Hi,

Thanks for writing to us,

HIV as you already know is a sexually transmitted disease where the risk is associated with sexual intercourse, anal intercourse, transfusion of blood or blood products etc. I am glad that you have taken a decision to stop the behavior now.

There is an increased risk of transmission associated with unprotected receptive anal intercourse compared to the risk associated with receptive vaginal intercourse. Although studies done are limited, the per-act risk for HIV transmission via this route is known to to be 1.4% for both men and women in a recent study.

Anal Intercourse not only has risk of transmission of HIV but also other sexually transmitted diseases like Hepatitis B, Gonorrhea, chlamydia, herpes, syphilis etc. You will need to get yourself tested for these too. Also get yourself evaluated by a doctor for any genital lesions etc.

The standard blood tests done to detect HIV infection is ELISA where the virus is identified >99.5%. If ELISA is negative then the test maybe repeated in 3-6 months. Only if positive, then the confirmatory test- western blot test is used. This is the guideline that is used. Only in case of persisting high risk behavior (anal intercourse) it is repeated in 3-6 months not otherwise.

The window period or the time taken from infection to virus detection in test extends not more than 6 months; so it is unlikely that you are positive. Get the other STD tests done as well.

As far as marriage is concerned, you may go to a therapist for premarriage counselling. The question of revealing your past, if you get married, arises which have its own pros and cons. Revealing is usually a better option in most cases. And also the question of not indulging in such high risk behaviors again.

I hope all your queries are answered,
Write back in case of any doubts,
Wishing you best of health,
Dr A. Rao. Kavoor

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Hi,

Yes, you have mentioned that the last act was in 2010, I had taken note of it before answering.

1. Let me stress here, most lab tests are not 100% confirmatory but they are highly accurate. ELISA is not 100% sensitive in any stage. But as I have mentioned in the previous answer it is highly accurate. Only when ELISA is positive confirmatory tests are done. Also in case of ambiguity like - once ELISA positive and once negative, a confirmatory test is done. Since in your case you have repeated it four times and it was negative it is HIGHLY UNLIKELY that you are infected.

You may have gotten a few terms mixed up. Probably that is the reason you have repeated some of the questions.

The stages of HIV infection in humans is as follows:
a. Seroconversion - here the virus enters the body followed by development of detectable specific antibodies to virus in the blood as a result of infection. These antibodies are detected by the test. This can take a few months where the screening tests can be negative because the antibodies are not detected till seroconversion takes place (known as window period).

b. clinical latency - The virus load is less, replication is slow and there are no clinical symptoms. Since the seroconversion is complete, the test does detect the antibodies in this test (your doubt no. 2)
c. Subtle clinical signs - Few constitutional symptoms are seen and the test is able to detect antibodies here.
d. AIDS - full blown disease. Usually symptoms are present in the patient. and the test may or may not detect the antibodies here because the immunity is weak.

3. Since your last contact was in 2010 you need not repeat it (it is past 3-6 months).

4. Marriage is an abstract concept involving not only medical but also social and moral aspects etc. Medically speaking since you have been tested negative for HIV (considering your other tests for STD, as mentioned in previous answer, are also negative) your marriage is justified.

Hope this answers your queries,
Dr. A. Rao. Kavoor

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Hi,

I am glad you found the previous answer useful.

In full blown AIDS, which usually presents many years following time of infection, symptoms are usually seen in the patient because the viral load in the blood will be high and body immunity tends to be low. Common ones being, lack of energy, fatigue, weight loss, frequent fevers, frequent yeast infections, skin rashes, swelling of lymph nodes, mouth or genital herpes infections. There may also be opportunistic infections, which means infection by agents that usually cannot infect a person with normal immunity. I believe you do not experience these and it is highly unlikely that you have AIDS.

In this stage since the viral load is high, they are measured in the blood by lab tests. The simplest of the direct detection tests is p24 antigen capture assay. Other tests to measure and monitor HIV RNA in blood are reverse transcriptase PCR (RT-PCR), Branched DNA assay (bDNA) and nucleic acid sequence–based amplification (NASBA). These are done when ELISA and western blot tests yield indeterminate results (not when they are negative as in your case).

I hope this answered all your queries,
Wishing you the best of health,

Dr. A. Rao. Kavoor

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