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Author Topic: Advice on exposure to HIV Positive Sexual Partner  (Read 4070 times)

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Offline jryam

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Advice on exposure to HIV Positive Sexual Partner
« on: August 09, 2012, 04:25:35 AM »

I would really appreciate if someone would be able to address a number of questions for me as below,

I am a 26 year old guy, based in USA for the past couple of months but from the UK. I have a limited network of people around me here, and have found it really difficult to try and get some answers to my current situation that has occurred in the past 48 hours or find some kind of counsellor who is aware of the medical implications that may affect me.  Most of the GP doctors I have contacted don't really have any real indepth knowledge on HIV and just refer back to getting another Elisa/WB done.

If you could take the time to help me out, I would really appreciate a response.

26 days ago I had sex with a guy that I had only known for a few days.  I was the insertive partner only and we started with a condom, but then I stupidly, stupidly took it off and we continued having sex until I ejaculated inside of him.

I had been tested the day before with a rapid HIV test and also a HIV NAAT test (which has since come back negative). I have a completely clear history of any STDs. Before we had sex, I discussed with him my negative status and wanted to make ascertain that he was also negative - at the time he stated that he was negative and hadn't had unprotected sex with any other guy since his last negative test. The unprotected insertion before ejaculation was for a maximum period of approximately 5 minutes, and then possibly around another 60 seconds the next morning, but no ejaculation.

The next day I freaked out and asked him to go and get a test done for my peace of mind. He went and had a test (but not a rapid one) and then took a couple of weeks before getting back to me saying he hadnt received anything. 2 days ago, after I finally called him, he finally said that 'he was not cool'. Needless to say, I haven't slept since then and have been freaking out. I asked for a copy of the results, and they read as him being reactive to ELISA (with a repeat ELISA also reactive), but negative (no bands) to the Western Blot. I pressed him to please get another rapid plus NAAT test ASAP.

From what I have read, this can either be classed as a negative result (the ELISA being false positive) or inconclusive. From what I have now pieced together from him, he says he did actually sleep with another guy once as the receptive partner anywhere between 2 - 4 weeks before me. He said this was unprotected but the partner did not ejaculate inside him.

He has since come back today saying that he had a rapid test and that it came back as reactive and is awaiting the results of a NAAT or similar test.

During the week before we had sex, he had 2 days of a pretty bad fever where he was laid out on his bed for 2 days. I'm very concerned that this could have been the onset of ARS and if so, would his viral load be extremely high which would push the risk for me as the insertive partner even higher?

Given all of the above, I guess it would be conservative in the least to assume in this situation that he is indeed HIV positive and to factor my potential risk from this.

2 days ago when I found this out from him, I went immediately to have another set of tests. The rapid test came back negative, though the duration since exposure was only 24 days at that point. I also had a NAAT test done and the following morning a RNA qPCR test. I believe these are the same or similar tests, but were done with different providers. These will take at least 4-5 days to come back, and in the meantime I am not sleeping and am severely freaking out. I have had no signs of ARS but am now concerned that it is possible that something will show up in the next few weeks.

Not being able to wait for the results of the NAAT/PCR tests, today I went and got tested with an Abbott Architect HIV Ag/Ab Combo test and got the results back this evening - negative. This gives me some level of reassurance as the p24 antigen part of this test is supposed to be able to detect from very early stages of an HIV infection up until about 4 weeks. My duration today since exposure was 3.5 weeks or 26 days. I also had another rapid test today (yes, I know, there is not much chance of it showing anything different from the one I had 2 days ago, but still...) and that was also negative.

I am circumcised and very fit and healthy, I have no history of STDs or other diseases, and no visible cuts, lesions or any broken skin on my penis or surrounding areas. I know it doesn't really matter but I thought the more information you have the better.

Could you please, please offer your opinion on the situation;

1) What severity of risk you think I placed myself under given the circumstances (I know quantifying an exact percentage is very hard, but still, something along those lines).
2) The fact that the sexual partner has had 2 positive ELISAs (1 repeat for confirmation), 1 positive rapid test and then a negative western blot definitely points to him being HIV+, correct?
3) What level of reassurance should I have from the 2 rapid tests that have come back at 24 & 26 days (if the majority of rapid tests will show up if positive within around 25 days) and the negative HIV Combo (Ag/Ab) test received today (26 days post exposure) in the meantime while I await the results of both PCR tests?
4) As the insertive negative unprotected partner, does ejaculating inside the receptive partner increase the risk of transmission for me, the insertive partner?

I am totally aware of the 3 month definitive guideline for antibody testing, and plan on testing at intervals until then, but I'd really like an expert opinion on my specific situation.

This was the stupidest thing I have ever done and I am praying that everything comes back negative into the future and that I will ensure I never have to go through this massive ordeal again.

Thank you again in advance for taking the time - I know this is a long post but I wanted to be entirely clear on everything.

JR in San Diego

Offline Ann

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Re: Advice on exposure to HIV Positive Sexual Partner
« Reply #1 on: August 09, 2012, 05:19:48 AM »

1. How long is a piece of string? As the insertive partner, your risk is very much on the lower end of the scale and I would expect you to test negative following this one-off incident (yes, I know, 60 seconds in the morning as well). Regardless of his viral load.

2. A negative WB means a negative diagnosis. However, if he tested too soon - and it sounds like he did - that may be the problem. He needs to test again at the six week point following his other unprotected encounter. If he is indeed positive, his WB will also be positive at this time. Positive antibody results are not confirmed with NAAT or PCR testing, they are confirmed with a WB test (and sometimes a newer test called a Multispot). If he's unhappy with the WB results, he may be able to have a Multispot depending on the availability at his testing facility.

3. 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 is highly unlikely to change, but must be confirmed at the three month point.

Neither NAAT nor PCR testing are diagnostic tests. Regardless of what results you get from them, the results must still be confirmed with antibody testing, and WB testing if the antibody test comes back positive. There are no short cuts to hiv testing, so stop wasting your money on NAAT and PCR testing.

4. No, ejaculation only matters to the receptive partner.

Given all you've told us, I expect you to continue testing hiv negative. You'll need to have a final test at three months for a conclusive result.

You really need to learn from this and use condoms regardless of what someone claims about their hiv status. Many people only think they're hiv negative, and unfortunately, sometimes people lie.

Here's what you need to know in order to avoid hiv infection:

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 without a condom lasts only a matter of minutes, but hiv is forever.

Have a look through the 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. Some of the other STIs can be present with no obvious symptoms, so the only way to know for sure is to test.

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

Condoms are a girl's best friend

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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

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Offline jryam

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Re: Advice on exposure to HIV Positive Sexual Partner
« Reply #2 on: August 09, 2012, 01:20:40 PM »
Ann, thank you for your response, I really appreciate it. I am praying that everything continues to come back negative and will keep testing up until the 3 month mark.


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