HIV symptoms timing and testing accuracy

[riskandar]

Hi Doctor,

I had an unproctected sex with a prostitutes in Indonesia, I ejaculated outside.  I was inside her for less than 2 minutes.  I also received an unprotected oral sex which lasted less than 5 minutes.  I didn't know her HIV status.

My concern is that:
Around 4 days after the possible exposure, I had sore throat that lasted for a week or so.

Since 1-2 weeks after the possible exposure (until now), I had migratory joint pain (finger and knees).  For example, I felt pain on my finger joint on the left hand and the next morning I could feel it on my right hand while the pain on my right hand disappeared, and so on.  The pain themselves did not prevent me from doing normal activities.

In the 3rd week and until now, I felt that my neck lymph glands a bit enlarged.  In addition, I could feel many small size, soft round thing on my groin and thigh area.  Evenmore,  sometimes I felt a minor shart bites under my armpit.

I did not have any fever or dry cough.  I slept well.  Muscle sores every now and then.

My questions are:
1.  Based on the symptoms, what is your assessment for my HIV risk?
2.  I did a self-test (by HOME ACCESS) at exactly 28-day after the possible exposure.  How reliable will the result be?  Does the test have high false-positive or false-negative rate?

Thank you so much

[H. Hunter Handsfield, M.D.]

1)  Symptoms never are a particularly useful indicator of early HIV infection, especially when the risk of infection is low to start with.  Although some of your symptoms are consistent with HIV, the identical symptoms are hundreds of times more likely due to other things that are much more common than HIV, such as a garden variety respiratory virus.  Also, in people with symptomatic primary HIV infection, high fever is almost always present; its absence is strong evidence your other symptoms are not due to HIV.  Self-assessment of posssible lymph node enlargement is totally unreliable.  Thus, my assessment of your HIV risk is completely unrelated to the symptoms you describe, and comes down to the level of risk from the exposure you describe.  Even if your Indonesia partner had HIV, the likelihood you caught it was less than 1 chance in 1000.  If you turn out to have HIV, I would suspect you caught it some other time.

2) Home Access uses standard HIV antibody testing.  False positive results are not an issue.  About 80-90% of infected people develop positive tests within 4 weeks.  If you remain anxious despite my reassurance, you might want to get tested again 6-12 weeks after exposure.  (Search the STD Forum threads for "time to positive HIV test" for extended discussions of when to be tested, how the odds work out in low-risk situations like yours, and so on.)

Best wishes-- HHH, MD

[Willl]

I remember somebody previous posting previously about Home Access using first generation method. You may try Oraquick if you have a clinic nearby, it may pick it up sooner if you are really anxious.

[H. Hunter Handsfield, M.D.]

First generation, 4th generation, makes no important difference; just a few days shift in when tests turn positive.  But I would be surprised if it is true that Home Access isn't using up to date technology.

HHH, MD

[Willl]

I sent an email to Home Access asking how they would classify their test. I will post if/when they reply.

[joeworried]

HomeAccess still uses first generation ELISA technology.  For information on HomeAccess, go to thebody.com under Understanding Your Labs.  There is a posting entitled Home Access Test dated July 11, 2001, with information provided by the makers of this test.

You can search the web to find out the time for various generation tests to detect HIV.  In general, a fourth generation test will detect HIV about a week earlier than a third generation test (by detecting the P24 antigen) and a third generation test will detect HIV antibodies about a week earlier than a first generation test.  A second generation test (such as used by LabCorp) will detect HIV antobodies somewhere between the first the third generation tests.

[wwarrior]

I know this may sound like an oxymoron, but I read somewhere (sorry for not remembering the place) that although Home Access do use 1st generation test, they use the latest testing technologies.  They claim (now this they told me personally over the phone) that after 6 weeks all generations results are the same.  Complex as it may seem, the only conclusion that can be drawn here is that all testing labs know that whoever (almost 99%) is gonna turn positive is going to do it within 6 weeks.