple does , most of them with condon but some not
i guess is not the same risk my case compares to the casual risk of others.....
i miracle is what i need!!!!

what do you know about axsym test sensitivity ? it was negative and im testing in 3 weeks what are the odds this test result change?
thanks for your help

[Teak]

If he was recently infected he could have a high viral load which would increase your chance. Not everyone will contract HIV on the first time or the 100th time but why take a risk when it can be prevented with a condom? 3 weeks is way to early to test. Take your test at 3 months post exposure to obtain a conclusive test result. You can take one at 6-8 weeks MOST will have tested positive by then but you will still need to get a conclusive test result if your test is negative at 6-8 weeks post exposure.

[Teak]

Your MEIA test is the same as an ELISA test and is very reliable.

[bemyown234]

In this case, being a high risk situation,( several unprotected contacts with a confirmed positive  contact) agree with Teak that although a 6-8 week test is highly reassuring, your pre-test odds were still high enough to warrant a 3 month test to be absollutely sure.

[dell111]

According to the doctor in the other hiv forum on this site, with modern blood test today searching for antibodies, it can be picked up in as little as 2 weeks, and for most people be picked up by 6 weeks. He said something along the lines of he would bet his lifesavings at a roulette table on someone being negative if they tested negative at 5 weeks, so it would not hurt just getting a test in the next couple days for peace of mind.

[helpme649]

thanks for your comment
recently infected ?  i do know now that his exgirlfriend was the person he got it from and he broke up with her in june 2006 they were together for 18 months , is that recent?  how much time is recent ?
he had no symptoms...but i guess i have to wait his test (viral load cd4 and cd8)

[Teak]

It all depends if he is on HAART or not. Either way you'll need to get tested.

[helpme649]

no he was not aware of his status so he was not on HAART we just find out the bad news

[helpme649]

i went to my doctor and he did not gave me profilactic medication
is it too late for that?

[Teak]

You could have been given PEP up to 72 post exposure. The earlier it's started the better.

[helpme649]

thanks
but i did not know his status until 33 days after .  
i will get tested at 8th week
at day 17th after exposure  i had a headache and after that cough for 3 weeks almost., no fever no lymph nodes.

what is the chance that my 4th week negative test turn positive??? considering my case

[Teak]

Just get tested at 6 weeks and then again at 12/13 weeks.

[ECN44120]

Just to give you more hope and support, the good news for you is that your 33 days test, was done with one (if not the best) available test, the Abott axsym MEIA is a 4th generation test that looks for antibodies and for the p24 antigen too, this test has the best evaluation among a lot of test, and had the best performance on detecting the early infection of HIV, you can read how the test perfomed in an evaluation of the MHRA of UK = FDA US, and then you can read the knoledge base of the HIV test in this two links.

www.hpa-midas.org.uk/documents/reports/HIV/MHRA_03132%20AxSym%20HIV%20Ag-Ab%20combo.pdf

http://hivinsite.ucsf.edu/InSite?page=kb-00&doc=kb-02-02-01

Eventhough you need the 3month test to be 100% sure, you can be pretty confident that your 33 days test is very very encouraging.

Best luck for your upcoming test.

[helpme649]

thank you so much for you comment
i felt some relief after reading your words ,
i know i still have so many difficult things  to go through....
this is  a matter of time , but i feel i have some hope now
once again thanks

[siteheld]

I know someone personally who was in your same shoe. She is still negative after five years after her last exposure.
Any negative result is quite encouraging.
At three months go take your conclusive negative test.
Good luck.
Next time get the person tested before taking it to another level.

[HSci34]

The Axsym MEIA is indeed a good quality immunoassay. Your 33 day result is highly encouraging. It was done at a time when about 90% of people would have tested positive. Due to your high risk, however, I suggest to continue testing until the 3 month mark. It is unlikely your result will change, but due to your repeated exposures, it is best to test out to 12 weeks to be completely sure you are not infected. My prayers and thoughts are with you.

[LFanswers]

Helpme649, I am in your situation  but slightly different. I had unprotected sex with my partner twice after he got infected having unprotected sex with someone else..... I tested negative at 3 weeks and at 8.5 weeks.. I've been told countless times my last negative was the one that told the story but I am still scared ****less. I am now at 11.5 weeks and waiting patiently...

I have the feeling you'll continue to test negative. You were exposed so many times, the infection would have appear long ago ( meaning, in your 33 day test ). I find it hard to believe that whatever kept you from getting infected the first couple times wasn't present the last time. The fact that he never ejaculated inside may have set the deal in your favor.

[regularjoey]

I agree with the comments above.  It would be extremely unlikely for you to test positive now.  Follow the testing protocol, but don't be so worried about it, sounds like you dodged it.

[ECN44120]

If you continue testing with the same test, dont wait for the 3 months alone, take another test at 42 days (6 weeks) this would be 95% accurate, and then at 9 week the test would be 98%-99% accurate, so you have more encouraging results, it a lot more easier to wait 2 or 3 week and have an ecouraging result that wait 60 days for the definitive results, anyway is up to you but that strategy is helping me a lot, and another thing, when you get your 3 month negative result (Im confidentyou will be negative) forget about it, dont read more post, forums, studies, ect. becouse in the internet you can find whatever you want, and is common to find more worryng info that good info.

By the ods you ask before, taking that CDC states that the risk per exposure are
0,5/10000 (receptive oral sex)
1/10000 (insertive oral sex)
10/10000 (receptive vaginal sex) so asuming and that you had 10 unprotected vaginal sex, 100 unprotected receptive oral sex, and received 100 unprotected oral sex, you overall risk is 2,5% But this risk, when you have a 85% accurate result will be 0,375% in other words you have 1 chance in 266 to be positive and 265 to be negative, when you get your 6 week the chances would be 1 in 800 to be positive and 799 for being negative, at 9 week the chance would be 1 in 4000 to be postive and 3999 to be negative and at 3 months tou will be 100% sure you are negative.

In poker numbers the chance of having 4 of kind palying caribean poker on a casino is 1 in 4166,66  pretty close to what you have at 9 weeks, and if this would be usual Vegas would be broke and we would be rich. so keep the fait.

best wishes again

[helpme649]

thank you all for your comments
your words are very encouraging
the only thing that was present the last time .........  last day of my period wich may increae the risk but he eyaculated outside.
its quiet unbelievable sometimes to think that im going to be ok considering the high risk
i put myself through .....just for being stupid and confident in the only one thing in life you can´t be
for those who share with me this horrible nightmare  i will keep praying that everything is going to be ok  and that your test will be negative
once again thanks

[ECN44120]

Your period may increase the risk for the penetrative partner, not for you,

[snippets69]

If he didn't *** inside you, someone already mentioned, this is a huge weight in your favor.

Your 4th generation HIV test at almost 5 weeks pretty much proved you don't have HIV.

A 28 day Antigen / Antibody test is as good as any 3 month ELISA.  The Antigen test in your assay are 99%+ sensitive.

The antibody test alone at 4 weeks is 90%.   The antigen test would of caught the rest.  Congrats.

[ECN44120]

snippets69 is right when I calculated your risk i forgot to ad the p24 test to your ods, so your chances right know are 1 in 40000 so you are pretty close to 0,

[helpme649]

well  i just tested today 46 days after last exposure (6,5 weeks) and it was THANK GOD negative
AxSym abbott AGg/Ab p24  4th generation test
what are my odds now?  
when should i get tested again ?
my prayers to everyone

[lostone08]

thats great at 6.5 weeks most people would have showed up positive if they were your almost there like the hiv expert on here states he has never seen anyone test neg at 6 weeks and test positive after the fact good luck

[regularjoey]

In the US testing protocol calls for a test at 3 months to rule out HIV infection.  Since you are not in the US (I'm guessing because of the test that you took), you might want to contact your local health department for information that applies to your situation.  At any rate, the odds of you having HIV are now in the one-in-a-million range.  Follow the protocol, but I'm sure that you have nothing to worry about now

[ECN44120]

I`ll repost a Dr answer, whit the test you had 5 week would be the window period since is a duo test, the odds of you getting hiv are less than 1 in several hundred thousands, just test again in 6 weeks since you where at high risk.

by H. Hunter Handsfield, M.D.
Feb 13, 2008 11:18AM
A negative duo test at 5 weeks will be 100% reassuring; even 3-4 weeks.  That's the whole idea of dual testing for antigen and antibiody:  it is almost impossible to have a new HIV infection without one of those being positive by 4 weeks.

[Teak]

A DUO test is not negative conclusive any earlier than an antibody test. The only thing with a DUO test is earlier detection of up to one week earlier than a standard HIV antibody test.

[stelutu]

       Actually Teak is right, I have read about this too.Duo test is 1 weak better than the others   (p24 is detectable at 2-4 weeks maximum) than only the Ab is detected, but what about the seroconvertion when the Ab are being produced?
       The test you took is good indeed (i took a duo Elisa 4th gen, not knowing at the time it was the worse duo test there is), but anyway, that is not important for you, as your 6.5weeks is more than encouraging, very unlikely to change.
        For your being 100%ok (for your peace of mind) you need to confirm with a 12 week test, but do not give it much thought now, as you surpassed the nightmare. For you to be infected at your last encounter....would be unlikely, as you did that many times before and you tested negative for those occasions.
       So congrats and be careful with your future partners , as I learned this simple postulate the hard way too.......
       You are very close to an wooo hooo now and a great party, but do not forget to confirm with an 12 weeks !

[peekawho]

I'm glad everything is coming up negative so far, and that's very encouraging, but as many, many people have told you, you'll have to test again at 12/13 weeks to be 100% conclusive.  

[ECN44120]

Sorry to disagree but Dr. HHH, PHD Neil Constantine, ROCHE, BIOMERUX, and a lot more of scientist and doctors says that a 4th generation test like the Axsym MEIA are conclusive at 4-6 weeks, is not my personal opinion is the labs and scientist opinions read this links, any way to be extrasure get the 12 weeks test.

http://www.biomerieux.es/servlet/srt/bio/spain/dynPage?open=SPN_CLN_PRD&doc=SPN_CLN_PRD_G_PRD_CLN_37&pubparams.sform=1&lang=es

http://www.roche-hiv.com/portal/eipf/pb/hiv/Roche-HIV/first-line_diagnosis

http://hivinsite.ucsf.edu/InSite?page=kb-00&doc=kb-02-02-01

Niel Constantine, PhD, University of Maryland School of Medicine

Fourth-Generation Assays for the Simultaneous Detection of HIV Antigen and Antibody

Antibody can be detected in a majority of individuals within 6-12 weeks after infection using the earlier generations of assays, but may be detected within 3-4 weeks when using the newer third-generation antigen sandwich assays.(2) The window period can be shortened to about 2 weeks using p24 antigen assays or reduced to 1 week with the implementation of nucleic acid detection assays.(12) Consequently, the window period between infection and detection of infection may be <2 weeks if a comprehensive testing approach is utilized. The detection of p24 antigen by ELISA is a simple cost-effective technique to demonstrate viral capsid (core) p24 protein in blood during acute infection due to the initial burst of virus replication after infection. In order to maximize the detection of all infected individuals, including those in early infection, antibody, antigen, and viral RNA tests should be used. However, viral RNA tests are expensive, time consuming, and unavailable in many laboratories. Laboratories that possess ELISA capability can increase the ability to detect most infections by testing for both HIV antibody and p24 antigen. During the late 1990s, assays in an ELISA format that have the capability to detect both HIV antibody and HIV p24 antigen simultaneously were developed, thereby eliminating the need to perform separate assays.

The new generation of combination ELISAs that simultaneously detect both antigen and antibody has been developed and marketed, and offers advantages for decreasing the time, personnel, and costs necessary to perform each assay individually. These assays have demonstrated a high analytical sensitivity of detection that is most likely attributed to the combination of a third-generation format (antigen sandwich) for antibody detection and the ability to simultaneously detect HIV p24 antigen. To date, there are 8 commercial, combination antibody and antigen assays that have been developed and evaluated.(13-31) These fourth-generation assays include the VIDAS HIV DUO Ultra (bioMérieux; Marcy l'Etoile, France), Enzymun-Test-HIV-Combi (Boehringer; Mannheim, Germany), Vironostika HIV Uni-Form II Ag/AB (Organon Teknika; Boxtel, Netherlands), AxSYM-HIV Ag/AB (Abbott Laboratories; Abbott Park, IL), Enzygnost HIV Integral (Dade Behring; Marburg, Germany), Genescreen Plus HIV Ag-AB (Bio-Rad), and COBAS Core HIV Combi (Roche Diagnostics; Mannheim, Germany). The eighth assay is an 18-minute, double-antigen sandwich combination assay called the Elecsys-HIV Combi (Boehringer) that has been reported to have a specificity of 99.8% when challenged with a cohort of hospitalized patients.(16) This rapid assay is based on electrochemiluminescence and is reported to reduce the window period by 5 days over antibody tests. A ninth, unidentified assay is a lineal immunoenzymatic assay evaluated to have a sensitivity of only 99.5% and a specificity of 94.8%.

The benefits of testing for both antibody and antigen are justifiable due to the need to identify individuals with both established and early HIV infection not only for the blood donor population but also for some clinical applications. Early detection of infection via antigen testing promotes the prompt referral of infected individuals for the initiation of treatment, counseling, and prevention interventions to reduce the risk of transmission. Due to their ability to detect p24 antigen, the fourth-generation ELISAs will be of value in detecting early infection. These assays are highly applicable for the diagnosis of early and established HIV infection by hospital and private clinical laboratories and other laboratory settings. In these settings, individuals to be screened for infection are of higher risk groups than the blood donor population, and thus require the use of testing methodologies with high levels of analytical sensitivity to detect primary infection. Of significance, the high level of analytical and epidemiological sensitivity demonstrated by most of the fourth-generation assays with seroconversion and clade panels, as well as a variety of patient populations, makes them ideal for use in a variety of testing situations for the diagnosis of early and established infection. In routine laboratory settings, HIV-infected samples that are identified via antigen detection would not have been identified by the usual screening antibody assays, because antigen testing of patients is not performed commonly as a screening tool outside blood banks. The detection of early infection has been shown to be beneficial for the prompt initiation of appropriate antiretroviral therapy in a clinically relevant time frame. Additionally, early detection will help in the timely implementation of interventions such as the counseling of patients, prevention of transmission, and management of infection.

[Teak]

What is 12 weeks? It's three months and no the DUO test is not much better it has two window periods compared to the standard antibody test that have one window period. What kind of treatment are you going to get from early detection? None. They aren't going to start anyone on medications with a CD4 of 350^ and people that are newly infected usually have normal CD4s which is between 500-1500+. There is no real benefits.

[helpme649]

well teak is right about treatment,  you dont start medication until your cd4 falls below 400 , early detection for sure gives more hope to the people who are in a situation like me , makes shorter the nightmare, and  more important i think  is prevention interventions to reduce the risk of transmission
thanks to all for your comments it helps a lot
ill keep waiting for next test .....hoping to be negative
sure i want to  yell  wooo hooo now, but i rather be conservative and wait until 12 weeks test to be negative to do so, a change in the results will be devastating for me
my prayers to all

[LFanswers]

Teak and Helpme,

I'd really like to have your opinion.

my partner had a viral load test and it said there were 120,000 copies per ml.. I don't know th CD4 number but the doctor said it was o.k. regardless, he prescribed antriretroviral medicine ( combivir+sustiva combo)...

my boyfriend got infected just 6 months ago, was it the right time to start with the medicine?

[helpme649]

viral load and CD4 lymphocyte count are determinants of progression to AIDS and survival, The maintenance of sequential viral load values < 35.000 copies/ml is associated with a lower risk of progression. The maintenance of sequential viral load values < 150,000 copies/ml is associated with higher short-term survival rates.
so it was the right time to initiate medications

[helpme649]

Benefits of delaying therapy include avoiding the negative side effects and toxicities associated with the drugs, delaying selective pressures that induce the development of resistant strains of the virus, and preserving a limited number of treatment options. On the other hand, the risks of delayed therapy include the possibility of irreversible damage to the immune system, development of AIDS-related complications, and death. data from randomized trials are not sufficient to guide the decision regarding when to initiate antiretroviral therapy in asymptomatic persons,  The near-uniform finding that disease progression and mortality are significantly worse among patients whose treatment is delayed until the CD4 cell count is less than 200 per cubic millimeter
Persons who present initially with CD4 cell counts of less than 200 cells per cubic millimeter should be offered treatment as soon as the baseline evaluation and initial counseling regarding drug adherence are completed. Persons with CD4 cell counts of more than 350 per cubic millimeter generally can be observed without therapy, on the basis of data showing similar outcomes with and without therapy among patients with CD4 cell counts in this range; exceptions are patients whose plasma HIV-1 RNA level is more than 100,000 copies per milliliter, since this level is associated with an increased risk of progression to AIDS that is independent of the CD4 cell count. In persons who are being followed without therapy, a rapid decline in the CD4 cell count (i.e., a decline of more than 100 cells per cubic millimeter per year) may also be factored into the decision regarding when to initiate therapy.


i also send you this articles


1- Rates of Disease Progression by Baseline CD4 Cell Count and Viral Load After Initiating Triple-Drug Therapy  
http://jama.ama-assn.org/cgi/content/full/286/20/2568

2-  HIV Viral Load Response to Antiretroviral Therapy According to the Baseline CD4 Cell Count and Viral Load
http://jama.ama-assn.org/cgi/content/full/286/20/2560
best wishes

[LFanswers]

helpme, thanks a lot for the info, I wasn't sure if my partner should trust his doc.. I don't know, just a feeling.

but it seems he is right on his prescription, after all.

one more thing, since you seem to know a lot:

isn't 121000 c/ml a big number for merely 4.5 months of infection? I thought the thing progressed much slower :( ..

[regularjoey]

No, it doesn't work like that.  Viral loads are usually very high in the first months after infection - that by itself does not mean that there is rapidly progressing disease.  That's not a reason for additional concern. Regarding treatment - some doctors believe that treatment early after infection has long-term benefits.  There is no hard proof for that and many people still choose to wait until their CD4 T cell count drop to 350.

[helpme649]

hi
so how was your 12 week test?
i hope negative
regularjoey is right , the high viral load around 6 months after infection doesn´t mean a rapidly progressing disease it reflects the initial stage and im sure he is asymptomatic
but is highly infectious though ,  pretty soon his inmune system and medications will low the viral load and will be like that for many years just keep going to the infectologist as he has to and take medication as indicated.
best wishes

[helpme649]

does anyone have any stats on how many people who have had antibody tests at 6-weeks, become positive at a later date?????.

[LFanswers]

Hi, thanks for your concern. I decided long ago to wait until I reach the 13 weeks mark. I dont want my mind later annoying me with " 12 weeks isn't 3 months " ideas...

for practical purposes, 12 or 13 weeks is just the same but 95% of the medical world speaks about "3 months", specially the official guidlines of my country. Noone ever speaks in terms of weeks for consluvie results, its always " 3 months". SOME people say 12 or 13 weeks is the same, I'd rather wait and be absolutely,completely conclusive than leave room for doubts.

I am not sure I can be helpful in regards to your last question but a moderator at aidsmeds.com ( apparently a person devoted to all things hiv/aids and that tests people very frequently) says that she still has to witness a 6 week negative turn into positive weeks later after the same last exposure... she claims a 10 week negative test turning into positive is "unheard of".  The docs at this site begin talking about unchanging, reliable ( though not conclusive) results around the 8 week mark ( 98%-99% of people will have turned positive by the 8th week, the docs claim, still they use an estimate of 95% for the 6 week mark. )

this all may sound encouraing but then you go to forums with HIV positive people claiming to have seroconverted as late as 7 months later after exposure. They are most likely spreading BS but one can't help to think " what the **** is going on here, isn't it 3 months?? conclusive "

I suppose there are people who turn positive later, after all I don't think a 3 month window period is there just to mess around with us, people exposed to the virus. We just have to consider that if we are basically healthy there is no reason whatsoever to no be developing antibodies at 6-8 weeks.

[alienshadow]

84 to 90 days is three months if it helps any here i stopped testing at 84 days and i took the uni gold test and got the results in 10 minutes all test before then where the hiv rapid test

[LFanswers]

I won't go into a debate about whether 12 or 13 weeks is the really magic point just consider the extremely high risk that people like help649 and I had in regards to HIV exposure: unprotected sex more than once with persons later discovered to be HIV+, were you in such a risk? going by your confidence, you sound like yours was a low risk encounter.

it won't be easy for us to get peace of mind at any week or month. like help649 said, I still can't believe the risk I was put into and that I will very likely get out of this uninfected, it is like you think of the incredibly good luck you had and you instantly want to cry.

As for me,the 2 tests that I have taken were extermely soul and energy draining so I want a VERY conclusive test ( meaning one done past 90 days, 13 weeks ).

[alienshadow]

thats your choice not mine
as for my exposure sex with an escort and condom slipped off low risk or not still a risk anyway from all the research i have done 84 days would be sufficient enough to show a positive result this day and time

[ECN44120]

The guidelines realy says 3 month (becouse in stadistic a month is count for 90 days) so the window period in weeks is really 12 weeks and 6 days, but is the same if almost no one has seen an 8 week turning positive, is even less posible a 12 week becoming positive in 6 days. to answer helpe question, Drs. here said that they never saw a 6 week negative becoming positive, but if the guidelines says 90 days, that is the guideline so we should follow it.

[helpme649]

does anyone know if the viral load can influence the window time ???
i mean if the person you had contact with is hiv + and has a low viral load , lets say you got infected (considering the risk)  ,  this low viral load can make your body recognizes the virus slowly making the antibodies appear later in the window period???
is it only your inmune system which determinds this or does it has to do anything the viral load in the time of the appereance of the antibodies ???
sorry if this is  not quiet clear but english is my second language
i hope you can understand

[helpme649]

does anyone know?

[HSci34]

That number is very arbitrary.

There is no real difference between antibody levels at 11.5 weeks vs 12 weeks vs 13 weeks. Don't get hung up on technicality - this is science and not politics :P. As long as ~3 months has passed you are in the clear with higher risk exposures. You're not going to magically seroconvert in the last week prior to week 12.

[Teak]

His infection has nothing to do with how your body handles HIV and produces antibodies. When you are first infected with HIV your immune system is not damaged, the damage happens later if one is not on HAART.

[helpme649]

well thanks but i was just wondering that if my ex- partner had a low viral load at the moment of exposure that would have an influence in the time of the appearence of antibodies in my body  (window period)???

[Teak]

NO...

[HSci34]

No. You need to stop analyzing things. Nothing will affect the appearance of antibodies in your body, except if you area on immunosuppresants (i.e. you are a transplant patient) or you are undergoing chemotherapy, and this has tremendously weakened your immune system.

[helpme649]

i mean the antibodies will appear at the same time  ????with the elisa test ????????  no matter if it was just 500 copies or 100.000 copies that enter your mucosa barrier at the time of exposure?????  

[regularjoey]

Look, people are either infected or not, and once one is infected his/her body starts to mount an immune response.  There has never been any evidence that smaller inoculum of virus produces slower onset of infection and thus prolongs the window period.  It's a threshold event, not a gradient.  Like HSci told you, stop overanalyzing things, follow the testing protocol and trust the result you get.

[HSci34]

Stop worrying about that. Once you are infected, your immune cells mount a response. From your question stem, it is apparent you are reading too much into things. Stop thinking about it.

Test at 6 weeks - almost everyone tests positive by then
12 weeks - get a conclusive result with higher risk exposures

That's it. Nothing more. All else is irrelevent.

[helpme649]

thanks for you comments yeah you are right i am overthinking now
i tested negative with duo test at 6,5 weeks (46 days) and im going to trust that
i ll wait for my conclusive test at 12 weeks hoping is going to be negative i ll let you know
my prayers to all