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Dr. David
Dr. David, Other
Category: HIV and AIDS
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Experience:  Experienced physician
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HIV and/or AIDS specialist only please, I had following

Customer Question

HIV and/or AIDS specialist only please,I had following Exposure(s) : multiple Receptive unprotected anal sex with person of unknown and known status.Symptoms: All typical ARS symptoms including Fever, Night sweats, body rash, diarrhea for 2 months, and so on. I don't want get in to too much of it as I have had ALL symptoms.Tests : 2 and 4 month 4G Ab/Ag negative,
CD4 @ 2 month , 1600
CD4 @ 4 month , 851 significant drop in two month
3 month std panel is -ve1) Am i all clear?
2) when delay sero conversion occurs, how does antibody, rna and cd4 count relates ?
3) I'm not on chemotherapy, not a drug user...But, NOT sure if I have any confection with anything or not. Also, I don't know if i'm immuno compromised or not ....
Submitted: 2 months ago.
Category: HIV and AIDS
Customer: replied 2 months ago.
Please make sure to help me with providing me some detail along with rational/prospective on the answer.
Expert:  Dr. David replied 2 months ago.

This is Dr. David. I am reviewing your question now and will be with you momentarily.

Expert:  Dr. David replied 2 months ago.

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm#tab1

unprotected receptive anal sex with an HIV positive person each time has a 50 in 10,000 chance of you contracting HIV

after 4 months of duo HIV test being negative you have a 95-98% that you are truly HIV negative.

testing your CD4 counts doesn't help you. these counts go up and down on their own and is not used to check for HIV.

you should be using a condom for anal sex.

when serocoversion occurs, your antigen levels are positive and your antibody levels become positive. yours are both negative.

you don't have HIV.

you have no reason to be immunocompromised

let me know if you have questions.

Customer: replied 2 months ago.
OK. Thank you for taking some time and providing me information. How come from 95-98% chance to I don't have an HIV. For sure, AS OF NOW, I have not diagnosed with it.I have had all ARS symptoms. Specially 2 month of diarrhea and I have had colonoscopy done as well and nothing came out from it except the fact that I have had 3rd grade hemorrhoids which increased my chance to even acquire it even more.Few additional risks
1) grade 3 internal hemorrhoids
2) exposure to known/unknown hiv person
3) what if the known/unknown hiv person was going through ACUTE phase, which increase change to 27 more times ?
4) i know for the fact that in initial hiv RNA goes way up and CD4 counts way down, in my case I believe that's why I can see at 4 month ?Am i just really in a situation where I can't do anything except wait and then test to confirm Positive results at 6 month ?
Expert:  Dr. David replied 2 months ago.

you won't get positive results at 6 months

you can get HIV PCR testing now, you can get HIV Elisa tests now.

I bet these additional tests at this point will continue to be negative.

then you don't need more testing at 6 months.

Expert:  Dr. David replied 2 months ago.

let me know if you have other questions.

if done for now, please leave positive rating of 3-5 stars so I can get credit for helping you today

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you can always reach me directly with "a question for Dr. David" in the medicine or oncology categories if you have other questions

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Customer: replied 2 months ago.
Hi,What would be rational for your suggestions that my 6 month test would be negative ? My elisa -ve was at 4 month which is only 4 more weeks more from CDC recommendation for conclusive for 97% of the people.What would be the reason for sudden drop in CD4 ? Exposure, symptoms, screwed up cd4 test but -ve elisa.Is there any scientific reason that my 4th generation test won't turn positive at 6 month ?
Expert:  Dr. David replied 2 months ago.

you seem to be worried that you could serocovert at 6 months.

I don't think you will

I suggested more blood tests you can have now which I bet will be HIV negative.

as I said, your CD4 levels can go up and down normally. a drop in CD4 doesn't mean you have HIV.

it sounds like you have a lot of bad anxiety and worry about late seroconversion.

this doesn't happen after all of the HIV testing you have had which is HIV negative.

Customer: replied 2 months ago.
AFAIK, CD4 count decreases by 100s per year in chronic hiv phase but drastic drop in acute phase.https://www.google.com/search?q=hiv+rna+cd4&biw=1024&bih=495&tbm=isch&source=lnms&sa=X&ved=0ahUKEwjimK3jv4jPAhWBbR4KHbxnCc0Q_AUICSgC&dpr=1.88I'm so much worried that RMA would be detectable now.
Expert:  Dr. David replied 2 months ago.

if HIV was causing declines of your CD4 counts right now, your duo HIV antibody and antigen test would be positive.

your HIV elisa test would be positivec.

Customer: replied 2 months ago.
I'm not sure about that as in delayed seroconversion , people don't have antibodies between infection and 3 month. Then it comes to between 3-6 months and even in those cases, antibodies generally shows up with it would show up....What if the amout of virus is way low for even RNA test to miss it ? I've also read it that when RNA goes so much up that's when the antibodies start to form...so if the viral load is so low to be detectable in rna test , thus very low antibodies or may be not detectable by tests...
Expert:  Dr. David replied 2 months ago.

those people who don't have antibodies have antigens

and would test positive with Elisa by 4 months.

your anxiety is trying to make up all of these super rare and crazy scenarios.

your virus load would not be too low to detect for RNA at 4 months.

you are HIV negative.

Customer: replied 2 months ago.
Antigen appears for very short period of time and it's not that sensitive to elisa test.i also know that 25% of the hiv positive people have hep a/b or c.Also if you are coinfected then it would delay seroconversion. also i had std panel at 3 month but hep c window period could be longer that that...
Expert:  Dr. David replied 2 months ago.

hepatitis would not delay seroconversion.

Customer: replied 2 months ago.
The Centers for Disease Control has published guidelines for health care workers who sustain a significant occupational exposure to a patient coinfected with HIV and hepatitis C viruses. The health care worker guidelines for occupational exposure to coinfected patients suggest HIV-antibody testing at baseline, six weeks and twelve weeks after exposure. if,the health care worker develops acute hepatitis C infection, then and only then would additional HIV-antibody testing be recommend. In this case, are HIV tests out to 12 months recommended.
Expert:  Dr. David replied 2 months ago.

no, you don't need testing out to 12 months.

Customer: replied 2 months ago.
i understand. my main concern is exposure, symptoms, 4 month -ve test with dropped cd4 count and 2 months to go
Expert:  Dr. David replied 2 months ago.

yes, I understand

and I have told you already you are 95-99% HIV negative

Customer: replied 2 months ago.
is there any advanced test that i can get done which can tell me right away if i'm 100% negative or positive ?
Expert:  Dr. David replied 2 months ago.

nothing in medicine is 100%

Customer: replied 2 months ago.
or conclusive ? Do i need further testing before i get in to AIDS situation?
Expert:  Dr. David replied 2 months ago.

your testing so far is conclusive

you don't need more testing.

Customer: replied 2 months ago.
Can I resume unprotected sex with my wife? I don't want to infect her no matter what...i definitely do not want to infect her.
Expert:  Dr. David replied 2 months ago.

yes, you can resume unprotected sex with your wife.

Customer: replied 2 months ago.
TY. I understand that this is great news for us. However, If I resume unprotected sex and then later find out that my G AB/Ag test turns out positive, wouldn't I be putting my wife at risk more then 26 times as I'll be in acute phase of it ..
Expert:  Dr. David replied 2 months ago.

your future tests will not turn out to be positive.

all of your tests have been negative

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