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Risky Exposure with Commercial Sex Worker

Question: 

I had a risky exposure with a commercial sex worker on Aug 6th 2018.I had protected Vaginal sex but i licked her vagina with a lotion this was unprotected.Afterwards washed my eyes in the bathroom .My eyes became red still experience eye pain even now. I had night sweats,body warmness,fever 97-99 and rashes now there are present under my left arm near my back.

Performed hiv elisa p24 antigen and antibodies test after 12 weeks at 86 days. Result is negative.But still experience the symptoms cold,cough which persist daily. Thinking of hiv everyday are my results Conclusive.Also did hiv 1 pcr rna qualitative on 76 th day which was negative less than 35 copies.

Answer: 

Hello and thank you for contacting the AIDS Vancouver helpline.

I understand that you are asking about the accuracy of a 4th Generation EIA (aka DUO or COMBO or ab/ag test) performed at 86 days after a potential exposure, as well as a NAAT PCR RNA Test performed at 76 days after the same exposure.

The two activities you describe are protected vaginal sex, and giving oral sex. Both of these activities are assigned a low risk for transmission of HIV, meaning that they present a potential for HIV transmission because they involve an exchange of body fluids. There have been a few reports of infection attributed to these activities.

Fourth-generation HIV tests can detect HIV infection in 50% of people by 18 days after infection; 95% of people by 34 days after infection; and 99% of people by one and a half months after infection. Fourth-generation HIV tests have a sensitivity of about 99.9% At 86 days you can consider your negative result to be conclusive.

The NAAT PCR RNA Test, sometimes referred to as an "Early Test", can detect viral RNA in the blood of individuals who have do not yet have detectable antibodies. The window period for this test is 2-3 weeks post exposure. This test is 90% accurate at 10-12 days, 95-98% accurate at 6 weeks, and 99.6% accurate at/after 12 weeks. Your test was performed at 76 days (about 11 weeks) so you can consider your result to be conclusive.

The recommendation for this low risk activity would be HIV testing, which you have already done. The symptoms you describe could be caused by a number of different conditions, and cannot be attributed to an HIV infection in the absence of a positive HIV test result. Please consider seeing a doctor if these symptoms persist.

In the future, you might consider using safer oral sex practices to further reduce your risk level and your anxiety. I have included a link below with information on this topic. (2)

Regards, AIDS Vancouver Helpline Volunteer, Dyson