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please assess my risk, should i relax now?

Question: 

i had an exposure with a CSW on april 7. she sucked my nipples and gave me a blowjob. It was protected oral sex and I was wearing condom throughout. I did not have any vaginal or anal sex with the girl. She gave me an unprotected handjob. Later She lied naked with me for half an hour and later I just chatted with her about her life, why she became a sex worker and if anyone in her family knew about what she did. I felt really bad after her hearing her story and felt I was exploiting someone and just asked her to go without having even any protected penetrative sex.

I dont know her HIV status but she insisted on using condoms for oral sex even though I was willing to go for oral without condom,saying she needed to protect herself. She also refused anal sex,saying she never has it and only has vaginal sex with a condom and told me she never had sex without a condom with any customer of hers. She also told me she does not let anyone ejaculate on her body as she is scared of diseases and STD. Now i dont believe any of this as such since at the end she is CSW. I am assuming her to be hiv positive.

After she went I freaked out the next day that I may have caught HIV because of her sucking my nipples if she had any bleeding gums or mouth ulcer. I checked my nipples and did not notice any sign of injury or mark but got very scared and started testing for hiv.I did not notice any blood coming form her mouth and did not have any cut or injury before she sucked my nipples. After the event i checked my nipples repeatedly but could not find any injury or small cut. I am very scared.

please refer to my test results below:-
risk date- april 7,2016
hiv-1 rna QUANTITATIVE pcr on april 18- negative, target not detected (10 days after exposure)
hiv 1/2 & p24 antigen combo test on may 6- index value- 0.07 negative(28 days after exposure)
hiv-2 pcr detection on may 14- negative,target not detected(37 days after exposure)
hiv 1/2 & p24 antigen combo test on may 21- index value- 0.11 target not detected(44 days after exposure)
hiv-1 rna QUALITATIVE PCR on may 24- negative, target not detected(46 days after exposure)

now can i consider myself 100% negative for both hiv-1 and hiv-2 and move on with my life or do i need a confirmation with an antibody testing at 90 day mark? is there a possibility that all my pcr and hiv 1/2 and p24 antigen combo test(CMIA) are false allnegatives? Is the hiv 1/2 & p24 combo test the same as the hiv duo test? I have read that both the duo and pcr test are considered conclusive by 4-6 weeks by hiv specialists... i know u may say that i dont really need testing but please help.

Answer: 

Hi there, and thanks a lot for contacting the AIDS Vancouver Helpline for your HIV/AIDS related health information. It seems you're concerned about the possibility of HIV transmitting during an encounter. We're happy to answer your question for you.

Her sucking on your nipples is a no risk activity. You mention checking your nipples to see if there were any cuts that you think could possibly increase the risk of transfer. In reality, small cuts do not increase the risk of transfer. Much larger, gaping wounds are required to increase the risk of transfer to any significant extent. Receiving even unprotected oral sex is considered a negligible risk activity, meaning that while transmissions are theoretically possible, none have been shown to actually occur. We would presume protected oral sex carries with it an even lower risk. To see the risk level of these and many other common activities, we encourage you to check out our risk assessment page.

Here is a bit more information on the tests you've had (the COMBO test is another name for the DUO test):

Test Name
Method
Window Period
Conditions
NAAT (PCR RNA & DNA) Nucleic-Acid Amplification Testing (NAAT) looks for the genetic material of HIV and tests for it with a Polymerase Chain Reaction (PCR) test. 2-3 weeks post exposure NAAT tests generally take two forms: DNA PCR and RNA PCR tests. DNA PCR NAAT tests are usually used for screening babies of HIV+ mothers. RNA PCR NAAT tests are often used to screen blood or organ donations. Both measure the viral load of a positive person’s blood. Conclusive at 3 months post exposure.
4th Generation EIA Blood test that looks for antibodies AND p24 protein antigens. Commonly referred to as the "combination," "combo" or "DUO" test. P24 protein is detectable immediately after infection but only for the first few weeks. The antibody (ab) test has a window period of 4-12 weeks post exposure. This test is widely available in North America. Most HIV specialists consider this test to be conclusive at 6 weeks but official HIV testing guidelines still recommend re-testing at 12 weeks for conclusive results. Conclusive at 3 months post exposure.

You'll see that common with the tests you've had are that they are not considered conclusive until 3 months post exposure. Please remember the risk levels associated with the activities you engaged in (at most negligible risk). You do not actually require testing after this specific encounter. However, we at AIDS Vancouver recommend routine testing for all sexually active individuals, so it's great that you've gone for testing. Normally, after higher risk activities, we'd recommend you go for further testing at least 3 months post exposure. This is not required in this case.

Thanks a lot for contacting the AIDS Vancouver Helpline with your question, we hope it has been answered fully.

Trevor

AIDS Vancouver Helpline/Online
helpline.aidsvancouver.org