possible delayed seroconversion?

[canyon721]

I am a life-long asthmatic, now in my late 50s. I take Singulair and epinephrine regularly and on occasion other steroids (Advair).  I also received a needle stick within three weeks of having anal and vaginal intercourse.  I had an HIV test taken at about 8 ½ months after these events.  It came back negative.  Here is the story; please read and advise as, like others, I’m very anxious.

About 16 months ago (3/05) I had unprotected vaginal and anal sex. (I'd known the woman many years and she assured me she was HIV negative.)  Soon after that I became very ill.  First, came a prostate infection about three weeks after the intercourse.  I was taken to the emergency room at a local hospital and catheterized. The attendant stuck me with a needle in the thigh sometime during catheterization. Within a few hours a red welt appeared around the stick area.  (This welt took about six months to resolve.)  Soon after the intercourse/stick I lost about ten to twelve pounds. I began to have pains in my lower abdomen followed by spontaneous and explosive diarrhea.  (This lasted about seven to eight months and has slowly abated.) (I went to a gatro dr and he suggested gall bladder surgery; which I did. This did not stop the diarrhea.)  I had a terrible sinus infection. (Something I'd never had before.) I began to have unexplained and severe bloody noses.  About five-six months after the intercourse/stick, I developed a bright red rash under my arms and in my groin area.  No ointment or creams the dr. prescribed have resolved these rashes and they continue to worsen. About a month ago (13-14 months after the intercourse/stick), I had a stomach virus. A week later, I came down with the flu, a mild fever (up to 99.8) aches, sore throat, and swollen glands. This lasted about two or three days, though my glands still seem to be swollen.  Then, within another week, the skin peeled off the bottom of my left foot.  I had only one sexual contact after the 3/05 activity and that was with the same woman; I used a condom.  It was about four months before I took my HIV test.

I have sought the advise of my internist and some other doctors.  Again, I was tested for HIV at about 8 1/2 months after the needle stick, which came about a month after the anal intercourse.  The test was negative.  

Now, with the persistence of symptoms (there have been others, including strange lesions that appear and disappear, arthritic like pains in my hips area), I am wondering if my life-long status as an asthma suffer, constant use of Singulair and epinephrine (I also take Nexium, triamterene, doxazosion, altace regularly) could have suppressed my immune system and affected the HIV test results. Or, I am also wondering, if I was infected by the stick, that I did not seroconvert during six-month window period because I’ve read it might take longer for antibodies to develop after a needle stick.

With all these things happening, could I have had a false negative; is it necessary to retest?

[H. Hunter Handsfield, M.D.]

First, your risks for HIV was nil; there is no realistic chance the needle that stuck you was contaminated with HIV, and your sexual exposures were not risky.  Second, there is nothing about your symptoms that is particularly suspicious for HIV anyway.  They are consistent with many other condition, all of which are much more common than HIV; and HIV does not particularly predispose to the other infections you describe (sinusitis, prostatitis).   And most important, with modern HIV tests, failure to seroconvert (or delay beyond 6-12 weeks) is a thing of the past, for all practical purposes.  Your test results prove that your symptoms cannot be due to HIV.

Follow up with your internist or other provider if your symptoms and/or other concerns persist.  But stop worrying about HIV.

Good luck--  HHH, MD

[drsuess]

Dr,

From a previous thread that I did not post to you.

Quick question about transmission. Websites are constantly saying condoms are not 100% effective against HIV transmission for anal sex. However, is that only because breakage occurs? If someone wears a latex condom and no breakage occurs, how would it be possible for the receiver to contract HIV? Especially if they pulled out before ejaculation.

Just curious because of all the conflicting information on the internet.

[H. Hunter Handsfield, M.D.]

Many websites and other sources have a CYA mentality.  The only reason condoms aren't 100% effective against HIV for anal sex is that they sometimes break; and sometimes people who believe they are using them correctly in fact are not.  A properly used latex or polyurethane condom that remains intact is 100% effective, for practial purposes, against HIV transmission in either direction.

HHH, MD

[canyon721]

Dr. HHH, thank you for your speedy answer.  However, given your response that my exposure was nil, I wonder if my original post was misleading. When I had the anal and vaginal intercourse with the woman, I did not use a condom.  It was only the next time, months later that I used one.  I wonder if this alters your thinking.  Thanks.

[Pretty Boy Floyd]

canyon,

It doesn't matter anyway, because you got a test result at 8 months. you're negative.

[H. Hunter Handsfield, M.D.]

Your test was negative several months after all possible exposures.  All the other information you provide is irrelevant.  You cannot have HIV.

Anyway, you said "I'd known the woman many years and she assured me she was HIV negative."  Can't get much lower risk than that.

HHH, MD

[canyon721]

Dr. H, thank you for your time, consideration, and assurance. Enough can't be said about the fine work you are doing.

[Kibbles'nbits]

Dr. H says, "failure to seroconvert (or delay beyond 6-12 weeks) is a thing of the past" but yet I am still confused as what to what time period "thing of the past" should be defined as. I have read Dr. H's comment that the majority of patients test positive 4 weeks post last exposure, but yet I wonder about cases on the net from the mid to late 90s in which a person has been found to test positive after 4 weeks. It makes me wonder if modern tests are truly that much more advanced than the tests used in the mid to late 90s. I am a new user of this forum so if I have in anyway posted anything inappropriate, I apologize.

[H. Hunter Handsfield, M.D.]

Kibbles'nbits is exactly right that the current tests aren't all that much advanced since the late 1990s.  The first HIV antibody tests (1980s) were only fair by today's standards.  The next ones ("second generation") were a great improvement, but still newer tests (third and fourth generation) were modest improvements, with only slightly quicker seroconversion.  Many readers of this forum make too much of whether they have been tested with the latest version.  With rare exceptions, it doesn't matter.  HIV testing experts themselves rarely use the "generation" terminology any more.

This is a modest jump from canyon721's topic, and not the place for an ongoing discussion.

HHH, MD

[Willl]

First generation tests are still widely used today.

[JohnnyV]

The practical implications of delayed seroconversion, in the eyes of someone like canyon, are fairly straightforward. Let's say you don't totally believe Dr. H, and you think that because lots of other websites say something else, you might be a rare case of someone seroconverting after 12 weeks.... The answer is easy. Get tested again.

That's what I did. Last summer I read when Dr. H said 6 weeks was enough; then in a few posts he told some gay guys that they had to test at 12 weeks.... I said, hey, something's up. I went to get tested at 9 weeks, because one website had given 8 weeks as the window period, then I got tested at 12 weeks, to match Dr. H's most cautious advice, as well as the advice of Dr. Bob and Dr. K and New York and California state health.

Then the CDC websites and the HIVInSite data that insisted on *6 months* got me worried, and I went back after 10 months, and a year -- hey, why not?

Guess what! Every test was negative. So Dr. H was probably 100% correct when he said the 6-week test was enough.... but if you just can't believe him at face value, then you don't need to keep reposting the question again and again on Medhelp. Just keep getting tested and prove it for yourself! :)

Lots of blessings to all,
J

[Willl]

The Mass. hotline told me "they have the data that supports the 6 week conclusive for over 99% of cases". I would like to "have the data" for myself.

[Kibbles'nbits]

Personally Will, I'm not sure if I can trust that MA hotline in saying that 6 weeks is 99% conclusive. I think Johnny has a point in that a person who is scared they may have been infected should just keep testing. I was searching the net and I found a case of a nurse in the 90s who became infected through an occupational exposure, and every test came back negative until her 6 month test, which came back positive. I realize that her exposure was an occupational one and the vast majority of people on this forum are concerned about possible nonoccupational exposures, but this story still scared me. While I realize this is now 2006 and testing is different than it was in the 90s, Dr. H has said that tests aren't THAT different from the 90s which scares me. I absolutely am not intending to frighten anyone on this forum, but I just find it so hard to believe that 99% of infected people would test positive after 6 weeks.

[Willl]

I think that case you are referring to was an HIV and Hep C coinfection.

[monkeyflower]

Why do you find that statistic so hard to believe? Particularly since your contradictory evidence is: "I found a case of a nurse in the 90s..." Seriously. ONE case, out of literally millions, from ten years ago, and this scares you?

If so, I'm sure you're terrified of literally everything, because there are millions of things that are far more likely to kill you than the tiny possibility of contracting HIV. Besides, I'm guessing that like 99.9% of posters on this board, you had a virtually zero risk exposure. I think it would be a good idea to stay off the internet and seek counseling to help you deal with your anxieties and fear around these issues.

On a somewhat related note, I actually think part of what freaks people out about testing, risks, etc. is the lack of a scientific/medical background. Most of this stuff isn't written for healthcare consumers, so it can be tough to wade through and really understand. A little knowledge really can be a bad thing when you can't put it into context and don't know how to apply it.

[JohnnyV]

Hi Monkeyflower,

I just wanted to add a little explanatory note....

I was not in a zero-risk situation. I had engaged in oral sex with high-risk males, over a period of several months. I took the last incident, May 5 2006, as my baseline date.

I don't really blame people for treating HIV so differently. It is scarier than most conditions for many reasons.

But it's still worth it to remember that Dr. Handsfield is one voice among many, and not everyone in the field of HIV prevention agrees on the window period. I haven't been thebody.com or Dr. K's column in months, but the last time I looked, both of those sources were still unwavering about a 3-month window period. I know Massachusetts now accepts 6 weeks, yet Harvard University is in Massachusetts and their health information page still insists on "6 months to a year, and even longer" for the window period. And my primary care physician in New York City insists on a 6-month test because he has soon a few cases of supposed seroconversion in the 4-5 month range (though, I should add, before people go crazy, my doctor can't be sure that the people involved were telling the truth or remembering correctly when they indicated the date of their last exposure.)

For that reason, for people who have been to several websites, I think it's a good compromise to repeat the test until you're satisfied. My gut tells me that Dr. Handsfield is correct with his 6-week window, but for most people who are on this website, it's impossible to ignore other experts who have different timeframes. Instead of forcing yourself to stop testing after a 6 week test, and then going crazy with self-doubt, for many people it's a decent alternative to simply test at all the different windows for peace of mind.

After each test I took, I found it a little easier to sleep. And I can tell you -- after the test I took 12 months after the last exposure, I stopped losing any sleep at all/ :)

J

[JohnnyV]

Ooops, I had a few errors in the post above. The date of the last exposure for me was May 5 2005, not May 5 2006.

[Kibbles'nbits]

Again, I agree with Johnny. Monkeyflower, I have seen your responses to many posts and you have suggested counseling for many worried people, but with all the conflicting information found online it is easy to understand why so many people are in a state of panic. The case of the nurse was one of a few I found of people in the 90s who were found to seroconvert after 3 months. It worries me that I was able to find these cases so easily from searching the internet and it causes me to think that perhaps these cases weren't really that rare. While I understand an occupational exposure is different from a nonoccupational exposure, I realize that an exposure is an exposure and I am sure there are many people who will continue to worry until they have made it through the longest window period suggested by a reputable source (the CDC, Dr. H, the Body, Harvard, etc.) If a 6 week test is supposedly 99% accurate, why would so many sources, for other than legal reasons, extend the window period from 3 months up to a year and even beyond? If testing isn't so much different than it was in the 90s and these tests are so sensitive, why can I search the internet and find cases in medical papers in which a person was found to seroconvert beyond 3 months? While misusing information can cause a disservice to the person who is misusing it and to others, it is important to realize that people are often frazzled by the conflicting data and their feelings of regret for their actions. While many people on this forum would undoubtedly benefit from mental counseling, they would also benefit from knowledge and less conflicting information. While what may be seen as an irrational fear of contracting HIV may cause a lot of mental anguish for many people, I often think these people are a lot better off than those (and there really are so many out there) who don't consider the possible consequences of their actions.

[canyon721]

Doctor, after taking time to consider you comments I have a question. I am confused by this statement: "And most important, with modern HIV tests, failure to seroconvert (or delay beyond 6-12 weeks) is a thing of the past, for all practical purposes."  I am confused here.  What does the hiv test have to do with seroconverion.  If a person is infected with HIV and takes longer than, let's say, 6 months to seroconvert, what differnce does it make how sensitive the test is?  I would assume it cannot pick up what is no there.  So even with the new tests, how can "failure to seroconvert" be a thing of the past?  I'm sorry, I'm probably confused here, so thought I would ask.

[bebe13]

I am trying to find out how long HIV lives outside of the body if it was in liquid and on the rim of a glass.  I am very worried about an exposure.  Also, if you are infected with a small amount of blood, will it take longer for you to test positive for HIV? I am also wondering how long the EIA and oraquick tests really take to register antibodies, the minimum time?