High risk exposure - what does testing tell us?

[TonyDewitt]

Hello and thank you in advance for reading my post - I'm a early 40's male and had unprotected receptive anal intercourse with a male of unknown status 10 weeks ago. About ten days later I developed body and joint aches, loss of appetite, and fatigue. Thankfully these symptoms have lessened in the past few weeks. I had a NAT test done on day 17 (negative), and a rapid antibody blood test for HIV at 5 weeks (negative), then found an infectious disease specialist who ran tests for many things (hep, syph, blood counts, Ig, etc.) including HIV antibody (negative) & viral load (undetectable) at 8 weeks. When going over the results, he said that a possibility exists for the week 8 tests that while both HIV antibodies and HIV viral load couldn't be detected, I could actually still be HIV infected. Based on his comments, I am still concerned about HIV. I've spent much time reading forums (including heated debates, and unfortunate name calling) and web sites, and clearly different belief systems exist about testing windows - all the way from Lisa Capaldini MD on the Aegis forum saying that current generation antibody tests are conclusive within 3-4 weeks, versus the AIDS Action Committee of Massachusetts web site saying 6 weeks is conclusive, to the more typical 13 week recommendation, and also the 26 week (and occasionally longer) suggestions. I'm not looking to rehash the antibody window civil war, all I want is intelligent advice on how much further to antibody test considering my particular circumstances (I do intend to do a 13 week antibody test), in the face of continuing to feel ill. Also please, I have some additional questions:

(1) Assuming I was co-infected simultaneously with another virus (e.g. hepatitis C), could that obstruct HIV antibody production & detection over the first 13 weeks? If so, how much longer should I test?

(2) Since my doctor didn't test for Chlamydia or Gonorrhea, could my long term symptoms be caused by sexually reactive arthritis?

Thank you again for reading my questions and concerns - from reading all of your responses I've seen that you've done enormous work in answering everyone's questions (sane and otherwise).

[Ann]

Tony,

The vast majority of people who have actually been infected will seroconvert and test positive by six weeks, with the average time to seroconversion being only 22 days. A six week negative must be confirmed at the three month point, but is highly unlikely to change. Yes, we go by the standard three month window for a confirmed negative result.

The only people who have experienced delayed hiv seroconversion due to simultaneous hep C infection have been intravenous drug injectors who had compromised immune system due to chronic, daily, street-drug misuse. Unless you fall into that category, you do not need testing past three months.

It is much more likely that you were infected with an STI that is much more easily transmitted than hiv, such as gonorrhea or chlamydia. You need to test for these as well as all the other STIs.

You also need to wise up and stop having unprotected intercourse, or sooner or later you're going to end up hiv positive. You were lucky this time (I don't expect your eight week negative to change) but you might not be so lucky in future.


You need to be using condoms for anal or vaginal intercourse, every time, no exceptions until such time as you are in a securely monogamous relationship where you have both tested for ALL sexually transmitted infections together. To agree to have unprotected intercourse is to consent to the possibility of being infected with an STI. Sex with a condom lasts only a matter of minutes, but hiv is forever.

Have a look through all three condom and lube links in my signature line so you can use condoms with confidence.

Anyone who is sexually active should be having a full sexual health care check-up, including but not limited to hiv testing, at least once a year and more often if unprotected intercourse occurs.

If you aren't already having regular, routine check-ups, now is the time to start. As long as you make sure condoms are being used for intercourse, you can fully expect your routine hiv tests to return with negative results. Don't forget to always get checked for all the other sexually transmitted infections as well, because they are MUCH easier to transmit than hiv.

Use condoms for anal or vaginal intercourse, correctly and consistently, and you will avoid hiv infection. It really is that simple!

Ann

[TonyDewitt]

Thank you Ann for everything you wrote - I will let you know how my 13 week test goes.

[Andy Velez]

Like Ann, I would say that at this point with a negative at 8 weeks the likelihood is that you're going to continue to test negative at 13 weeks.

But you do need to learn from this experience. You can have anal intercourse with anyone you want to regardless of their HIV status. Just do it the safer way and that means that everytime the insertive partner is wearing a condom. No exceptions. Remember that doing otherwise you are putting your life at risk.

Baed on those previous negative results, this time I am expecting you to scoot through safely. 

[TonyDewitt]

Thank you also Andy, I feel stabilized by you & Ann providing final testing times - I think most people who are worried about being infected can go crazy with the different window testing times; certainly that is how I felt during my visit to an infectious disease specialist. And yes, I have learned from this experience and it is a lesson that I will not forget, thank you again.

[Andy Velez]

You're welcome.

Good luck with that final test at 13 weeks. I expect the result to be negative.

Cheers.

[TonyDewitt]

Hi Ann & Andy,

I did a rapid blood test today (13 weeks minus a day since exposure) and it came back negative. While I am happy that the test results are negative, I'm still feeling severe symptoms of body aches and fatigue. Should I continue testing?

Thanks again to both of you for all of your guidance - Happy Thanksgiving.

[Andy Velez]

You're HIV negative. Period. End of that story. There's no need for further testing.

If you have symptoms that are bothering you that is something to discuss with your doctor.

Happily, HIV is not your problem. Period.