Risks, window period, unusual illness

[Steve3011]

I'll get right to the point - you have to read enough each day, and I thank you in advance for your reply.

Me: 51 y/o uncircumsized gay male.

Experiences: 12 years ago (1 time anal; several mutual masturbation; several oral sex - unprotected); 6 months ago (was masturbated by someone in a gay steamroom - may have had precum on his hands; someone got a few drops of semen on my skin).

Unusual illness: C-diff infection in September (cleared by antibiotics); current pneumonia; lots of night sweats.

Tests: HIV antibody tests at 2 months, 3 months, 4 months, and 24 weeks (just short of 6 months); Home Access test at 6 months - all negative; HIV-DNA test at 7 weeks (negative).

Here's my concern:
I read this article: http://www.ucsf-ahp.org/HTML2/Online_Resources/WindowPeriodExamined.pdf
It's from a reputable scource (USCF), but states that the 3 month window period may be an error.

You have both stated that 8 weeks is fairly conclusive.  Teak sticks with 3 months.  The CDC site still has mention of 6 months.  And, now, it seems like California is using 6 months (5+ months in the attachment).

Questions:
1) Did my more recent sexual experiences (mutual masturbation with 2 high-risk gay men) have any risk?
2) Would the anal sex that I had 12+ years ago somehow not show-up on a test?
3) Am I definitively HIV-negative (no concern whatsoever for HIV infection) at this point?
4) Can I have unprotected sex with my long-term partner again (I am his only partner ever, and he is negative)?

Thanks doctors... Having read that C-diff and pneumonia can be related to HIV, I got scared again.

[Edward W Hook, MD]

Thank you. I am pleased to hear that you are now comfortable that you do not have HIV.  Take care.  EWH

[Steve3011]

This will be my last post, and it comes to you both with thanks, and to those who follow this forum with some words of advice.  I will start with the words of advice:

I had a truly miniscule (if any) possible exposure to HIV back in May.  True, the two persons were both promiscuous and in a known high risk group, but the actual contact provided almost zero (if not zero) potential for HIV (or other STD) transmission.  Over the course of the last 6 months, I have over-tested: 8 HIV 1/0/2 antibody tests; 1 HIV DNA test; and 8 Home Access tests (including one just last week at 28 weeks).  When I think of all the money spent (wasted) on SO many tests, I can't help but think of how that could have been better spent/donated.  I am typically a very level-headed person, but not this time.  My problem, like others, is anxiety, not HIV -- and I am going for counselling to better control that.  So, if you are worried as I was, I urge you not to follow what I did -- so many tests out to 6 months.  Trust the advice of the two experts here: Drs Hook and Handsfield.

And now to Drs Hook and Handsfield.  First, I can't imagine any other condition where a person would be advised that they are fine (negative), but then don't believe it.  I have family members who had cancer, but were told they cleared it.  They believed their exams and tests.  I understand that HIV is a newer disease than most, but the thought that we don't know how its transmitted (or not) or how accurate tests are is simply not true.  And so, on my own behalf, I apologize for not believing you -- or the other experts, physicians, and hotline personnel I've talked to since May.  I appreciate your expertise and advice -- and also your tone when people (like me) get out of hand in terms of anxiety.  It is, indeed, tough love -- but true concern nonetheless.

I am done here.  No more visits to this forum for me.  I've spent enough time over the past 6 months doing so, and I am moving on confident that my 8 week test was probably accurate, my 3 month test was definitive, and my 6+ month negative test was only for my anxiety.  I won't lecture anyone else -- but I can only say I wish I believed much earlier on, as it woudl have saved a lot of time, energy, and sanity.

[Edward W Hook, MD]

No, pneumonia will not change the reliability of your HIV test. EWH

[Steve3011]

Out of anxiety, I did a Home Access test yesterday, and am awaiting the results (this will be over 6 months, and follows all the negative tests already done).  I am on the tail-end of pneumonia.  Would pneumonia affect the test results in any way (false positive)?  I promise, this is the last question -- and thanks again.

[Steve3011]

Thanks for the reassurance and expert information.  My nerves are getting the best of me, as I am rarely sick and having C-diff followed closely by pneumonia had me scared.  I can understand why some sites (California, CDC, etc) still stick with a 6-month or longer window period -- liability and over-caution.  I also understand why they probably will not change anytime soon.  The article, although 10 years old, worried me.  That's why I wrote.  

I'll try to keep my anxiety in check, especially since the exposures were so minimal as to be near-zero (if not zero).  Thanks for replying.

[Edward W Hook, MD]

Welcome to our Forum.  I'll be happy to comment although that will not change the fact that I am confident that you will still be able to find the disparate recommendations you are already aware of.  As I have said before, for all practical purposes both of these types of test perform comparably and provide accurate information on the presence or absence of HIV infection in virtually everyone at 8 weeks following exposure.  The recommendations for testing at 3 and even 6 months are the result of two factors- data from older tests no longer used (you really do not need to worry about which generation of tests you were tested with, at this time virtually all tests are far more sensitive that they were even 4-5 years ago when the 3 month recommendation was made) and secondly, the fact that some, mostly governmental agencies which have to provide recommendations for virtually everyone without the sort of interactions such as those you get with your doctor or on personalized sites such as this one, feel they cannot "afford" to be wrong and therefore make recommendations and guidelines which leave most people unnecessarily nervous for 4-6 weeks longer than the 6-8 weeks it takes virtually everyone to develop HIV antibodies.   It's also worth noting that all of the data from the article you cite are from articles published more than 10 years ago- they are "old news".

As for your specific questions:
1) Did my more recent sexual experiences (mutual masturbation with 2 high-risk gay men) have any risk?
No, these are no risk exposures, irrespective of the nature of your partners.

2) Would the anal sex that I had 12+ years ago somehow not show-up on a test?
No, believe the test results.

3) Am I definitively HIV-negative (no concern whatsoever for HIV infection) at this point?
Yes, you are HIV negative - your test results show this.

4) Can I have unprotected sex with my long-term partner again (I am his only partner ever, and he is negative)?
Yes you can

I hope my comments and answers are helpful to you.  EWH