High risk exposure-from Canada

[stephan1900]

I had a high risk behaviour 3 weeks ago.  Insertive anal sex with another man who says is HIV neg. and got tested a few weeks ago.  However,  I can't rely on that for sure. 2 weeks after I developed two swollen nodes on my neck only.  A few days after that I developed a red rash with pin size bumps on the back of both arms only, not anywhere else on the body.  I am very concerned that it could be an ARS rash.  No other symptoms.
I just called an STD clinic in Toronto and asked them about the Duo p.24 antigen test.  They told me I was outside the window period for the Duo p.24 test (only good 2-3 weeks after)  I read on this site you have to wait 28 days if you want accurate results from that test.  What is the real info?  Which test should I do to relieve some of my fear before the 3 months standard HIV testing? I see my doctor tomorrow and would like to know what kind of test to ask for.  Is there any test that can give me accurate results before 3 months. Thank You very much for any insight.  The stress is really getting to me

[stephan1900]

Good day Dr. Cook!  Just wanted to let you know that I received the results of my DUO test today.  result:  negative
I am very happy about that.  My doctor told me that I had to retest in 3 months but I don't really see a need for it.

I wanted to thank you for all sound advice you provided me earlier on.

[Edward W Hook, MD]

I find myself repeating myself again and again. The thread will need to end after this.  

From above- "The DUO test which tests for both the p24 antigen and antibodies to HIV provides definitive information on the presence or absence of HIV infection at 4 weeks following exposure and beyond. " -  your test will be a DUO-type test.  the word "defintive" means -"Biol. fully developed; complete" (Defintions.net)  

I understand you are anxious. I've done what I can to address your questions and alleviate your fears with facts.  I hope it helped.  EWH

[stephan1900]

Thank Dr. Hook for your quick response.  It is greatly appreciated.
I just found out from my doctor today that Canada has started (in July 2010) testing for HIV using the Combo test.  Here's what it tests for:
Effective June 1, 2010, the Ontario Agency for Health Protection and Promotion (OAHPP) public health laboratories (PHL) began to phase in a new human immunodeficiency virus (HIV) screening test known as the “HIV Ag/Ab Combo Screen.” This screening test simultaneously detects both HIV p24 antigen (Ag) and antibodies (Ab) to HIV type 1 and type 2 (HIV-1/ HIV-2) in human serum or plasma.

My doctor has booked an appointment for this coming Monday.  It will be 29 days after exposure.  Can the result be reassuring?  The Labs in Canada told my doctor that it is conclusive before a repeated test at 3 months.  Is it common for someone who test negative after a DUO HIV test after 28 days to become positive later?

Thank You so much.

[Edward W Hook, MD]

The rash you describe does not suggest HIV.

For testing I would call one of two places, the Minneapolis health department or the University's Infectious diseases division. Either should be able to help you arrange testing. EWH

[stephan1900]

Thank You Doc for the info.
I was wondering, would it be common for an ARS rash to appear only on the back of both arms?
Would you know of any clinic in Minneapolis, MN that would offer that DUO test?

Thank You for your help!

[Edward W Hook, MD]

Welcome to our Forum.  If your partner has HIV, your risk of infection from a single episode of insertive rectal sex is about 1 in 200.  Your risk is lower hower since your partner told you that he was not infected and even provided detail as to when he was last tested. most people do tell the truth.

The DUO test which tests for both the p24 antigen and antibodies to HIV provides definitive information on the presence or absence of HIV infection at 4 weeks following exposure and beyond.  Perhaps what the person you spoke if was referring to is the fact that in some persons with HIV the p24 antigen may no longer be detectable after a few weeks if infection. In such situations however, antibodies are present and thus the test does detect infection accurately even when there is no p24 antigen.

At this time the DUO test will provide you with the answers you seek sooner than any other approved test and long before the 3 month guideline (which is overly conservative anyway-- standard HIV antibody tests provide defintive evidence of the presence or absence of infection at 8 weeks following exposure.

I hope this helps. EWH