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Is A HIV Test Done Of 21 Day Post Exposure Conclusive?

Posted on Mon, 12 Jan 2015

Question: Dear Dr XXXXXXX sir

I received unprotected oral sex from sex worker one month ago. I did 21st day hic p24 antigen and hic duo 4th generation test ,all came negative.and also I done hic pct viral load test on my 10th day result 66.9 copies per month.it is conclusive sir.

Recently I got yellow patches on my tongue.

Answered by Dr. Sankaranantham Murugan (2 hours later)

Brief Answer:
HIV 1 free. Antibody test after 12 weeks ruled out both HIV 1 and 2.

Detailed Answer:
Hi XXXX,
Welcome to HCM.
Thanks for posting your query.

HIV risk through oral sex is low when compared to that of vaginal or anal sex.

Saliva does not contain adequate HIV virus to make an infection. So you need not worry much. P 24 antigen test and antigen part of HIV DUO test are almost conclusive by 3rd week. So your negative P24 and HIV DUO test ruled out HIV 1 infection which is the most common infection (99%) throughout the world except in certain parts of XXXXXXX Prevalence of HIV 2 is less than 1%. There is no antigen based test available for HIV 2 infection. It can be ruled out only with antibody based test after the completion of window period (after 90 days of the risky contact?). So better you go for an antibody test after 12 weeks and rule out this remote possibility also and the get relaxed.
Regarding the PCR test at 10 day is also reliable to an extent but more conclusive by 3-4 weeks. What you had, was the quantitative RNA PCR test which would show minimum detectable copies. Nothing to worry.
Dr S.Murugan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sankaranantham Murugan (10 minutes later)

Thanks sir,
Reason for yellow coating on tongue sir.Also red bubble appeared on the tongue.

Answered by Dr. Sankaranantham Murugan (1 hour later)

Brief Answer:
Yellow color tongue appears with jaundice or temporarily.Consult physicain

Detailed Answer:
Hi,
Welcome back.
Yellow coloration of tongue may be present in any type of jaundice or there may be a coating during some fever or illness or due to some diets. Consult some physician, they will be able to help you in this regard.
Dr S.Murugan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sankaranantham Murugan (12 hours later)

Sir ,

Please send me the mail address for sending my tongue red bubble photo.

Thanks

Answered by Dr. Sankaranantham Murugan (1 hour later)

Brief Answer:
Upload your photos in HCM itself

Detailed Answer:
Hi XXXXXXX
Welcome back.

You can very well upload your photos in this web site itself as there is such facility available.
Expecting your response
Dr S.Murugan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sankaranantham Murugan (2 hours later)

Hi, I have provided some attachments. Please review them.

Answered by Dr. Sankaranantham Murugan (4 hours later)

Brief Answer:
Yellow coloration of tongue not due to HIV.

Detailed Answer:
Hi,
Welcome back.

I saw the pictures sent by you. They are not at all related to HIV.
Are you a smoker or user of tobacco or pan parag? It could be due to nicotine stain . Otherwise this could be possible due to food habits or inadequate cleaning. Nothing else.
Forget about HIV and about your past high risk activities. Try to be safe in future. Nothing to worry.
Dr S.Murugan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sankaranantham Murugan (4 days later)

Sir,
Appeared red bubble on tongue is related to herpes

Sir,
25 days before I checked blood count lymphocyte was 23, yesterday I done same lymphocyte was 14.is it problem sir,

Please

Answered by Dr. Sankaranantham Murugan (1 hour later)

Brief Answer:
Lymphocyte percentage vary with mild infection. not specific.

Detailed Answer:
Hi,
Welcome back.

Herpetic vesicles are not common over tongue when compared to lesions over lip and palate, uvula and tonsil. The clarity of the pictures was not very clear to differentiate them as Herpes vesicles. It could be a traumatic or aphthous ulcer. A direct examination would help rather than diagnosing through a snap.

Regarding the lymphocyte, what you had mentioned could not be the count, but the percentage. It could vary grossly time to time even with a respiratory tract infection or any other infection. Nothing to worry. It has no predictive value.
Dr S.Murugan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sankaranantham Murugan (13 minutes later)

Thanks sir,

Reducing lymphocyte is due to early stage hiv

Answered by Dr. Sankaranantham Murugan (7 hours later)

Brief Answer:
Reduction of lymphocyte is not necessarily be due to HIV

Detailed Answer:
Hi,
Welcome back.

Reduction in lymphocyte percentage is not necessarily due to HIV. HIV 1 already had been ruled out.HIV 2 is rare. So this reduction is not necessarily due to HIV infection.
Dr S.Murugan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sankaranantham Murugan (6 hours later)

Thank you sir,

I uploaded photos, is it herpes

Thanks once again

Answered by Dr. Sankaranantham Murugan (1 hour later)

Brief Answer:
Possibility of Herpes simplex can not be ruled out.

Detailed Answer:
Hi,
Welcome once again.

The possibility of Herpes infection can not be ruled out from the pictures sent by you. Direct examination would help much either to confirm or rule out Herpes (Close inspection and investigations). Herpes is a treatable infection. Not a life threatening one. We are having good antiviral drugs to treat Herpes.
Get well soon.
Dr S.Murugan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sankaranantham Murugan (1 hour later)

Thanks sir,
Yellow coating tongue , after srub it goes again it is forming,is it related to hiv sir

Answered by Dr. Sankaranantham Murugan (15 hours later)

Brief Answer:
Not related to HIV

Detailed Answer:
Hi,
Welcome back.

This is not related to HIV. May be related to your food habits or brushing habits or smoking, if any. Nothing to worry.
Dr S.Murugan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sankaranantham Murugan (19 hours later)

Thanks doctor,

I am getting body chills and cough cold sir,I am really scared.

Dear sir,

Getting cough,cold and body chills is due to decreasing lymphocyte sir. I am still worried about hiv. Am I free from hiv,shall I move on.

Thanks

Answered by Dr. Sankaranantham Murugan (2 hours later)

Brief Answer:
Any body can have fever, cold and cough without HIV.

Detailed Answer:
Hi,
Welcome back.

Cough, cold chills are quite common symptoms of a FLU like fever that anybody can have. In viral fever there might be lymphopenia.
Get treated for the fever through a physician nearby. Wait for few more days and have an antibody HIV test 12 weeks after the contact. That only could rule out HIV totally and can relieve your tension. That only could be conclusive.
Dr S.Murugan

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Sankaranantham Murugan (5 hours later)

Thanks doctor,

I am worried about hiv, do not mistake me. You told me I am hiv 1 free, shall I move on.
Once again I am asking low lymphocyte is related to hiv.

Thanks sir

Answered by Dr. Sankaranantham Murugan (4 hours later)

Brief Answer:
The fall in lymphocyte count not necessarily due to HIV.

Detailed Answer:
Hi,
Welcome back.
HIV disease is like that of any other illness. It is no longer a life threatening one. Nowadays it is a well manageable disease. The possibility of HIV 1 had been already ruled out from the negative result of your tests. So 99.6% possibility of HIV infection had been ruled out.
So the fall in lymphocytic count is unlikely to be due to HIV infection.
The less than 1% possibility of HIV 2 infection has to be ruled out after 12 weeks through an ELISA or a Rapid test. I hope you got the point.
Dr S.Murugan

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Sankaranantham Murugan (1 hour later)

Thank you very much sir,

I have done the mistake stupidly,due to anxiety I am asking so my questions to you.do not mistake me sir.
.Sir some website says received unprotected oral sex no risk some days negligible some days low risk,what is your opinion die. I am worried, i have beautiful family. Also I would like to ask to you shall I have sex with my wife.already 45 days gone, she doesn't understand my problem.Please help me and am I hiv free.

Sorry for many questions,thanks

Answered by Dr. Sankaranantham Murugan (1 hour later)

Brief Answer:
Oral sex carries a low risk for HIV transmission.

Detailed Answer:
Hi,
Welcome to HCM.

Center for Disease Control at XXXXXXX belongs to US Public health Department is an authorized source as far as HIV information and most of the world follow their guidelines only. As per CDC, Oral sex carries a low risk for HIV transmission when compared to anal and vaginal sex. If the saliva mixed with blood (rare- oral ulcer,injury and diseases of gum), then the risk is little high.

You can have protected sex with your wife till 12 weeks after the oral sex then you can have free sex with your wife. That will avoid unnecessary complications.
Dr S.Murugan.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Sankaranantham Murugan (54 minutes later)

Thank you sir,
After my 3rd week p24 antigen and hiv duo test are all have come by negative,still I am in risk sir.

Regarding the appeared red bubble on tongue some specialist said it is due to stress or anxiety, one doctor saying due to herpes.what's your opinion sir,I am still worried.

On my40th day I did western blot test,negative sir.

Is there any documented cases by received unprotected oral sex from hiv.

Without testing herpes doctor prescribed valcivir 1000mg -bd 5 days for herpes,is it ok sir.

Thanks for your great sevices

Answered by Dr. Sankaranantham Murugan (42 minutes later)

Brief Answer:
HIV DUO ruled out HIV 1, Western blot at 40 days has no value.

Detailed Answer:
Hi,
Welcome back

DUO test has two parts. One is P24 antigen part. By 21 days it would be reliable, so the possibility of HIV 1 is ruled out. 2nd part antibodies to HIV 1 and 2 which could be detected after the appearance of antibodies inside the body in presence of an infection which might get delayed up to 3 months in some cases. So HIV 2 is yet to be ruled out. Western blot on 40 days has not of much value as it detects only the antibodies against HIV.

Regarding the tongue lesions, this sort of lesion can occur with stress. But It is difficult to give a definite diagnosis by seeing the picture. Examination might be essential. The treatment given for Herpes is adequate and if it is due to Herpes it would heal within 5-7 days.

I had come across one such case who had the habit of only oral sex and not vaginal sex.
But it is HIV 1 infection, which is ruled out in your case.

Dr S.Murugan

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Above answer was peer-reviewed by : Dr. Shanthi.E