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sex with indian csw: please advise
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An_254090 posted:
I am an indian, a 30 year old male. I had sex with an Indian csw. I had used double condoms. My urethera was covered throughout. [br>[br>Seconds after pulling out, I removed the condom using my right hand. Some vaginal fluid stuck to my fingers. I took some amount of water and with the same hand cleaned my penis repeatedly. After this I took some water in the same hand and used it to gargle/ gulp. [br>[br>A month later, too afraid to take an hiv test, i took a cd4 count test and a liver function test. LFT was normal and cd4 was 843 at 43.2%. [br>[br>50 days after the incident, I took a cd4 test, an hcv test and a lft test. [br>HCV was positive. liver enzymes were significantly elevated and cd4 count went down to 454 at 42.7%. [br>57 days after the incident I took a retroquick hiv test. It was negative. A retroquick test is a 2nd gen test. [br>[br>[br>My cd4 count significantly decreased in a span of 20 days. My liver enzymes became elevated in these 20 days. [br>These are classic symptoms of acute hiv infection (Including increased enzyme levels). [br>[br>[br>I am afraid that I might have contracted hcv from the sex worker. Also, since prevalence of hiv is very high among indian csws, i am afraid, I might have contracted hiv from her too.


1.What percentage of people would test psoitive using a 2nd generation test?2. Can factors other than hiv cause such a drastic drop in cd4 count as in my case?
3. Seconds after taking off my condom, I felt vaginal fluid on it. Using the same hand I repeatedly cleaned my penis. Then, I used the same hand to gargle

Could any of these activities have enabled hiv transmission.

Please help.

Reply
 
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georgiagail responded:
The one and only valuable test for HIV from the entire event was (possibly) the one taken at 57 days. It was negative.

You need to have a better understanding of how HIV (and HCV) infects someone. Both viruses must be able to actually ENTER the body, typically through an open cut, wound, appropriate damaged mucous membrane, etc. Simply gargling or swallowing water with a hand that previously cleaned a penis with water and touched vaginal fluids from a sex worker would not transmit either virus to you UNLESS you happened to have an open, bleeding wound in your oral cavity at the time.

It would appear from your posting that you are positive for HCV; whether from this event or some previous exposure is unknown from the details you have provided. However, the fact that your liver enzymes became elevated is NOT a "classic" symptom of acute HIV infection.

Repeat the HIV screening test (NOT the cd4 test) at the 90 day mark.

And in the future, avoid the use of double condoms; the frictions between these tends to increase, not decrease the risk of breakage.

Gail
 
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scaredindian replied to georgiagail's response:
Hi Georgia,
Thanks for your reply.

microcuts on penile shaft or the mouth - which cannot be seen - can they not provide entry points to viruses?

What I read was that when a virus infects a person, elevated sgot and sgpt levels show that the body is fighting back.
Because liver enzymes levels changed from normal to high in a span of 25 days, i thought that the hcv infection might be acute.


And also Georgia, the sharp drop in cd4 counts in a span of 26 days (albeit with negligible drop in cd4 %) , is that not a matter of significant concern? I did not have flu, herpes or influenza (diseases that can decrease cd4 counts in the short run)


What % of infected people would test positive at 8 weeks using a 2nd gen test?

I would test at 90 days, but I need some reassurance.

How concerned do you think I should be?


Thank you for your time.
 
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georgiagail replied to scaredindian's response:
Stop worrying about microcuts. Focus on testing results.

Up to 95 percent of newly infected folks will have "reactive" (i.e., positive) test results by 1 month of testing. By three months this has increased to 99.99 percent. Eight weeks would fall somewhere inbetween these two statistics.

From your description of what took place, I would not be concerned about HIV transmission.

Gail
 
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scaredindian replied to georgiagail's response:
hi georgia thanks. you talked about 95 percent at 1 month.however 2nd generation test was used in my case. would the stat still be as valid? does simultaneous exposure to both viruses delay seroconversion?
 
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georgiagail replied to scaredindian's response:
Yes, the statistic would still be valid. And no, simultaneous exposure to both viruses would not delay seroconversion.

Gail
 
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scaredindian replied to georgiagail's response:
one last question gail. cd4 drop as in my case are?and based there factors other than hiv which can cause such drastic drop?i do not have influenza or herpes.yes i was not eating properly for days on end. could that have been a factor? and i should be quite confident coming out negative at the end of it, right?
 
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georgiagail replied to scaredindian's response:
I'd suggest laboratory error (unless you were also on some medications). Even in an untreated HIV positive patient cd4 levels do not drop that rapidly in that short a period of time.

And yes, you should be quite confident of a final negative test result.

Gail
 
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scaredindian replied to georgiagail's response:
wasnt on medications. u mean untreated hiv patients during acute infection right? because among chronic patients cd4 decline anyway takes time. and nothing to worry about liver enzymes changing from normal to elevated in 20 days right?
 
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georgiagail replied to scaredindian's response:
Yes, both acute phase and chronic patients. And yes, nothing to worry about in regards to HIV and liver enzymes.

Take the final screening test at 90 days to confirm your negative status.

Gail
 
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scaredindian replied to georgiagail's response:
hi gail. i am sorry if i sound repetitive. somehow i am just convinced that i have picked up hcv from this encounter. i have not had sex before. i have read about a couple of verified cases which were diagnosed during acute hiv infection. in all these cases liver enzymes were elevated. the physician i went to also said that liver enzymes do get elevated during acute infection. my liver enzymes chaged from normal to significanty elevated in one month. cd4 counts also dropped in the same period. also when i showed myndian csw ultrasound report to the gi he said that there was no damage to liver and he said that the infection might be a recent one. in this case the female in question was an indian csw who have very high rates of hiv infection. since hcv involves blood to blood transmission i feel that if i have contracted hcv from her then i am very likely to contract hiv as well. i am convinced that the urethera was covered. but the penile shaft was repeatedly held and cleaned by my fingers which had vaginal fluids. this happened barely 10 seconds (not a minute or 2 which it takes for hiv to be deactivated) after pulling out of her. i am still concerned about microcuts on shaft or mouth. i am also worried the virus might have gone to my tonsils(which are lymph nodes and susceptible. i couldnt format this as my phone doesnt allow mmme to. i would really need your comments here. i have read on medhelp and poz.com about afew people who always had protected vagina sex and still got infected. is there ay way in which i put myself to risk?
 
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georgiagail replied to scaredindian's response:
There are a couple of errors in your theory (and worries) about both hepatitis and HIV.

1. HIV and HCV are two very different viruses. Having one does not mean one has the other.

2. Tonsils are not lymph nodes and besides, they are not "susceptible' to HIV transmission. Lymph nodes become SWOLLEN after infection; that doesn't mean they are waiting around to suck up the virus if they come in contact with it.

3. "Microcuts" are NOT DIRECT links into the body. Your worries over these are the same as the folks who worry about hangnails and paper cuts being direct portals into the body (hint: they aren't).

4. The claim of transmission from protected vaginal sex is inaccurate (assuming the darn condom was used accurately and did not break or tear). The virus CANNOT cross an intact latex barrier.

There's really nothing further I can provide you regarding what took place. If you remain worried about all of this, don't have sexual contact with sex workers, even protected sexual contact. It sure isn't worth the agony of worrying over all of this and frankly, I get pretty darn tired of trying to convince the "worried wells" of the non-risk of these events.

Take the final screening tests at 90 days and report back to us then.

Gail
 
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scaredindian replied to georgiagail's response:
Dr. Scott J. Diede answered:High levels of ALT enzymes, can be HIV? High ALT...[a class="fiImage" link_to_pic="https://edc2.healthtap.com/ht-staging/user_answer/reference_image/1864/large/Hiv.jpeg?1344909609" target="_blank" style="margin: 0px; padding: 0px; border: 0px; font-family: inherit; font-size: 14px; font-style: inherit; font-variant: inherit; font-weight: 600; line-height: inherit; vertical-align: baseline; color: rgb(51, 102, 153); cursor: pointer; display: inline-block; width: 200px;"> Elevated ALT can be caused by hundreds of conditions. Acute HIV infection is one of them.
 
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scaredindian replied to scaredindian's response:
Hi Gail,


managed to track the female and asked about her status. She has been hiv positive for 2 years. She also has hepatitis c infection. [br>[br>This coupled with the following information from anothe doctor makes me feel I am screwed.[br>[br>[br>[br>Question: [br>[br>I have heard that HCV can interfere with the window period to test for HIV antibodies....is this true? If so, how long should one wait before testing for HIV? Will a PCR test be more accurate in a situation of suspected co-infection? [br>[br>Answer provided by: [br>[br>Douglas T. Dieterich, M. D. [br>Chief of Gastroenterology and Hepatology [br>Cabrini Medical Center [br>Assoc. Prof. of Medicine NYU School of Medicine [br>[br>[br>[br>A few more months. But neither virus interferes with the level of the other. So doing the PCR for HIV, HCV or HBV is the way to test. Or all 3. Good luck! [br>[br>051119 [br>ASKD051109
 
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georgiagail replied to scaredindian's response:
My answer remains the same.

Retest at 90 days.

Gail


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