Prednisone (anabolic steroid +immunosuppresant) Appreciate if a doctor could answer

[4ad]

Hello. I had a low risk to no risk exposure exactly at August 12 in the mornig (after party 4 a.m. aprox.). Although my exposure is qualified as low/no risk... I was in a high risk place (Cancún , México) and the person was a transvestite/transgender, so high risk she/he had HIV.

The thing is I even got robbed and I felt a lot of guilt and anxieety ansd still feel it.  Even thopugh I took a duo AG/AB test at 29 days (negative). I would be much more relaxed it it had been a common female prositute in a safer location.

But anyway, to the point,

Despite my low risk activity (almost no risk), I thought the 29 days duo test would tralquilise me. It did for a couple days. But then I just remembered that I had been taking prednisone, for 5 days (dosis of 50 mg). Since it is an immunosuppressant I've heard, that at least in theory, it might delay antibodies to form, delay seroconversion and extend the window period. Last dose was 2 weeks before the incident, but I did take another pill (50 mg prednisone) the day before or the same day of my probable exposure.
So I am worried now and this has made me not trust my results as -I would haave in another circumstance.
I  guess the prednisone (some specilists say its counter effects are only theoretical) could have made my antibodies not to show or masked them by that time. However, I am aware that 4th genertrion DUO tests also look for the virus itself (P24), so it should have most likely picked up on the virus by that time. Could it be possible that the test missed both at 29 days? I having another done at 5 weekks, then at 6 and then at 8. Maybe just to be completely sure at 12 weeks (All DUOS). But how safe tdo you think I am just about now? There was no sex, just touching (not masturbating) and she/he touched my penis over my pants... And since I was so drunk, it occurs to me that maybe, thinking it was a female I could have kissed her in the mouth but am not sure. Definetely ther was no sex involved.

Do you think I should trust my results? what is worrying me now is that I just remembered about the prednisone (immunosuppresant) I has been taking 2 weeks prior and the 50 mg I took 1 day before or the same day for asthma.

Could it be possible that a test negative at 29 days (4 weeks and 1 day) say if I don't test at week 5 and then at 6 and it comes negatove at week 6, might have been positive at week 5 for instance or at week 3 because of P24 and then it disappears and somehow my immune system doesn't produce antibodies because of the pills... I mean, cpould it be possible that if I took it at 3 weeks it might have been positive for p24 but then at 4 weeks not anymore and not reactive to AB as well becaue of the medicine? ant then could turn + at 5 weeks because of P24 but no antibodies present but at 6 weeks negative again for both tests? I hope you understood my question and hopefully you can give me some advice. This is the reason I am having tests 3 weeks in a row, to "not miss the P24 indiicator". But on the other hand, it seems to me that it is unlikely that once a test is positive (especially DUO 4th generation)  could go negative and then positive again for the reasons _I explained. Or if the test didnt catch p24 in 4 weeks, nor5, nor six, and theither antibodies...
I have read that immunosuppresant steroids such as this can only be a theoretical ailment to antibody detection but only if taken in vevery large doses and for a long period of time. However my dosing was big, but only for a few days. What worries me more is that I took a dose one day before or the same day of the incident. (just one since I had completed treatment 2 weeks before).

Most questions I see about concerns eith immunosuppressants are from people who had them months or yeaqrs ago before their encounter (nothing to worry about in my opinion) or before testing but after 3 or more months (also not  a concern I would think).

Can anybody give me some reassurance or guidance with this or help me transfer my question to a qualified doctor?

I hope you can help me.

Thanks.

[4ad]

Thanks a lot again!even if my OCD continues, you sure lower it... I think I will always have that illness in one way or another, but at least want to have it under control. Your answers mean a lot, thank you!

[nursegirl6572]

You say this.....


"What would you suggest besides therapy, I know I need it but am at a stage that can barely leave my house or choose what clothes to wear."

And then this...


"Thankas alot again and please don't limit your response to "get therapy" which I know I need. "


There IS nothing else to say!  You STILL don't have an HIV concern!  You cannot get HIV in this manner, it's impossible, period.  You do NOT need any HIV testing, and if you go forward with it.....it's only to quell your OCD ravaged mind.

You are at a crisis level with your OCD where you're unable to function normally.  Throwing items (valuable) away because of fear of contamination indicates a pretty severe level of anxiety.

Our advice is never going to change...,.you're focused on the WRONG thing.  You need to be taking part in aggressive therapy to address the OCD, or you will remain stuck on the merry go round.

[4ad]

Hey man, thanks for all your help... would you care to comment on my last posts on this thread (quite irrational, and fueled from guilt...I know)

[4ad]

PS- "I was hoping to get a 12 week test in 2 weeks for the transvestite incident (after 2 week duo negative)" I meant 12 weeks

PPS- The fact that bothers me is that the girl I was with a couple days ago was menstruating, and she told me... She used the bathroom and unluckily, the water had been cut that day due to repairs on my buliding.

My rational mind tells me because it is HIV (HumanIV) if I were to have gotten it, though very unlikey, it would have happende to ME and not to the cards or watch, and it would have needed to happen that same day (also very unlikely, especially after being tested at 8 weeks negative.

What would you suggest besides therapy, I know I need it but am at a stage that can barely leave my house or choose what clothes to wear.

Thankas alot again and please don't limit your response to "get therapy" which I know I need.

[4ad]

PD: just to clarify the asterisks where it says I licked her **** it means ttits, not vagina.

[4ad]

Hello and thank you for your comments, they did help a lot.
I had a Duo test at 4 and 8 weeks - negative.
But my mind keeps on playing cruel tricks on me.
a couple days ago I was drunk again and a girl clled me to hang out. I hadn't seen her in many years. She is a model (or so she thinks) and was leaving an event very late (5 am in the morning). As far as I know she is not a prostitute. Also, she has a 6 year old son. But the fact that she called someone that she hasn't seen for so long and wanted me to pay for the taxi gave me some red flags. Even the door man asked me if I was sure I wanted to let her in, because she came with a suitcase ad actually dressed and with makeup like a hooker... but she told me she was coming from an event, etc. Anyway, we had some drinks and sllepr together but no penetrative sex, not even oral. However, I did masturbate and she masturbated myself as well. She kept her jeans on all the time but I may have touched her butt and near her vagina, and she might have too.
I also licked her **** for a minute and we had light french kissing. Now, what worries me is that she was on her period (menstruating), so I (or she) could have got some contact with menstrual blood prior or during masturbation. I got her number and sh'ed probably agree to take a test but not sure if it is worth it.

The other thing is, about the last episode I had (being robbed by a transvestite, no sex) I threw away all my clothes I had on that day, (since she was all touchy feely) and grabbed my penis over my pants and probably was trying to get my wallet too but she didn't), Except for my watch which I really like, but has been stored for a while and my wallet which I did throw away and so I only have my credit cards that where inside my wallet. I did wash the watch as well as the credit cards kind of thoroughly, even dived into a pool with them.
I know this sounds crazy and I am pretty sure I know the answer... But some of this stuff I would rather not talk about with neaar people and as you may notice, talking to myself is no good, so I'd like to hear your opinion.The thing is more than 2 months have passed and I need to use one of the credit cards every day. Today, I was flossing my teeth and visible blood came out. I urgently needed to use that card so after about 2/3 hours after the bleeding happened, I put on some surgical gloves and took it to use it, and held it with my hand. I know this might be really nonsense but since I'd rather not talking to anyone about this or let people know I'm being crazy... I would sincerely appreciate your advice. The thing that triggered my OCD and phobia here was the fact that A transvestite in another country robbed me, however, there was no sex.

So my 3 concerns would be:

1) After taking a duo test 8 weeks after the transvestite should I forget that issue?

2) Whay¿t about the credit cards and watch? I mean, I think it would be a bit uncomfortable for me to shave for instance while using that watch or just after touching the credit cards, or to habdle the credit cards with a cut/wound on my hand or mouth like today.

3) About the girl who slept over but was no sex, just masturbation and light french kissing, bus she or I could have touched the surroundings of her vagina/*** before masturbating (I didn't masturbate her, just touched  the surounding areas, and I son'ththink she did either but she did go to the bathroom and might have contacted her hands with blood at that point.
Should I be comfortable wearing the watch again and using the cards no matter the circumstances? should I ask this girl to take a test? the truth is I don't really want to see her again if it's not for that.

Sorry if all this seems too crazy but I am going out of my mind... I was hoping to get a 12 week test in 2 weeks for the transvestite incident (after 2 week duo negative)... but I just could not stand waiting for another window period again

And sorry for the long post, I know most of this doesn't make much sense, if any and I also know I am paranoid... but some advise would really, really help me because at times I just don't believe my mind (why would I if it is so distorted and paranoid) Please help me... I know I need therapy but I also need to calm down and act normal and carry on with my life.

[nursegirl6572]

We're well aware of the new CDC testing recommendations, and we've posted the same link many times.

There's really not a lot of conflicting information about the testing.  The docs have been saying for at least a year or two that a DUO is conclusive at 4 weeks, it just took the CDC some time to catch up, and do enough research where they felt comfortable updating their testing guidelines.

A negative DUO at 4 weeks is conclusive.  

By reading your posts, it's clear that you're spending a LOT of time reading about this.  Remember that fear is not fact (great saying by our Lizzie Lou).  You're trying to rationalize and apply scientific reason to your "what if" thoughts.  That's going to lead to nothing but an anxiety disaster for you.

YOU are the one who is responsible for the stimuli/data you feed your mind.  If you continue to feed your mind info and thoughts about HIV, the more anxious you're going to be, and the more obsessed your thinking will become.  You're fueling your own anxious fire.

I know I sound like a broken record, but TRULY....you need to concentrate on addressing your OCD.  You do NOT have an HIV concern, and never did.  Think about it....what you're doing would be like a virgin obsessing and stressing over being pregnant.  If she's never put herself in a position of worrying about pregnancy, WHY would she waste a single moment worrying about it?  People without OCD and anxiety wouldn't.  People with OCD will worry and ruminate until a new fear finally takes that one's place.

How you proceed is up to you....but really, you're your OWN worst enemy right now.

[4ad]

I get that and basically was aware about the fact that P24 levels start to drop conversely as Antibodies start to form, and that by the time they disappear you most likely should have a detectable level of AB's. Thanks for reinforcing that info.

My doubt was that I thought it was not always a black or white scenario but that there could also be some grey zones or periods of time or variables as to timeframes, and yes, I was not sure if it could be possible that none of them are detectable at some point if/when both levels are too low, I.E during the first couple of days when AB's start to form. (I think I've read/heard that from experts as well, that there is a possibility for that to happen).

Anyway, maybe I didn't explain myself very good. I do have a basic understanding of how the test works (probably better than most regular people) but certainly am still unclear on some aspects hence my questions and doubts.

That was precisely the reason why I was concerned about the possibility of being immunosuppressed, since at least in theory, production/detection of ABs could be delayed, even if you actually do have one or the other at all times after accute infection starts. It was the possibility of immunosuppression factor in the equation that gave me some doubts and worry.

I know I am overthinking this but after reading the discussion you posted, it occurs to me that in the unlikely scenario that someone was actually immunosuppressed and AB's production delayed, if it is correct to assume that you will always have one or both assays that can be detected, then the Antigen would last longer in the body and thus would be detectable until AB's start to build up. Yeah, mental masturbation, but would you agree on that reasoning? I suspect probably not.

On the other hand, you previously stated that to have a theoretical possibility of delayed seroconversion due to immunosuppresion caused by Prednisone you would have to take 50 mgs daily for at least a week... But at which time would that have to happen (before exposure, during exposure, after exposure, before testing, during testing, etc?) Not really clear on that. Also, I did take 50 mgs daily for 5 days which is just shy of the 7 days you mentioned (That was 2 weeks before possible exposure) and then took a single dose the day before the exposure or the same day (not really sure).

If you can check out the chart I provided in a previous comment: http://www.cdc.gov/hiv/pdf/HIVtestingAlgorithmRecommendation-Final.pdf (page 13)

PS: I am a bit surprised that no one chimed in talking about testing at 3 months as it is quite usual for that to happen (even regarding duo tests) and that everyone has agreed that 4 weeks a safe timeframe to discard infection with these tests. There is often some dabate about that and I must admit that it has been frustrating to me (the conflicting info and advice given) and know for many others as well. Btw, my last test was yesterday at 5 weeks, 1 1/2 days.

Lastly, would you happen to know if Deflazacort is less immunosuppressant or safer than Prednisone? Since it is another option for treating asthma exacerbations and to keep into account if there is a meaningful difference.

Sorry for the long comment.

Appreciate your help and thanks for putting up with me.

[HowardH]

"My "reasoning", although probably totally biased, was that since P24 is only present for a limited time, and if youure immune system isn't responding well, you could "miss" the antigen period"

That is exactly why I said you don't understand the test. Here's the deal, from a discussion on the HIV expert forum not too long ago:

"Many people misunderstand the duo (4th generation) HIV test. It might seem that after the period in which p24 antigen can no longer be detected in the blood (around 4-6 weeks), the test behaves just like a stand-alone antibody test. This would seem to leave open a possibility that after p24 antigen disappears, there could be brief time before antibody shows up, and therefore a possible false negative test result.

"The tests for HIV antibody and p24 antigen that are incorporated into the duo test are not independent of one another. It is the HIV antibody that clears p24 out of the blood. If p24 antigen is no longer detectable, then antibody must be present -- that's the very reason p24 is gone. Therefore, every person with an HIV infection of 4 or more weeks induration has either antibody or p24 is detectable in the blood."

[4ad]

I do know at least reasonably how it works. My "reasoning", although probably totally biased, was that since P24 is only present for a limited time, and if youure immune system isn't responding well, you could "miss" the antigen period ant that's ehy I decided to take a duo 3 weeks in a row. I understand it is highly unlikely that the test misses both things though, and especially since my situation was low to no risk.
Thanks a lot.

Thought some of you would be interested in this chart regarding window periods, test generations, and time of onset of Accute infection and established infection. Check out the chart on page 13. It's updated for 2014 from CDC
http://www.cdc.gov/hiv/pdf/HIVtestingAlgorithmRecommendation-Final.pdf

[nursegirl6572]

Even at high doses, the modern tests wouldn't be affected by it.  You're "stuck" on that...that's your OCD for you.

[HowardH]

"glucocorticoid" and "corticosteroid" are synonyms, exactly the same thing.

To have an immunosuppressive effect that would theoretically influence HIV testing, your prednisone dose would have to be 50 mg or more every day for at least a week.  And anyway, immunosuppression could only (in theory) affect development of HIV antibody. It would have no effect on p24 antigen testing -- i.e. no possibility of impairing the DUO test.

And your opening comments show you also misunderstand the DUO test. Once positive, it never turns negative later. It stays positive for life. There are no exceptions.

[4ad]

Your advice is much appreciated! Thanks!

[4ad]

Thank you again Nursegirl.

I always like to know exactly what I put into my body and its potential harms/benefits. Since I suffer from asthma I sometimes need to take it (prednisone in this case) - a corticosteroid... or Deflazacort which is a glucocorticoid (only when I get  or am getting ill, like 3 times a year probably).

Well you are totally right about my OCD being off the charts. This has been triggered by the episode in question but I am working on it (had it somewhat under control before). So I am trying to get rid of anything that reminds me of that episode.

However, I think you are partially right about Prednisone. In fact it is not an anabolic steroid but it IS a steroid and immunodepressant. Precisely a Corticosteroid. So not all effects but many are the same, and regarding my concern Immunosuppression. But I think you must take very lare doses for very large periods in order for it to theoretically or potentially alter test results. My worry is that I took a high dose (50 mg) the day before or the day of the incident (not sure).

I hope my OCD doesn't get worse, think I'll start taking Zoloft.

[rocket27rocket]

You will continue to test negative too buddy.

I was on a high dose of pred when I was worried three years ago, - the great thing is with the Duo test is it looks for our bodies reaction(antibodies) and also the virus itself, this is called an Antigen.

You are 110% HIV Negative and must forget all about this now, - do not research any further, - except your result and move on :)

Best Wishes

James

[4ad]

Thanks a lot Howard, I actually took another 5 week duo test today. Results came very quick in a couple of hours, and negative as expected. Feeling a bit better now.

[nursegirl6572]

See, this is a perfect example of why it's detrimental to do your own "research".  You're confusing information.

Anabolic steroids and Prednisone are two totally different things.  Prednisone would not affect an HIV test.

That being said....you KNOW your OCD is off the charts, yet you continue to expose your anxious mind to info about HIV.  That's the very worst thing you could do.

You need to put your time and energy toward addressing the anxiety and obsessive thinking, NOT towards HIV.

[HowardH]

This is far too complex a question for a community forum, without professional experts. I haven't tried to read every word. But the bottom line is that you are way overthinking this. Prednisone has no effect on the reliability of a duo test. Your negative result at 4 weeks is conclusive.

[4ad]

Could P24 not show at all ever if I test at 4, 5, qnd 6 weeks and then 8? And that be mixed with the possibility of delayed seroconversion because of Prednisone? Is it possible a test could have been positive at week 3 (because of P24) but then P24 subsides and due to delayed seroconversion show a false negative afterwards? Should I be happy with my 4 week DUO test and 5 week (due tomorrow or in 2 days probably) then at week 6? And if not, finally just for peace of mind and to follow guidelines at week 8 and 12? Is it possible that my status changaes in that period of time or is it even possible that a DUO test in an immunosuppressed person can show positive before because of P24 but then negative a nd then again positve? By the way my only test has been at 4 weeks negative and am having another these days.
What do you think or recommend, or what do you know for a fact?

Thanks a lot.