Q. My last HIV risk exposure was three to four years back. Am I safe now?

Answered by
Dr. Kakkar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Mar 07, 2018

Hello doctor,

I am a 65-year-old white male and tested negative for HIV 1 and 2 in a one-time test three to four years ago. I am not sure if it was a third or fourth generation test. I tested negative with a fourth generation test four months back because I thought I might be having some symptoms. And I remembered the flu-like illness about six months after exposure.

I weighed 204 kg three months back and now I weigh 191 kg. I have worried a lot (pacing the floor, sleep loss) for past five months, took Paxil, and realized my worry could account for some weight loss. Shortly, after the test, I had the following symptoms:

  1. I started having a small patch of 8 to 10 pinpoint sized pink-light red dots under the skin of my left wrist that have been there for two to three weeks.
  2. I also had a smooth, flat spot about 3/8 inch in diameter that appeared on the back of my right hand about a week ago, that has now faded to a pinkish brown. I have read about Kaposi sarcoma being a definer of AIDS, but do not understand how that could happen with a non-reactive fourth generation test four months back.
  3. Three months back, I had sinus type headaches multiple times that would sometimes be severe. After three rounds of antibiotics and a CT scan two months back that showed shadowing in a sinus, my ENT doctor just told me this week that there is something in my sphenoid sinus. He is treating it with a rinse for inflammation for three weeks before I see him again. I have had blood in my mucous from my nose for past three months. It dries out in my nose and causes blood almost every time I pick at it. The ENT doctor said that the lining of my nose had been worn down from this, but did not seem concerned about it. I do mess with it a lot, and blow my nose a lot.
  4. My PSA elevated quickly in the last six months, going from 1.2 to 3.5. A biopsy two months back showed an early cancer in one of the 12 regions biopsied.
  5. I had a lithotripsy on an 8 mm kidney stone this month and I am still passing dark urine. I was told that I do have several small stones still in each kidney. I have had multiple stones over the years.
  6. I have a swelling sensation all the way around my waist down into my groin at times that has been there for about two months, but no noticeable swelling. Several doctors have felt in my abdomen and detected nothing abnormal. A CT scan with no contrast 10 days ago showed no abnormalities other than a little swelling in the right kidney where the 8 mm stone was blocking the passage into the ureter. A CT with contrast five months back was normal except for showing stones. But I have microscopic blood in my urine since then.

My vital signs have consistently been normal for past five months, including temperature, BP and oxygen. I know I am getting old and some of these symptoms happen with age. But it is driving me crazy that so much has happened since my negative fourth generation test which is supposed to detect antibodies may not be conclusive after three to four years of exposure. I had Zoloft 100 mg daily earlier but currently, on Paxil 40 mg and Propranolol 60 mg daily.

After nearly four years of exposure and a negative antibody test four months back, would that test have detected antibodies if I were in a stage of HIV or AIDS? Do you think it was conclusive? Or is there another test I should have done? I have read about an HIV RNA test, but it says early detection. I understand that it detects more than the antibodies. What are your thoughts on my next step?

#

Hi,

Welcome to icliniq.com.

Your test done before four months is certainly conclusive and final. A three months intervening period/window period between risk exposure and a fourth generation HIV screening test is good enough for it to be considered conclusive. 95 % of those infected with HIV will have detectable antibodies by four weeks and by 12 weeks, or three months 100 % of HIV infected individual will have detectable antibodies. Antibodies once formed will remain detectable by screening tests. In fact, antibody based HIV screening tests are the gold standard tests for the diagnosis of infection whereas an HIV RNA PCR test is more commonly utilized as a measure of response to antiretroviral therapy in HIV AIDS patients rather than as a diagnostic or screening test.

For more information consult a HIV AIDS specialist online --> https://www.icliniq.com/ask-a-doctor-online/HIV-AIDS-specialist

Thank you doctor,

I meant to say that my exposure was three to four years ago, not for three to four consecutive years. Does that make any difference in your answer?

#

Hi,

Welcome back to icliniq.com.

Yes, I got that. You said that your last risk exposure was three to four years ago and you last tested with a fourth generation HIV screening test four months back. Earlier you tested three to four years ago. My answer is the same. Antibodies to HIV develop within 4 to 12 weeks in all those who are infected and they remain detectable throughout the infection. So, if someone is screened for HIV after three to four years of infection, a fourth generation HIV screening test should be able to detect the antibodies.

As far as the skin lesions on your wrist are concerned, I request you to kindly upload a few clear images of the affected area so that I can have a look at the spots and let you know what exactly they are due to.

For more information consult a HIV AIDS specialist online --> https://www.icliniq.com/ask-a-doctor-online/HIV-AIDS-specialist


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