Uncertain

[runningaggie]

Doctors,

Roughly 2.5 weeks ago I went out with some friends and ended up drinking too much. I ended up blacking out and then was escorted out by the bouncer (friends told me as I don't remember). Next thing I remember is waking up on some random steps in midtown (next to downtown) close to the bar. This has caused a lot of anxiety for me. I am very frightened that I could have been sodomized or raped while I was out there asleep for 2 hrs (I called people for an hour before and after so I know I slept during the 2 hrs). I am worried that if I had gotten sodomized and didn't know it, I could possibly have acquired HIV had it been a homeless man, etc.

1) I woke up and there was no discomfort in the anal area whatsoever and all of my stuff (wallet, watch, etc was there). Do you think there would have been a sign or I woul have known after if I was raped?
2) I have not experienced any ARS symptoms and just wanted to know how many (%) of people who acquire HIV experience ARS?
3) I would like to take the combo test at 4 weeks so that I can move on from this, but I have called around an can't find anyone who even knows about it. Where can I find out where I can have this test done?
4) what would be the accuracy of antibody only test at say 3 weeks, 4 weeks and then 6 weeks?
5) do you think this is something I should be worried about given what happened? I know my chances are low since none of my stuff was taken, no mess on my clothes, and no pain, but I just don't like the uncertainty and don't want to wait until 8 weeks for a conclusive ab test.

I am also working on drinking less as to never put myself out of my control like that.

Thanks for your help!

[Edward W Hook, MD]

Testing for hepatitis C is a waste of time- this is not an STD.

Your HIV tests are conclusive, not that you needed testing- believe them.

This will complete this thread.  No further answers.  EWH

[runningaggie]

Dr. Hook,

One final comment.  I decided to just wait for the 8 week mark to take the antibody only test.  I took this at 1.5 days short of the 8 week mark (54.5 days total).  Does this change your recommendation that this test would be conclusive?

Also, I decided to take a Hepatitis C test as well... do you know if 54.5 days would be conclusive for Hep C test?  I know this isn't an STD, but wanted to know if you knew.

Thanks again for the help!

[Edward W Hook, MD]

Sorry, I can't comment on the impact of temperature during storage on test perfromance.  Your questions are reasonable and appropriate however.  I'll bet the company you are dealing with has an 800 number you could call to address these questions.  EWH

[runningaggie]

Dr. hook,

One final question as I know you do not like anxiety filled questions. I found a place (tkno) that offers the combo test in Texas and sends it to a lab in (I think) South Dakota.  I am doing this to put my mind at rest as the OCD has gotten the best of me (going to see someone for it).  The question is that I saw that the blood specimen must be shipped at 2-8 degrees celsius to preserve the p24 antigen. My question is that if they send the blood from Texas to South Dakota, how can I be certain it will be kept at that temp and would remain accurate?

Alternatively, if the blood is sent not at 2-8 celsius, does this affect the accuracy of the p24 results?

Thanks for the help and I promise this will be the end of this thread after your response.

[Edward W Hook, MD]

Glad I could help. EWH

[runningaggie]

As always, thanks for all you and Dr. HHH do!

[Edward W Hook, MD]

Yes I would.  EWH

[runningaggie]

Dr. Hook.

Would you say that 8 weeks would be conclusive for me and I would need no more testing?

[Edward W Hook, MD]

The data that I have reviewed suggests that the figure you quote is too high and that less than 50% of persons who acquire HIV get the ARS.  Conversely, many people who have the flu-like symptoms that are described for the ARS have other illnesses (like the flu)- in studies of this subject, less than 1% of persons with ARS-like symptoms turn out to have HIV,  These facts are behind our regular statements that worrying about symptoms is a waste of time and that the only way to really assess the presence or absence of HIV is with testing.

As far as testing is concerned, while contrary to what the people who sell them say, PCR tests are not recommended for HIV diagnostic testing however, at 4 weeks, if you wish to spend the money and accept a small (about 1%) chance of a false positive test, the combination of a negative HIV PCR AND an negative HIV antibody test is the equivalent of a negative combo test.  

I hope this clarifies things.  I really doubt you were assaulted during your period of unconsciousness. EWH

[runningaggie]

Thanks for the very quick response Dr. Hook.  I have bad OCD, so the fact that I think of something as a possibility, I then assume it happened to me, regardless of the possibilities - any remote possibility starts the anxiety.

Can you comment on the following. The first question is something that I had searched and was surprised that there isn't much out there on it. I saw one individual on the body.com mention it was about 90% of people wih HIV who get ARS. I would think the fact someone doesn't experience ars would be reassuring as well that they didn't acquire it.

-I have not experienced any ARS symptoms and just wanted to know how many (%) of people who acquire HIV experience ARS?

-I would like to take the combo test at 4 weeks so that I can move on from this, but I have called around an can't find anyone who even knows about it. Where can I find out where I can have this test done?
I've looked at various labs such as quest and labcorp and neither show them on their websites.

Thanks again

[Edward W Hook, MD]

Welcome to the Forum.  I find myself wondering why you would worry about having been sodomized during your period of unconsciousness.  Had you been, I suspect there would have been some sign, either with physical rectal discomfort or in your clothing.  Unless there is some evidence, my advice is not to worry about this aspect of this episode and rather to focus on the fact that you drank yourself to unconsciousness something that you acknowledge there is a problem with.

As for your risk had you been sodomized by a person with HIV (quite unlikely, as I said), your risk for infection would be about 1 infection for every 100 sex acts (1%).

If your fears persist and you seek testing, at 4 weeks standard antibody tests would detect about 90% of recent infections, 95% at six weeks and effectively all infections at eight weeks.  

I hope these comments are helpful EWH