HIV Transmission, Risk of Exposure

[dave1835]

Hi Dr. HHH-

Thank you for taking the time to answer my question.

My boyfriend and I had been in a monogamous relationship for 2.5 years. On April 8th he was away on vacation and had unprotected anal-receptive sex with a stranger. About 2.5 weeks later he came down with a 103 degree fever for 3 days, followed by an (almost) full body rash for 3 days. He tested negative at 3 weeks for antibodies, and positive for HIV (naat test and antibodies at 5 weeks).

We had unprotected anal/oral intercourse 1.5 weeks after his exposure (1 week before he had a fever). It was one time, and I was the anal-insertive partner.

It's now May 22nd. I have not had a fever or full-body rash. However, I'm being super-sensitive (aware of my body) and anxious about having contracted HIV from this exposure. My only symptoms are a few red bumps on my elbow and one on my arm (which the counselor at the HIV clinic said was a pimple). I also keep thinking my armpit glands are swollen but I really can't seem to feel them (no painful glands anywhere). I was blood-Rapid tested for antibodies and came up negative 2 days ago. NAAT testing has yet to come back. The counselor told me that my risk was very low, and I'd have to have terrible luck to have contracted it from one exposure.

My boyfriend and I are still together and I will be with him, even if we end up being a serodiscordant couple (though I'll have to find more info on how to still have a sex life). Anyway, my question is, what are my chances of having contracted HIV from this exposure? Is it likely he had a very high viral load (though undetectable antibodies) a week before becoming sick? I'm very scared. I know you answer a lot of similar questions in this forum, I hope that I am being specific enough to not have overlapped. Thanks again for answering my question.

[Edward W Hook, MD]

I'm sorry to hear of both your boy friend's and, by extension, your experience.  You gave me much detail but did tell me how long ago it has been between your last sex and your rapid test.  My sense is that it has been more than 4 weeks.  Is this correct?

While I wait for your reply, I can provide you with some facts which may help you to put your risk into perspective:
1.  It is not known what a person's viral load is a week before they get the ARS.  The symptoms of the ARS do correspond to very, very high viral loads which increase rapidly but it is reasonable to thing that a week before it may not be so very high.
2.  This risk for acquiring HIV as the insertive partner during rectal intercourse with an infected partner is about 1 in 200.
3.  If it has been 4 weeks since your exposure, that makes the odds of you not being infected good.  At 4 weeks about 80% of infections acquired 4 weeks earlier will be detectable with a rapid test.  If the your NAAT test is negative, while repeat testing at 8 and 12 weeks is a good idea, it becomes very, very unlikely that you were infected.

Again, sorry for all that has gone on in both your partner's and your lives of late.  I hope this helps.  EWH

[dave1835]

Yes, a conservative estimate is that it has been 4 weeks (we do not remember exactly when it was, but I was rapid tested at at least 4 weeks from the last/only time of possible exposure). I will hopefully find out the results of the NAAT test this week. Thanks again for answering my question. I appreciate that your information has put my mind at ease, at least to some degree.