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Newly infected: Time between exposure and seroconversion illness?
Apr 14, 2007

Dr Bob, I've been reading your advice for a long time because my partner is positive. I read a lot of the discussions about sero-discordant couples, but none of that is relevant anymore. I just found out I have HIV.

On month ago in Mar 07, I had a seroconversion illness. The p24 test result came as a big surprise as I am mostly a top and in the 6 months have mostly restricted my sex to receiving oral. I have one friend I'd had unprotected anal with (I was the insertive partner), we'd both had lots of discussion beforehand so it felt responsible. We both believed ourselves negative. I'd tested neg in Dec 06 and he did in Feb 07.

But one month after I had a very long session of performing anal sex with him, I got really sick. Two weeks before I got sick, I had low-risk sex with another partner (who told me he's negative) that involved mutual oral with ejaculation. For the rest of 2007 before that, I mostly received oral, except for one time when I have inserted anal with another guy where I wore a condom. And that's honestly just about it in terms of risk elements.

I guess my overarching question is that: realistically how long after an HIV exposure can a seroconversion illness arrive? I've mostly read 2-4 weeks, though I read 12 weeks somewhere. Would it ever realistically be longer?

I'm trying to figure out my risk factors to try and time my infection, and not coming up with two many options other than the unprotected topping of my friend a month before I got sick -- even though he's not that experienced and we were pretty sure he was negative (he's about to get tested now).

If I didn't get it from him, I'm crushed at the thought I may have unwittingly infected him, but even more puzzled as to how I could have got this. My positive partner and I use condoms and have only have sex 1 or 2 times this year anyway. Most of my other sex in 2007 has been receiving oral. I have shaved my shaft and scrotum a few times on those occasions, but generally made a point to do so 1-2 days before the planned encounter.

I had some very brief unprotected interludes in Fall 06 that may not have been covered off in my negative Dec 06 HIV test. Is there much likelihood at all I could have been exposed to HIV in Oct/Nov 06 but not got what my doctor says was a seroconversion illness until Mar 07?

I still can't believe it happened. In general, I've been safer and more responsible now than ever in the past.

Thanks for any advice, Dr Bob.

Response from Dr. Frascino

Hello,

Has your positive HIV test been reconfirmed with another test? If not, that should be your next step a repeat ELISA with confirmatory Western Blot, if the former is positive, to rule out false-positives, technical errors, clerical errors, etc.

Assuming you are HIV positive, seroconversion would have taken place between Dec 06 and Mar 07. From the potential exposure history you provided in your post, there is no doubt the "very long session" of unprotected insertive anal sex with your partner of unknown status would carry the highest statistical risk for HIV transmission.

The exact timing of the onset of symptoms associated with acute retroviral syndrome following primary HIV infection can vary somewhat from person to person. As you can see from your own case, it is often difficult to pinpoint exactly when the exposure took place. Consequently, it's also difficult to document with certainty the time to onset of ARS symptoms. What we can say is that in most cases the symptoms of ARS manifest themselves two-four weeks after infection.

At this point, I wouldn't waste too much energy trying to decipher what happened in the past. You had a number of potential HIV exposures, including an episode of unprotected insertive anal sex, which poses a significant risk for HIV transmission. And now you have tested positive. Focusing on the past won't change the present. It's best you concentrate your energies on the present, work on accepting your new reality and begin preparing for the future. You'll need to establish care with an HIV specialist, if you haven't already done so, and advise any potential partners, who may be at risk, to get tested.

Good luck. I'm here if you need me, OK?

Dr. Bob



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