HIV risk

[helpspring1]

Dear Doctor,
I am a 40 year old heterosexual man. In February 2009, I had a mishap during heterosexual intercourse in South America.  The ejaculate spilled on the bed during withdrawal and there is a possibility that unprotected sex occurred toward the end of intercourse.  I had a normal absolute/% CD4 of 1063/45% at 5 wks followed by negative ELISA tests at 6 wks/77 days/80 days. The first 2 ELISA's were with a home kit and the 2nd one was ordered by an ID physician. Where those tests conclusive?  I am still worried that there was no specific HIV2 test ordered. Restricted sexual activities have involved condom use afterwards except for insertive heteroxexual oral sex in June '09 and Feb '10. I am concerned about those potential exposures. Starting at the end of May '10, I had 2 months of preauricular swollen nodes that developed in the setting of severe bumps while I attempted to grow a beard. Lymphadenopathy has resolved. I also developed horizontal ridges in all 10 fingernails at the same time and that lasted 2 1/2 months, until the nails grew out. In the past 2 1/2 months, I have also developed brown arcs at the tip of my fingernails and toenails. I don't know if heavy stress 2 months prior to nail issues is a contributing factor, but, I am aware that these can be HIV findings. I have no fever, weight loss, or swollen glands now. However, I have new toenails' fungal infection as well as initial thumbnails' fungal infection.  This is completely new for me and I am concerned.
What are the possibilities of developing hiv related nail disease now If I contracted HIV between February '09 and March '10? What do you think I should do.  Thank you.

[Edward W Hook, MD]

Oh please.  Negative is negative.  HIV-2 would have been picked up.  Sensing that there may be no reasonable end to these anxiety driven questions, this will end this thread.  It is (past) time for you to move forward and not be stuck thinking and re-thinking what might have happened in the face of evidence that it did not.  EWH

[helpspring1]

Thank you.  Should I have tested specifically for HIV2 also?  I was in a very cosmopolitan South American city that attracts tourists from all over the world and HIV2 has also been found there.

[Edward W Hook, MD]

the reason that I told you not to worry is becasue , as I said above, between the sorts of low risk exposures that you describe and your testing, you should be confident that you do not have HIV.  Do not let non-specific nail changes which, in your case are not suggestive of HIV make you worry about this.  Believe the tests, not a bunch of non-specific findings.  EWH

[helpspring1]

Thank you Doc for your prompt response.  Did you mean: "You don't really need to worry"?  The fact is that I am worried that I may have contracted HIV.  Is it possible that I could have nail changes of HIV so soon, if indeed I contracted the virus between June 09 and Feb 10.  The constellation of signs disturb me.

[Edward W Hook, MD]

Your time line is a bit hard to follow.  However, your exposure sound to be low risk and all of the HIV tests taken more than 8 weeks after your encounter in February 09 prove that you did not get infection at that time.  

Your oral exposures in June 09 and Feb 10 were virtually no risk.  The quoted figure for HIV risk, if one has oral sex with an infected partner (giving or receiving) 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.  

Your lymphadenopathy and fingernail changes are non-specific. The nail findings of HIV you mention are quite uncommon.

You really need to worry.  If you have a specific question that I missed, please ask it again.  EWH