Cortisone injection and effect on HIV anitbody test

[haresh111]

Dr. Hook,

I had one exposure of unprotected insertive oral sex with a CSW on an International trip. I am assuming she is HIV+ based on how she has talked after the oral sex. 1 and 1/2 month (45 days) before the exposure I had a cortisone injection in my butt due to severe eczema. I have since then been applying eczema (cortisone cream) - Halobetasol tropionate Propionate Cream 0.05 (this is a strong cream) twice a day on affect body parts (some portion of hand, chest, legs and neck)

I had a 20 minute OraQuick ADVANCE Rapid HIV-1/2 Antibody Test, ORAL SWAB test done at 5 weeks after exposure and it came back negative. I just read in one of your posting that Crotison Injection delayed the antibody production. Is that the Case? also if i am regularly using the cream twice a day 45 days before exposure and still using it, does that mean my test results are not valid?????  Also I take allergy medication like zyrtec (1 a day). and 2000 mg of Niaspan. Does any of these have any effect on antibody test.

I was a bit relaxed after I got my result but tensed once again after reading your post on cortisone injection, i read a similar one on thebody stating heavy does of cortisone can effect the antibody production. Does cortisone suppress the immune system which delays the production of antibodies?

Please help, I am very scared. Also do i need a DNA PCR test for HIV 1/2?

[Edward W Hook, MD]

You seem unable to believe that you do  not have HIV.  You had a virtually no risk exposure and you have a negative HIV test.  You need to move on from this. This will be the last answer and further answers will be deleted without comment.

I have already answered your question about the cortisone shot.

Thrush is not an early sign of HIV and it unlikely that you have thrush.  If you do, it is not due to HIV.

The thread is now over.  EWH

[haresh111]

Hello Dr. Hook,

One last question. Today I have a sore throat, I have difficulty when i swallow. Also when i press on the left side under my jaw it kinda hurts. Second, when i look inside my mouth, I have dry mouth and white stuff inside the cheeks (covering the inside of both cheeks) and also the mouth roof top is white/yellowish all the way and around my tonsils also. I am assuming this is oral thrush. I am assuming sore throat is due to my allergies (pollen/spring) because of which I take Zrytec (1 tablet a day).

1) Is oral thrush an early sign of HIV. I read at many places Oral thrush is not and ASR symptom and some say it is?

2) I will complete 6 weeks since exposure this Wednesday, I am freaking out because of this symptom. Can you please advice me. Is this because of HIV exposure? DO i need more testing since i had cortisone shot and  people can get symptoms 2-6 weeks and i am just under the 6 weeks. I know my exposure had low risk but get concerned because of this white/yellowish coating in my mouth.

Thanks and regards.

[haresh111]

Dear Dr. Hook,

Thank you. I will now relax knowing I do not have HIV and will not need further testing.  You have been a great help and I really appreciate it.  Thank you once again. Have a great day.

[Edward W Hook, MD]

None of this changes my opinion or my advice.  you did not get HIV from the exposure you described.  eWH

[haresh111]

Sorry fDoctor, forgot to add, in point 2 above: I am using the cream since the last 9 months, twice a day.

Thanks.

[haresh111]

Hello Dr. Hook,

Thank you for your response and I feel less stressed.

Sorry I had mistyped the cream name, it is Halobetasol Propionate Cream 0.05% . I use that twice a days since the last several, 9 or so months and still use it today.

I called the dermatologist's office and they told me I had an injection of "Steroid Shots - Cortisone / Kenalog Shots" (he calls it  TRIAMCINOLONE, a form of cortisone and Kenalog is the brand).  This was 55 days (i got the exact date) prior to the exposure. and my test was 5 weeks (1 days short, 4 weeks and 6 days) after the exposure.

Does this information change your decision. Also Do i need any more testing for HIV 1 and HIV 2, if so when and what type of test. If not can i assume I am safe and HIV free because of your feedback given the following:

1) the low risk exposure
2) Immune system normal after 55 days from Crotisone shot to produce antibody
3) Topical cream twice a day will not reduce the immune system response to produce antibodies
4) HIV 1/2 rapid oral swap test negative at almost 5 weeks. (4 weeks and 6 days)
http://www.medhelp.org/posts/HIV-Prevention/Cortisone-injection-and-effect-on-HIV-anitbody-test/show/1198670#

Thank You

[Edward W Hook, MD]

Welcome to the Forum.  You have nothing to worry about. The quoted figure for HIV risk, if one receives oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.  None.  Never.  Thus there was virtually no risk to start with.

Regarding the affect of steroid medications on antibody response.  You are correct that systemic administration of steroid medications can delay (but not prevent, at least in the case of HIV) antibody response.   In your case however, that 45 days had passed since your injection is long enough so that your antibody response would have been normal. In addition use of topical steroids would not have an effect. The reasons that steroids are used topically is because the medication acts locally and is not absorbed.  Therefore it does not lead to side effect (and does not modify antibody production).

There is no effect of Niaspan or syrtec on antibody production.

Bottom line, you do not need to worry.  You did not get HIV from the exposure you describe.  Even if your partner had HIV (and I doubt that she did), your risk was virtually zero and your negative test at 5 weeks is just further proof that this is the case.

I hope this helps.  You have nothing to worry about.  EWH

[haresh111]

Forgot to mention, the Niaspan (2000mg higher does) is for for my triglyceride and cholesterol.