Unprotected vaginal sex with confirmed hiv+ female

[Redgreg10]

Hi Drs

Awesome forum! I'm sure you're aware  you truly are doing the world a great service with this forum.

This question concerns my 35 year old brother
8 years ago he was in a california state mental hospital, as an inpatient, and had a single incident of unprotective penetrative vaginal sex with a female patient who was confirmed hiv positive. The female knew she was positive, and I believe was taking anti viral medication as she was an inpatient at the facility. This is where I get a little fuzzy with my memory because it happened 8 years ago. I believe he was tested 6 weeks after the incident and test came back negative. However I don't believe the hospital re tested him at the 3 month mark to be conclusive which I would think is extremely irresponsible. But after asking my brother the other day he believes he was tested at 8 weeks. So it was either 6-8 weeks and the nurse had told him it was at the time that he was negative.
Fast forward to 2 weeks ago and my brother was diagnosed with shingles.  So of course I searched through Dr Google and all I could find was "Shingles...young people...HIV" so I couldn't help but put his experience 8 years ago with getting shingles at 35 years old, which I read is rare in healthy young people, and getting super scared that he could have hiv and that the test wasn't conclusive
Here's my questions

1. Considering how accurate the tests were in 2004/05 would a 6 week negative test pretty much rule out hiv?
2. In your expert opinion does it sound very concerning that he had this unprotected vaginal sex exposure with a confirmed hiv+ female 8 years ago and now has shingles at 35? I just can't get the coincidence out of my head
3. Should he repeat a hiv test? The problem with this is it's my brother and he is pretty bad about getting blood work so it's very hard to convince him. It's almost like I'm 10x more scared for him than he is.

Thanks for your help

[H. Hunter Handsfield, M.D.]

Sorry -- I guess I shouldn't have made assumptions.  Congratulations for taking what seems to be an appropriate and generous level of responsibility for your brother.

As noted above, the result at 6 weeks was very close to 100% reliable.  And most people with HIV for 8 years would have had symptoms or illnesses that brought their HIV status to light.  This isn't definite, of course, but if he remains outwardly healthy, it further reduces the likelihood he has HIV.

Thanks for your kind comments about the forum.  Happy holidays.

[Redgreg10]

Yes you are correct. It is his business but since he still suffers from a mental illness that dibilitates him to some degree I can't help but watch over him.  

[Redgreg10]

Thanks for the advice. Very helpful

So a 4-6 week negative result is very reliable?

Thanks again Doc. I've been reading your replies on this forum for a few years and this is the first time I've asked a question
I love reading other peoples questions. Some I can really relate to and others or so far out but they're super interesting and sometimes funny to read. You and Dr Hook should think about compiling the craziest stories uve heard and publish a book. There might be enough people, especially OCD people like myself that would read it.

Thanks! Happy holidays

[H. Hunter Handsfield, M.D.]

See above.

Although the standard advice 8-9 years ago was that the antibody tests were only ~90-95% valid at 6 weeks, today we know better.  It's very close to 100% by 6 weeks, and that includes the tests that were being done in 2004/5.

The only additional consideration is your brother's sexual lifestyle in the past few years.  All people who are sexually active outside mutually monogamous relationships should be tested from time to time for HIV, like once a year.  And it is not unreasonable for anyone with shingles to have an HIV test.

So perhaps your brother should be tested.  However, I don't see that this is your business.  He's a grown-up; it's his issue, not yours, don't you think?

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

The HIV blood tests are among the most accurate diagnositic tests ever developed, for any medical condition.  As long as sufficient time has passed since the last possible exposure (4-8 weeks, depending on the specific test or combination of tests), the test results overrule all other considerations, such as symptoms and exposure history.

Singles is indeed more common in people with certain kinds of immune deficiency, including HIV infection.  But it also is common in people without such problems, and the large majority of people with shingles (at any age) do not have HIV.  (As it happens, I've had shingles myself, and so did my son at age 13.  Neither of us has HIV, which didn't even enter my mind at the time.)

To your specific questions:

1) The HIV tests done routinely in 2004-5 were just as reliable as today's tests.  The negative results are 100% reliable.

2) No, this sequence of events does not concern me at all.

3) Mellow out.  This is your brother's responsibility, not yours.  And for the reasons above, there isn't the slightest reason to be concerned he has HIV.

I hope this has helped.  Happy holidays--  HHH, MD

[Redgreg10]

I also forgot too add that when my brother received his 6 week negative result, 8 years ago, the social worker told him it was 90% that he did not have HIV.  It's hard for me to agree with that assessment since I have no idea which type of test was preformed and as you know everyone has their opinion of window period and testing accuracy
One extra question
  how sensitive and accurate were hiv tests in 2004/05 campared to today's tests?