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Quantity of HIV transmitted affect window period?

Question: 

Dear Team- Thank you for taking the time to answer this.
I had protected vaginal sex, the condom broke right in the beginning and he pulled out immediately. I was tested at 6 weeks, 3 months and 4 months with 4th generation HIV test all coming back negative. My concern is I had two vaginal yeast infections about 7 weeks after and then again about 13 weeks after. I also noticed about 15 weeks after my right lymph node on my neck is swollen.
My questions:
1- Are my tests conclusive or do I need to retest at 6 months
2- Does the quantity of HIV transmitted affect the window period. Meaning if only a small amount of HIV was transmitted would it take longer for my body to respond to it thus lengthening the window period?
Thank you!

Answer: 

Hello,

Thank you for your inquiry. From what we gather from the question, you were asking about the conclusiveness of 4th Generation Ag/Ab HIV tests taken 6 weeks, 3 months, and 4 months after a Low Risk (Evidence of transmission occurs through these activities when certain conditions are met) exposure as well as if the amount of HIV possibly transmitted affects the window period of the 4th Generation test.

The scenario mentioned above could meet the three components of the Transmission Equation if a bodily fluid containing HIV gained access to your bloodstream during the condom breakage. It is important to note that wearing condoms during sex is a very responsible thing to do as it reduces your risk of acquiring HIV by 80% (1). I also commend you on reaching out for testing after such an exposure. All of the tests that you received are outside of the 6 week period, which most HIV specialists define as the testing window for the 4th Generation Ag/Ab test. Some physicians and guidelines recommend re-testing after 3 months for completely conclusive results, which you have already done. So, you can be rest assured that your results are considered completely conclusive.

You bring up an interesting question on whether the quantity of HIV transmitted affects the window period. Simply put, the answer is no, but it can be a rather complex question. I will answer using information regarding the actual amount of virus required to cause a new HIV infection. An HIV infection can be caused by a single virus in the right place at the right time. An HIV infection may not occur even if a lot of virus particles are present, simply because our bodies are pretty good at defending us against intruding infections and we sometimes luck out. Regardless of whether there is a lot of HIV virus particles or just one, if the virus gets into its cell of choice (CD4+ T cell) and is able to replicate, then infection will result (2). Once infection happens, the amount of virus increases exponentially, and you will end up with a whole lot of HIV virus regardless of whether it started out with many infected cells or just one. So, the window period is not affected by the amount of virus, but it is more likely that an infection could result if there is more virus transmitted.

Recommendation: No need for further HIV testing. Refer to a physician for other health related questions regarding the symptoms you are experiencing.

Regards,

AIDS Vancouver Helpline/Online, Marie