HIV antibody test while on immunosuppresive drugs

[boykan]

Hello. I had an unprotected anal sex with a 21 year old black man 3 weeks ago whose HIV status is not known. I was the top (insertive) partner, we had sex for a few minutes using lube and I ejaculated inside him. What I did was very irresponsible and I regret it deeply, and since then I have been worried sick and have very bleak thoughts of HIV infection, the anxiety is driving me crazy!! Everyday I wait for the "onset" of ARS symptoms, and what is making this worse is that it's the flu season, so I could be infected with normal flu and interpret as ARS. Everyone around me had flu and I was so worried to catch it, but thankfully I didn't which I believe in part is due to my healthy life style and my daily supplements of multivitamins and minerals. So far after 3 weeks no symptoms at all, but I am still very worried nonetheless because not all experience ARS.

My case is a bit special since I had kidney transplant 10 years ago and was put on immunosuppresive drugs since then. I take 50 mg of Cyclosprine and 500mg of Cellcept twice a day. I already ordered OraQuick HIV in home test and is due to arrive within a few days. I plan to test at 4, 8, and 12 weeks after exposure just to get a peace of mind as I have to wait for the 3 months mark.

The question is: Because I am on immunosuppresive drugs already, and especially cyclosoprine (CsA), would this delay affect the HIV antibody test in anyway? Should I get a HIV PCR test instead?

Thank you for your support.

[jkinatl2]

That's actually a good question. I did a small bit of research and found that the drug you are on has actually been toyed with, with mixed success, in helping to fight HIV infection (along with standard therapies.)

For that reason, I would absolutely suspect that it could extend your window period. In your case, which is a rarity in these forums, I would absolutely discuss this with your doctor, as the standard Oraquick Home Test might not be appropriate, at least not at this time.

I am certainly not ashamed to say that your situation seems out of my pay grade, and I will allow the other moderators to chime in. Personally, I would think that you might need an extended testing window, as your immune system is chemically compromised by the powerful anti-rejection drugs that act as an immunosuppressant.

As the insertive partner, your risk was significantly less than the receptive partner, but it was a risk nonetheless, and you do need to get tested appropriately.

[Ann]

boykan,

Even most people who are on immuno-suppressive drugs following organ transplant will seroconvert and test positive by three months. You might want to test again at six months to be absolutely certain, as hiv is nothing to guess about.

You should wait to test for the first time at six weeks, not four. Testing at four with the in-home tests is a waste of time and money. And quite frankly, testing again at eight weeks is also a waste. Don't get into the habit of over testing.

However, as the insertive partner during unprotected intercourse, the odds are very much in your favour that you won't have been infected from this one-off incident. But yes, you have had a risk and you do need to test.

Stop looking for signs and symptoms of hiv infection. All you'll do is drive your anxiety through the roof and guess what, anxiety can make you feel ill and do all sorts of nasty things to your body which you might then misinterpret as hiv. Don't do that to yourself.

The best thing you can do is to keep yourself productively busy with other things while you wait for the appropriate time to test, and don't micro-examine your body all the time.

Ann

[boykan]

Thank you Ann &  jkinatl2 for your insightful answers. The thing is I have an appointment with my nephrologist in a couple of weeks. Should I ask him for HIV RNA PCR test (it will be 6 weeks by the time I see him)? This would be a definitive test if I recall correctly. I would still do the three & six months post exposure antibody test, but if the PCR test if negative, I am sure it will ease off my anxiety.

[Ann]

Boykan,

While the RNA PCR hiv test is approved for use in a diagnostic setting, it is NOT a stand-alone test. You will still need the result confirmed with antibody testing to confirm the PCR results. (Please note - the DNA PCR test is NOT approved for diagnostic use although many doctors seem to be unaware of this fact.)

I was actually thinking of suggesting a PCR test for you, under your unusual circumstances. But again, it is NOT a stand-alone test.

For example, some people, although rare, can control the virus on their own and maintain an undetectable viral load without meds. If you happen to be one of these people, you could easily get an UD (undetectable) result on the PCR test (that's what viral load tests are) when you're actually poz. False positives also occasionally happen. This is why it is NOT a stand-alone test.

However, yes, a negative (UD) result should ease your anxiety. Most people have an extremely high viral load in the first few months following infection, but as noted above, there most definitely are exceptions.

Again, you'd be very unlikely to end up poz over a one-time unprotected insertive encounter. I really don't expect you to test positive, but you must test to be sure.

Ann

[boykan]

Thanks all for the help and support. I tested negative 6 months after exposure using OraQuick and also a blood test in a hospital. I was so relieved and will never ever put myself at this excruciating risk again. The emotional toll itself was a lot of handle, but I'm happy it is over. Hopefully someone will learn from my experience as well.

[Ann]

Boy,

Good news! Thanks for letting us know the outcome of this unusual situation (that of you being on anti-rejection meds following organ transplant). You weren't likely to end up poz over a one-time insertive situation, but testing was still the right way to go.

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.

ALTHOUGH YOU DO NOT NEED FURTHER HIV TESTING AT THIS TIME, 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!

Ann