• 6 months ago

    Reliability of (Quantitative) RNA Tests after 9 days in Sub-Saharan Africa, and using ARVs while not diagnosed HIV-positive for certain

    Dear all, please I kindly request your outmost support and help!
    I try to explain my case below:
    I am male, 36 years old. I had a risky sex on AUGUST 9TH at a massage parlour with a woman. After some friendly touch, I did some fingering mostly in her vagina and a bit anal way with my right hand. After that I put on a latex condom. I believe and hope (!) that I did not use my right hand while putting on the condom. (IS THIS A RISK?)
    After I put on condom, I did vaginal penetration slowly, and that last at most 20 seconds.
    I pulled out, after that, I could see the condom still on my penis, and semen in the condom. It seemed proper.
    After that I remember I removed my condom, and cleaned around my genital area with a dry towel. (I am scared that maybe I touched my urethrea before the towel, or inside my nose with my right fingers after the towel.) (IS THIS RISK?)
    After a week, I became paranoid, thinking what if she was HIV positive. EXACTLY AFTER 7 DAYS (AUGUST 16TH), I went to see her again. I requested her to do a rapid HIV test. The result seemed positive to me. So I told her to go to a clinic and get it confirmed.
    In the meantime, I got also HIV test on AUGUST 16TH. The result was surely negative.
    She texted me 2 days later. She said she was positive. She said; she had unprotected sex only with her boyfriend; she was probably infected in the 1st or 2nd week of May after his business trip; in the beginning of June, she had some light flu and afterwards some cough. (So this makes her just at the end of WINDOW PERIOD on AUGUST 9th, right?)
    After that I immediately visited a clinic and explained my case to a doctor. Doctor told me; I have 2 advantages: 1st I used a condom, 2nd I am circumsized.
    Still I insisted to have a viral load test. Doctor said OK. I got the viral load test done on AUGUST 18TH (9 DAYS AFTER SEX).
    In the meantime, on AUGUST 19TH and AUGUST 20TH, I started taking ARVs which doctor prescribed. (Tenofovir disoproxil fumarate 300mg, Lamivudine USP 600mg, Efavirenz USP 200mg). ARVs made me dizzy, so I stoppped on AUGUST 21ST and AUGUST 22ND.
    I got the viral load results on AUGUST 23th. The test is called “HIV-1 Viral Load by Taqman Plasma (Quantitative)”. It read as “below 20 copies/ml” and log value “below 1.30”. It reads as “HIV RNA DETECTED (!), less than 20 HIV/RNA copies/ml)”
    I got terrified. The doctor told me to continue ARVs. I immediately started again. I am scared because this time ARVs make me feel a bit less dizzy. DOES THIS CONFIRM THAT I HAVE HIV VİRUS? Because doctor told me that ARVs make HIV-positive people feel better, but HIV-negative people bad, dizzy, vomitting, etc.
    Finally doctor told me to finish ARVs (30 per box, one per day) and after I finish ARVs, we will run additional tests or a second viral load test.
    These are the questions I have now.
    I am very scared but I am trying to stay strong. So please I need your support and valuable opinions!
    (As for symtoms: Between 15th – 22nd AUGUST, I developed a flu which seems to have stopped by now. I am scared that I will have more symptoms in upcoming weeks. DO ARVs ALLEVIATE SUCH SYMPTOMS IN THE WINDOW PERIOD?)
    I asked so many questions. I am so sorry for taking this much time of yours. But I feel really alone and don’t know what to do.
    Thanks so much!


  • 6 months ago

    RE: Reliability of (Quantitative) RNA Tests after 9 days in Sub-Saharan Africa, and using ARVs while not diagnosed HIV-positive for certain

    You don't have HIV. Obviously you went to a physician who knows little or nothing about HIV. I'll try to explain.

    Someone who was recently infected (and likely not yet producing many antibodies) would have an extremely high viral load. Viral load testing typically doesn't come with "zero" copies cut off; they will have a cut off that might say "less than 20 copies" or might say "less than 5 copies" depending on the test used. What this actually means in your case is ZERO copies; zip, nada, nothing.

    Not to sound mean but if your physician had any common sense they would have pointed out that your "risk" consisted of fingering her vaginally and anally. THIS IS NOT A RISK FOR HIV TRANSMISSION EVEN IF YOU DID PUT THE CONDOM ON WITH THE SAME HAND.
    Keep in mind that HIV is an EXTREMELY delicate virus outside of the body. Picking your nose, drying your genital area with the same hand that fingered her would NOT transmit the virus to you.

    You did ALL the right things; you had PROTECTED vaginal intercourse with this woman. Instead of focusing on issues that would not/could not/did not transmit the virus to you, focus on what you did right and stop worrying about this.

      • 6 months ago
        Dear Gail,

        Thank you so much for your response and encouragement!! It made me feel really good! Thanks million times again! I promise myself and God that I will never take such risks again!! I realised that I really appreciate life!

        I have to say I read it before I received my PCR RNA qualitative test results. It is NEGATIVE! (I could not help myself and I took an additional test!)

        Hope you may understand, I still want to share some details with you:
        PCR-HIV QUALITATIVE: NEGATIVE (Performed using the Roche COBAS Ampliprep/COBAS Taqman HIV-1 Qualitative Version 2.0 assay.)

        It reads more as follows: The qualitative DNA HIV PCR test may be used for the diagnosis of HIV infection in the following circumstances:
        1. Any patient 2 weeks after known exposure to HIV or 2 weeks after "prophylactic ART (?)" is completed. In all instances, the PCR results should be confirmed with an ELISA after 6 weeks.
        2. Babies under 18 months of age…
        3. For confirmation of indeterminate HIV ELISA results.

        Just to remind you… My exposure was on AUGUST 9th, and this blood sample was taken on AUGUST 29th (i.e. after 20 days). However, as I mentioned, I have been using ARVs (one pill per day) since AUGUST 23th.

        So, I beg your understanding for these 2 additional questions below:

        1) Even if I used ARVs between AUGUST 23th and AUGUST 29th (in total 7 days), may I assume that those ARVs would NOT suffice to influence the result of my latest PCR HIV QUALITATIVE test?

        2) Because the test says “2 weeks after prophylactic ART is completed”. My ARVs (Tenofovir disoproxil fumarate 300mg, Lamivudine USP 600mg, Efavirenz USP 200mg), ARE THEY “PROPHYLACTIC ART”?

        (I read somewhere on http://helpline.aidsvancouver.org that “the early PCR test and p24 antigen test are most accurate within the first 3 weeks of infection”) I pray God that this test result of mine is certain!

        3) This test “the Roche COBAS Ampliprep/COBAS Taqman HIV-1 Qualitative Version 2.0 assay” is, I hope the latest state of art in testing?

        (Please note that I will still take an ELISA test 6 weeks after exposure. Because as far as I see this is what’s available in this part of Africa)

        I would be so happy if you may share your valuable opinions with me! It really helps me! Thanks so much!
      • 6 months ago
        Again; what you need to FOCUS on is that your encounter was NOT risky in any way, shape or form. Fingering someone vaginally and anally and then putting on a condom with the same hand is NOT a risk for HIV transmission.

        Honestly. Really. Truly. I would not lie to you about this.

        From your posting I suspect at least some of what you are feeling is perhaps guilt at what you did in that massage parlor. I'm not sure why (and perhaps I am reading this incorrectly) but again, please understand that you did all the right things by engaging in protected intercourse with a latex condom.

        You can, of course, continue testing. The test results will continue to come back as "non-reactive" (negative) because this event did not leave you infected.

      • 6 months ago
        Dear Gail, thanks so much for your encouraging comments. Indeed I feel very guilty, regretful! I will never risk my health like this. Thanks so much again! Best
      • 5 months ago
        Hi Gail,

        On October 2nd, (54 days after risky sex, and 13 days after last PEP dose, I did fingerprick test. It turned out negative.

        So far it goes well.

        I have one more question about which I am quite confused...

        Should I take the "exposure date" or "the date when I took my last PEP dose" as the reference date for conclusive testing? I mean are my tests conclusive 3 months post-exposure or 3 months post-PEP?

        Thanks so much! This is a website which delivers public health service for all over the world!
      • 5 months ago
        Your tests are conclusive no matter the date you took them because there was no risk for transmission in the first place.