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HomeAnswersHIV/AIDS specialisthiv risk factorsMy last HIV risk exposure was three to four years back. Am I safe now?

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

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At March 8, 2018
Reviewed AtJuly 17, 2023

Patient's Query

Hello doctor,

I am a 65-year-old white male who 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 have some symptoms. And I remembered the flu-like illness about six months after exposure. I weighed 449.7 lbs three months back, and now I weigh 421 lbs. I have worried a lot (pacing the floor, sleep loss) for the past five months, took Paxil, and realized my worry could account for some weight loss. Shortly after the test, I had the following symptoms: I started having a small patch of 8 to 10 pinpoint-sized pink-light red dots under the skin of my left wrist that had been there for two to three weeks. 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 (Acquired Immunodeficiency Syndrome), but I do not understand how that could happen with a non-reactive fourth-generation test four months back. Three months back, I had sinus-type headaches multiple times that would sometimes be severe. After three rounds of antibiotics and a CT (Computed Tomography) scan two months back that showed shadowing in a sinus, my ENT (Ear, Nose, Throat) 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 the mucous from my nose for the 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. My PSA elevated quickly in the last six months, going from 1.2 to 3.5. A biopsy two months back showed early cancer in one of the 12 regions biopsied. I had 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. 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 ten 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 had microscopic blood in my urine since then. My vital signs have consistently been normal for the past five months, including temperature, BP (Blood Pressure), 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 I am 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 (Ribonucleic acid) test, but it says early detection. I understand that it detects more than antibodies. What are your thoughts on my next step?

Answered by Dr. Sushil Kakkar

Hi, Welcome to icliniq.com.

Your test done before four months is certainly conclusive and final. 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 (Human Immunodeficiency Virus) will have detectable antibodies by four weeks, and by 12 weeks or three months, 100 % of HIV-infected individuals 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 (Polymerase Chain Reaction) 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.

Patient's Query

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?

Answered by Dr. Sushil Kakkar

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 (Human Immunodeficiency Virus) 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.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Sushil Kakkar
Dr. Sushil Kakkar

Dermatology

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