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boyfriend tested positive, lots of prior unprotected exposure
Mar 10, 2006

My story is a bit convoluted, but I've been seeing a guy for about six months now. After a week or two, we stopped using protection because we are monogamous and I had been a virgin before that and he had always played safe. Yesterday, we went to get tested for HIV, not on any suspicions of anything, but because I found out a longtime friend of mine is HIV positive (he'd been positive for a while, but I just found out). Anyway, my boyfriend's test came back positive and mine negative, but I realize my result means nothing since we've had unprotected contact as recently as a two days before the test. His tests were the OraQuick saliva and fingerstick blood tests and both came back positive and we're waiting for the ELISA and Western Blot. Obviously, this result was devastating for him since he had absolutely no reason to believe he could be positive. As I said, before, he always used condoms for anal sex, although not for oral.

Despite the obvious bewilderment at his positive result, I am now very scared that I may have contracted HIV from him. We have had numerous instances of unprotected sex over the past six months, and I realize my negative result of yesterday still leaves a window of a few months. With the exception of five or so times spread evenly over the entire relationship, I was never the receptive anal partner. I understand the per-incident risk for insertive anal sex is somewhat lower, but the number of times we've engaged in it makes me worry regardless. Additionally, I had some non-specific illness (low-grade fever, headache, significant sinus pressure and stuffy nose) last week which makes me worry that could have been primary HIV infection. Also, I think the lymph nodes in my armpit and possibly the back of my neck (occupital and posterior cervical) are swollen. Either way, I'm scared witless and faced with the prospect of waiting three to six months for an accurate result.

Although my boyfriend's status is not completely confirmed, I believe if he is HIV positive that it's possible he contracted it over the summer, several weeks before we met. At that time, he was hospitalized with some non-specific viral illness and the doctors couldn't pinpoint a cause. This was also two to three days after his last sexual encounter. Given all of this info, my questions are as follows: I realize there is significant risk, but at how great a risk am I? Also, would I benefit from PEP? Finally, what are the odds that my boyfriend encountered two false positives on the OraQuick tests? I realize that manufacturing defects and such factors would tend to be independently distributed and very rare for two false positives in a row. On the other hand, are there personal factors (such as recent heightened immune response) that could cause the quick antibody tests to have a lower specificity in certain cases?

Response from Dr. Frascino

Hello,

I certainly understand your concern! I'm sure this is a very trying and confusing time for both you and your boyfriend.

Starting first with your boyfriend, it's absolutely appropriate to run an ELISA (and a WB, if the ELISA is positive) as a confirmatory test following positive OraQuick oral and blood tests. If the ELISA and WB confirm his positive status, he should establish care with an HIV specialist for further evaluation and management of his HIV disease. The "non-specific viral illness" for which he was hospitalized last summer is worrisome and could have been ARS (acute retroviral syndrome).

As for your risk, if your boyfriend is confirmed to be positive, the best we can say is that your risk is significant and definitely would warrant testing out to six months (due to a significant confirmed exposure) per the CDC guidelines.

Would you benefit from PEP? No. PEP needs to be started as soon as possible after an exposure. The sooner it's started, the better chance it has of working. Starting PEP beyond 72 hours is not recommended.

Regarding "false positive" OraQuick tests, the important thing to remember is that while a negative test is considered to be definitively negative (unless tested during the window period), a positive OraQuick is only considered to be "preliminarily positive" and must be confirmed with standard serology tests. At this point, your boyfriend is only "preliminarily positive."

Good luck to you both. I'm here if you need me!

Dr. Bob


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