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ARS Two Days After Exposure?
Jan 31, 2009

I started HAART during acute infection in July 07. I have been undetectable since Aug of 07, and take my pills religiously. My labs from Dec. 08 showed that I was still undetectable (below 50 copies,) and had no other STDs. The test performed, the viral load test the Veterans Affairs Hospital uses, says if HIV RNA is detected even if it is below 50 copies per ML and cannot be quantified. In my case, the test showed no evidence of HIV in my blood at all, it reported Non Reactive for HIV. Two weeks ago I had sex and the condom broke; I believe that I had been having unprotected sex for an extended period of time, probably upwards of an hour as a top. I did not ejaculate inside this person. One and a half days later my sexual partner developed what in my lay view appeared to look like Acute Retroviral Syndrome. He had a 103 degree fever, swollen lymph nodes, fatigue, severe sweats (and night sweats,) and body and limb pain. He also had inflamed tonsils and appeared very pale. He had no rash, vomiting, or diarrhea and maintained a hearty appetite despite being ill. I took my sexual partner to the hospital around 60 hours after the initial exposure to see if they would consider post-exposure prophylaxis. The attending ER physician said no, and said it could be anything. However, when the physician took a test for strep and the flu they both came back negative. The doctor ended up discharging him with Tylenol and orders to rest. The sickness crested two days after it began, three and a half days after the initial exposure, and he was fine five days after the onset of symptoms. I started HAART to reduce the chance of infecting others with HIV. I practice safer sex, however since the condom broke in this instance I am very worried that I might have transmitted the virus. Could you please tell me what the actual chance of viral transmission with my consistently and early treated undetectable viral load is during an unprotected encounter, and could you please tell me if the symptoms and time frame I described for my sexual partners illness are consistent with ARS and acute HIV. All the literature I have read so far says ARS starts 2-4 weeks after exposure and last for weeks, and that his symptoms start time, one and a half days after exposure, are too early and lasted for too short a time to be consistent with the onset of an ARS diagnosis. I am hoping that this is the case and I am just being a hypochondriac, please let me know.

Response from Dr. Holodniy

Seems unlikely to be ARS, but he should be tested.



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