Only anxiety?

[the_smith]

Dear Dr. Handsfield

My case is pretty similar to many others on this forum although regardless of statistics etc I've got a feeling that your post will help me get a bit on the track

Two days ago I had a vaginal intercouse and oral contact with HIV positive female. most of the time it was protected but when the condom broke we did continue without it. It wasn't long. I would say less than 10 minutes and I did not ejaculate. She was performing oral for a longer period but I guess there is no risk at all

Once I found out she is an ex-drug user and hiv positive the nightmare started. She takes antiviral medication and from what she states her load is less than 50. She is having regular visits to the clinic

I will definitely get tested. The only problem is that for those 3 months I will get completely mad!! That's why I believe that the only way to "know" this earlier is to wait for the symptoms. My questions:

1/ How would you assess my risk?

2/ when the first symptoms occur?

I would be very grateful for your help

Regards

[Edward W Hook, MD]

Dr. Handsfield and I share the forum.  You got me.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.

Your questions are good ones and deal with subjects that we have not completely covered in the past.  Because of the condom break, your sex with your partner was unprotected and there are no data to help us know how the issue of duration of exposure influences your risk.  It is logical that shorter exposures carry less risk but as i said, there are no studies on the topic. Thus, on average, your risk of infection form this single exposure is about 1 in 1000 (you are right, there is no appreciable risk from receipt of oral sex).  The other variable which you provide information on which is important however is how much virus is present,  One way that the activity of HIV is measured is by determination of the amount of virus present in blood.  There are good studies to show that the risk of infection is much lower when people are on therapy and some experts believe that when virus concentrations in the blood are as low as your partner reports (<50) transmission will not occur.  AT most it would be very, very rare.

In that your exposure was within the past 48-72 hours you may be a candidate for receipt of antiviral post -exposure prophylaxis (PEP).  this is taking anti HIV medication.  Studies suggest it is very good for lowering risk of HIV in exposed persons such as yourself.  If this is something you are interested in, you should seek the input of experts in your area, perhaps at a hospital affiliated with a large HIV care program ASAP  (i.e. now, not tomorrow)

Finally, as to testing, the standard blood tests for HIV will give you reliable information at 8 weeks or sooner.  AT 8 weeks over 99% of persons who are going to develop positive tests will do so. The 3 month testing only picks up an additional tiny fraction of 1% in persons at risk.  You can get results even earlier with a PCR test, the problem with these tests is that they sometimes yield false positive tests as well and they should only be done in consultation with someone familiar with the test and its interpretation.

I hope these comments help.  Go see someone now if you are interested in PEP, even if it is an emergency department.  EWH

[Edward W Hook, MD]

I agree with yoru assessment of the "information" found on all too many other sites.  While I am sure it is well intended, it is all too often wrong.  Take care.  EWH

[the_smith]

Thanks.  If the cited by myself studies (I found a few similar) are reliable I have to say that my view on HIV informations which are being spreaded almost everywhere (med help is really exception) is very close to the word "'bol*****s". For this situation of course there is also an explanation. The one that explains lots of other things.....
Hope I am right

Once again - thank you

[Edward W Hook, MD]

In my experience the transmission are rare, just as the statitistic would predict.  I would try not to loose sleep, the odds are in your favor in irtually every way.  EWH

[the_smith]

Thank you very much. Unfortunately now is past 72 hours although I do hava hope in statistic and what is more important in what she says re her viral load. I will do testing after 6 weeks and then repeat that.

One more question - could you let me know whether during your experience you did see many examples of transmission in similar cases like mine? The reason I am asking is that I have seen some studies that practically exclude woman to man vaginal transmission
Generally speaking should I loose my sleep over this for next 6 weeks?

thanks a lot again. I appreciae your help