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Avatar universal

HIV Exposure

Hello, doctors.

I am a gay male. For the past few months, I have been in a casual sexual relationship with another male who very recently tested positive for HIV. He tested negative several months ago, so his infection is a new one. Our sexual activities have been limited exclusively to oral sex. In almost all of our encounters, I performed fellatio upon him and swallowed his semen.

I understand that the average risk of a single episode of unprotected oral sex is somewhere along the lines of one chance in 10,000. I am also aware of the study in Spain performed among serodiscordant couples engaging exclusively in oral sex that found no new seroconversions at the end of a year long observation period. My concerns with these data are twofold:

1) The given figure for per-encounter oral sex HIV infection risk is epidemiological in nature, so it is difficult to apply it to an individual situation with any degree of accuracy. In my case, my partner has a new HIV infection, and thus his viral load will be higher than average.

2) The study performed in Spain was included serodiscordant couples whose statuses were known at the outset. I expect that the HIV infected partners were using antiretroviral medications and exhibited a lower viral load (and therefore, theoretically less infectiousness) than those with newly acquired infections or untreated ones.

As you can see, my own limited research skills have provided me with little guidance. So, I turn to your clinical expertise. Given the fact that I performed oral sex on this man on multiple occasions, at least some of which occurred during or shortly after his seroconversion, do you think that it is likely that I have become infected?

I intend to be tested sex weeks from today.
4 Responses
239123 tn?1267651214
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for a thoughtful (even erudite) question.

You are absolutely right that it is difficult to apply broad epidemiological studies to individual patients.  But unfortunately, that's the best we can do -- tempered by professional judgment, which is what you are asking for.  I hope the following thoughts are helpful.

Most research or the sort that has calculated HIV transmission risk is quite imprecise, and all sorts of factors that might be important could not be accounted for.  Perhaps most important in your case, the available data are generally not corrected for recent HIV infection, and thus high viral loads and elevated transmission risk, as in your situation.

That said, with an estimated risk of 1 in 10,000, even if the real transmission odds were 10 times higher in your circumstances, we're still at only 1 in 1,000; and even if the risk is 100-fold higher, we're still at only 1% risk per exposure, i.e. in 100.  If "several" exposures means 10, then the maximum risk you caught HIV woudl be aorund 10%.  That's very high, of course -- enough to be frightening -- but still it means a 90% chance you were not infected.  Understand that I am not estimating this as the actual risk, just showing that even the worst case scenario leaves the odds strongly in your favor.

You don't mention symptoms, which is a good sign.  Most new HIV infections cause symptoms of ARS, and although they can be mild and are certainly nonspecific (no different than for many minor infections), most alert and aware persons, which you seem to be, would have noticed them.  If during the months you were with your partner you did not have a 2-4 week illness with fairly severe sore throat, body-wide skin rash, fever, and possibly enlarged lymph nodes, it suggests you were not infected.

Unfortunately, it isn't possible to be more precise than this.  T'he bottom line is that all things considered, the odds you caught HIV are quite low.  Of course you need to be tested, and presumably you are doing that.  It would be best, in this circumstance, to find a doctor or clinic with substantial experience in early HIV diagnosis, then follow his or her guidance about tests and their timing.  But I expect negative results.

I hope this helps.  Best wishes--  HHH, MD
239123 tn?1267651214
MEDICAL PROFESSIONAL
I only now focused on your intention to be tested in 6 weeks.  As I said, your best approach is to find an experienced provider and follow his or her advice.  But most likely that will include earlier testing.  You could have a duo test, for both HIV antibody and p24 antigen, as soon as 2-3 weeks after your last exposure, when a negative result would be highly reassuring, if not yet definitive.  And some experts might recommend a nucleic acid amplifcation test (NAAT) for HIV as soon as 7-10 days after the last exposure -- which would also be a very strong indication you weren't infected.
Avatar universal
Thank you, Dr. Handsfield. I will follow your advice with respect to finding an experienced HIV clinician. I live in a large metropolitan area, so finding one should not be problematic.

As a personal aside, my background is in computer science and software engineering. Throughout both my personal and professional life, my default approach to any problem has been to first study it and learn about it. Thus, a short time ago, I set out to learn about HIV transmission.

Somewhat unexpectedly, my usual approach did not work quite as intended. Apparently, knowledge does not necessarily mitigate the anxiety one experiences when faced with the possibility of a serious illness. I calculated odds similar to the ones you presented. Even using transmission rates that were clearly absurd for oral sex -- a 2% transmission rate -- the odds were still in my favor. Yet anxiety persists.

It would seem that there is a curious divorce between intellectual understanding and emotional state where one's own health is concerned. In any case, it will be over in a few weeks.

Thanks again.
239123 tn?1267651214
MEDICAL PROFESSIONAL
Don't feel like the Lone Ranger. Anxiety by definition is not rational; this forum (and indeed all doctors' offices) are filled with people who have trouble translating objective data to personal reassurance.  Unfortunately, the best we or any online resource can do is to provide the availalble data and our professional perspectives about them, in the hope that some of it helps some people get beyond the more emotional aspects of their exposures, transmission risk, etc.

Maybe an additional anecdote will help, however.  In the 7+ years since inception of this forum, not one questioner has reported actually catching HIV.  You aren't likely to be the first.  When it happens,I don't expect it to be someone with a classically low-risk situation, like oral sex, a heterosexual exposure, etc.

At a professional/intellectual level, you know that this sort of observation is meaningless in regard to your risk.  But I'll bet it helps you feel a bit better about the situation.  Hmm?
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