Had HIV tests and nothing is helping

[depressed&anxious]

Dear Doctor,
Thank you for participating in this forum.  
I'm a married male, 45, and had a one time encounter with an unknown male partner on Jan. 20, 2006.  He took my penis (not erect) into his mouth and I pushed him away after about 10 to 15 seconds.  (That was the extent of the contact.  I don't know whether there was blood present.  I don't know of his HIV status.)  I immediately got scared and left the scene.  That night I worked myself up into a state of anxiety that had me feeling suicidal by morning.  I grew very depressed and my work and family life is suffering a great deal.  I'm seeing two different pyschoanalysts and taking three different drugs for depression and anxiety.  I had an HIV test after 5-1/2 weeks (negative) and another test yesterday (2-1/2 months) whose results I will receive later today.  The problem I've encountered is the wild range of data concerning the reliability of these tests.  The telecounselor who scheduled both my tests has tried to assure me that 6 weeks is pretty definitive.  However, yesterday at the lab the technicians told me that antibodies are usually not detectable for 6 to 18 months, which only worsened my fears (and so distracted my thoughts that I almost had an auto accident on the way back from the test).  I phoned my phychiatrist and asked her to refer me to a "live" HIV specialist who might be able to give me some assurance.  Despite my naughty episode I love my wife and she doesn't understand why I've lost interest in sex (I'm so afraid of infecting her).  I heard about your forum and wanted to get your opinion on my situation.  Thanks.

[H. Hunter Handsfield, M.D.]

All I can do is reiterate what you already know intellectually, even it you are not yet able to integrate the information objectively in a way that addresses your main problem - which clearly is anxiety over the sexual event you describe.

Those facts are:  1) The likelihood of acquiring HIV from the episode you describe are too low to measure.  For practical purposes, you CANNOT have acquired HIV from the exposure you describe.  In the exceedingly unlikely event you turn out to have HIV now (or someday), it will not be from that event.  2) The test result you already had is almost 100% reliable, and the negative result will be confirmed by the test done yesterday.  There is no disagreement among the experts about HIV test reliability.  You need to take into account the sources of the discrepant information (professional vs nonprofessional vs politically motivated, etc).

I'm glad you are receiving care from a mental health professional.  Continue to follow up with that.  And stop searching the web for information that, on balance, will only fuel your anxieties.

Good luck--  HHH, MD

[Willl]

6 to 18 months, that is funny. They were probably part time high school students.

[montrealer]

Dear Dr. Hansfield,

If you have a patient who had an exposure (unprotected vaginal sex) and he tested negative for all STDs and HIV. Would you recomend him to retest at 3 months. Or in your opinion that would be conclusive, even if he was at a possible exposure?

Thanks

[yugo]

I am glad this post came up -  have been trying to post a similar one but cannot get through with forum being overloaded with messages.

I can totally relate to the level anxiety described in the original post even though the event I am concerned about was hetero (also very unintended) and what most would describe as low (I am male and there was protection which I started doubting irrationally afterwards) but theoretically possible risk. I have worked myself up in a similar way and into a similar state during the last 11 weeks

[yugo]

Sorry I have meant to indicate that the previous post is directed to Dr HHH. Doctor,... pls answer if you have a spare minute. thanks * million!

[depressed&anxious]

The test I spoke of in my first message came back negative (10.5 weeks).  Not surprisingly, I felt little if any satisfaction.  I'm feeling that the test (administered by LabCorp) was an antiquated one and not one of the state-of-the-art tests you, yugo, described.  I know nothing of these tests and the lab technicians said that LabCorp's tests were the "standard" ones and that more "up-to-date" ones were available elsewhere.  I'm very confused and, even though I understand my exposure risk was extremely low (isn't ten seconds of insertive oral equivalent to having an infected person spit into your eye?) I can't stop obsessing.  Shaking the obsession and depression is extremely difficult.

[montrealer]

Hi Yugo,

What was your exposure and did you have any symptoms, i wanna compare yourself to me, maybe it will give me some reassurance.

I think at 2.5 months you should be confident that you are negative.

Thanks

[yugo]

risk objectively low but theoretically possible - details won't give you much as I seem them very subjectively (guilt). no symptoms (and I did pay attention) apart from clear anxiety-related problems with sleep and night sweating...especially when one wakes up and the first thought is the same one for 2.5 months now...

feeling a bit puzzled about no reply from Dr HHH - he does sometimes react to comments. pity. But I guess that means he has already said everything he could. I hope this means he really thinks we are home free with 10.5 weeks negatives and risks involved and would like to believe with all my heart that his is a fact. In any case thanks Dr HHHH.

[Willl]

The confirmation test used must turn positive before a positive result is given. So unless you are specifically told the ELISA was negative, a person will not be notified they are infected until the confirmation is positive, no matter what generation the ELISA used and when it shows positive.

My experience has been you are told you are negative but not told whether that was the result of ELISA only or positive ELISA then negative confirmation. At 2.5 months, the confirmation test should have been positive if you had it. People are not normally told of a positive ELISA unless the confirmation is also positive, that could unnecessarily scare someone.

[joeworried]

Labcorp does not use antiquated testing procedures.  They use a modern 2nd generation test.  You can search the web if you like, and what you will find is that a 4th generation test detects HIV  about a week earlier than a 3rd generation test (by detecting the p24 atigen) and that a 3rd generation test will detect HIV antibodies about a week earlier than a modern 1st generation test (like HomeAccess uses).  A 2nd generation test will test positive a few days earlier than the 1st generation test.  

I was tested for HIV about 8.5 weeks post potential exposure using LabCorp and again at 9 months.  Both were negative.  A negative test at 10.5 weeks using the testing procedure at LabCorp should be all but definitive, especially considering you had no risk to begin with.

You can continue to test as often as you like, but the results will not change.  They will continue to be negative, unless you have some additional exposure.