Question: Hello,
23 days ago I had some sexual contact with an acquaintance. Specifically, I performed analingus on her briefly, and we both fingered each other anally (without gloves). She also used a dildo on me, but it was clean and not shared. However, at times she was using up to 3 fingers on me, and there was a small amount of bleeding at the end (my anus). There was no traditional oral, vaginal, or anal sex. I don't think she had any cuts or scrapes on her hand, but cannot be sure. First question...how much risk do I have that I could've contracted HIV? I've read everything from "very little unless she was bleeding, even then minimal" to "zero, anal fingering is not a risk for HIV and there has never been a reported case of transmission from this activity."

Regardless of the level of risk, I intend on being tested. I took an Oraquick home antibody test at 21 days (negative), which I realize is probably pointless. I have also purchased testing from an online service that uses Quest Diagnostics, both an HIV Early Detection RNA Qualitative Test AND a 4th Generation Antigen / Antibody Test.

Can you advise me on WHEN I should take each of those tests for best accuracy? I understand that after 3 weeks the RNA test is pretty reliable, and perhaps the Antigen/Antibody combination test should be done at 4 weeks?
Should I still be following up with a regular lab antibody test at 90 days, even if both of these tests come back negative?
Please be as detailed as possible.

Thank you.
XXXXXXX

Thank you Dr. Jangid.

I took the RNA test today at day 25. The testing site said it was good starting from 9 - 14 days for most people (is that accurate?). Does the RNA test really have a high rate of false positives? I've read 2 - 10% show a false positive, ouch!

The Antigen / Antibody combination test says 21 days. I really want to take it for some additional peace of mind. I've also read that Antigens start to disappear around 4 weeks (and possibly there is a window between antigen and antibody detection). I don't want wait too long, but I don't want to waste anymore time and go too soon. When should I go for this test? I think in the UK they call this the 28 day test?

I am going to get tested at 90 days by the traditional antibody test also..would you recommend an antibody blood test performed by a lab for this, as opposed to a home test like Oraquick?

Thank you so much for everything. Is there anything else I need to do to make sure you get paid for the time you're spending addressing my questions? I bought the unlimited questions package.

Thank you doctor. I can appreciate this is a very low risk exposure, but of course in my non-medically trained mind, I still worry that it is "theoretically possible." Regardless, I took the following tests in addition to the Oraquick antibody test...

HIV RNA PCR at 22 days from exposure. The results haven't arrived yet.

HIV 4th Generation Ag/Ab Duo at 23 days from exposure. The result came back this morning NON-REACTIVE.

How much comfort should I take in that?

By the way, my white blood cell count runs in the 3.6 - 4.0 range.. It has for my entire life. My family doctor says "that's just normal for you." Would a person with lower WBC take longer to develop detectable antibodies (even though it's "normal" for me...I rarely get sick and have never had any serious illnesses)? Or is that irrelevant?

Sorry for the long message, I guess my questions are...

1. At 23 days with a negative 4th Gen Ab / Ag result, and two negative Oraquick Antibody result, is this a very good sign? Or not relevant?

2. Assuming the 22 day RNA test shows negative as well...are my odds very high of being negative?

3. Does my persistently low WBC affect any of these tests? If so, which ones and how?

4. Since you said 4 weeks (and I was just under 3.5 weeks), should I take the DUO test again at 28 days, 42 days, and then 90 days to be conclusive?

Take your time responding to this email, I know it's long. I should be done asking silly questions soon!

Good evening Dr. Jangid,

To my XXXXXXX my APTIVA RNA HIV-1 test came back today (Thursday afternoon around 5:00 PM), I took it on Tuesday morning around 8:30 AM. The result was negative. So I now have NEGATIVE / NON-REACTIVE results from:

Abbott Architect HIV Ag / Ab Combo test at 23 days.
APTIMA HIV-1 RNA Qualitative test at 22 days.
Oraquick Advance RAPID in home oral antibody test at both 20 and 23 days.

I think negatives on those tests, at those testing times post exposure, look really great! Especially since my "exposure" was very, very low risk anyway AND the female would be considered "unknown status," I do not know if she even has HIV or not. Any other thoughts?

From here, I plan to do what you advised and take the Ag/Ab combination tests again at 28, 42, and 90 days. In the meantime, I think I should relax a bit.

I can't thank you enough for your help. Your emails have been BY FAR the most helpful compared to other online help services. I feel like I should pay more than I did for this expertise (can I do that? If I can, I'd like to!). Thank you so, so much!