Dr. Bob, First of all, after reading through your site, I am so taken back by all the great things that are going on here... I am going to be donating to your Foundation!!! What great work! My question is this... I performed oral sex on three different men back in late April of this year over the course of 3 days while traveling in New York. I subsequently asked each of them their HIV status, and they all said they were negative. A week and a half later, I developed an illness that lasted for 4-5 days consisting of fever, sore throat, swollen and tender lymph nodes in the neck though only one was tender- the nodes under the back of the jawbone, some body aches, and I am guessing an unrelated canker sore that started four days before I felt ill. My gums were also swollen the last day or so of the illness, but that went away with a saltwater gargle. I totally freaked out being a gay man, as well as a bit of a hypochondriac, and persisted to research every possible cause relating to ARS on the internet... My doctor in LA who is an HIV expert, spoke to me over the phone while I was sick and thought it was probably a viral or bacterial infection from the traveling and lack of sleep. But still, I put myself on whirlwind 6-week worry fest where I could barely function... I tested with an ELISA blood draw at my doctor AND a Home Access test at 6-weeks and both of those came back negative... I was slightly relieved, but unconvinced. I also took another Home Access test at 8-weeks which also came back negative. I am an otherwise normal guy with a healthy immune system. It is now 4 months after the potential risky behavior... How conclusive are my 6 and 8-week results? Do I need to test again? Everything I read seems to contradict... Some say 6-weeks is conclusive, some say 8-weeks in conclusive, others 12 and 13 weeks, even for those with normal immune systems... I would really appreciate your guidance here, as you really know what you are talking about. I hope to get a response to your question. Thanks again for all your work on this site. All the best!

-David

Hi David,

Three blowjobs on three different guys within three days while traveling in New York!?! Hmm . . . if this was a business trip, I'd like to know what line of business you are in. If this was vacation, I'd like to get the name of your travel agent. But I digress . . . back to your problem. David, asking hunky-spunky studs about their HIV status after the fact isn't really all that helpful. It's safer just to assume all our sex partners could be HIV positive and consequently take all the necessary precautions to prevent HIV transmission. Personally, even if a dude strapped a lie detector on his Mr. Happy, I wouldn't trust his HIV status self-report. Remember, over 25% of the one million HIV-positive Americans have no idea they are infected with the virus.

Your risk, oral sex, carries only a very low risk for HIV acquisition. Check out the archives of this forum. We have a whole chapter devoted to oral sex. Not surprisingly, you're not the first one to have these concerns.

Regarding HIV-antibody testing, the current U.S. Guidelines state that tests taken prior to the three-month mark are not definitive. (And hey, we also have a whole chapter on HIV testing in the archives as well! Surprise, surprise, eh? Check it out!) Certainly your multiple negative HIV-antibody tests out to eight weeks are very encouraging, but they are not conclusive. If you desire an FDA-approved negative test result, you'll need to get a follow-up test at three months from the last potential exposure. The odds are astronomically in your favor that you did not contract HIV from your tricked-out triple-play.

Thanks for your donation to the Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's urgently needed and warmly appreciated. In return, I'm sending you my good-luck karma that your definitive three-month HIV test remains negative. I'm quite confident it will.

Good luck.

Dr. Bob

Ông Bob này trả lời là phải thử lại sau 3 tháng chứ có dám nói 100% đâu ???

Hi,Rick! I have two questions: 1. In your answers you often say that the virus does not survive more than a few minutes outside the body. I have read a paper by P.J.G.Butler. In this paper, he says that HIV is not unstable under normal enviormental conditions as is some times assumed. Infectivity has been shown to persist for up to seven days following air drying and for more than 15 days at 23-27c (and>11 days at 37c) in an aquaous state. Wnich one is correct? 2. If HIV is not transmitted through every casual contact, why there are 3% of patients haven't "identified risk"? How are they infected? Thank you very much! 

Answer

Hi. Thank you for your question.

There has been a lot of misunderstanding (and misinterpretation) of the scientific data looking at survival of the HIV virus outside the body. Studies that looked at HIV survival, used concentrations of HIV at least 100,000 times higher than concentrations normally found in nature. Using these extremely high concentrations of HIV was used out of necessity, because of scientific and technical limitations. In studies using these extremely high concentrations, HIV was able to survive for 1-3 days after drying, but inactivation of the virus was extremely rapid (90-99% within several hours). Now, does this mean that HIV at normal concentrations will survive for up to 3 days? No! Remember that these are concentrations of HIV that are at least 100,000 times higher than that found in nature. When we extrapolate this data down to natural concentrations of HIV, we can determine that HIV can only live for several minutes outside the body. If HIV were to be able to survive outside the body for many hours or days (at natural concentrations), we would have seen cases of HIV transmission through casual contact. In the over 15 years that we have been studying HIV transmission, we have never seen any cases of transmission through casual contact worldwide.

In regard to cases of AIDS where risk has not been identified, let me tell you the "statistic behind the statistic". I'll use USA AIDS statistics as an example. Out of almost 550,000 cases of AIDS in the USA, in only 893 cases, were we not able to determine the source of infection (as of 30 June, 1996). Of these cases, this includes heterosexual contact with a person not known to be HIV positive, persons who chose not to disclose their risk factors for HIV (which is not an unusual occurrence), and persons with possible occupational exposures. These 893 persons included:

Individuals having a history of other Sexually Transmitted Diseases (STD's) indicating high risk sexual exposures,

Individuals with Hepatitis infections (Hepatitis B and C share similar routes of transmission as HIV),

Individuals having a history of non-IV drug use (alcohol and other judgement affecting drugs, has a well-known link to HIV, due to behavior changes while under the influence of these drugs) and,

Individuals having occupational exposures to blood or body fluids.

So out of the literally thousands of cases of AIDS, in only a small number of cases were we not able to determine a definitive source of infection. But many of these individuals did have known risk behaviors, and markers of risky exposures. There is no evidence that anybody has been infected through casual contact worldwide. It's very easy to misinterpret statistics when it comes to how a person became infected. For example, if a person refuses to cooperate with health officials or doctors, is lost to follow-up if they move out of the area, or if they die before we can determine their risk, these individuals would be classified as having an unknown risk factor for HIV infection. This doesn't mean that HIV is being transmitted in a new way. What it does mean is that we were unable to collect the information. Statistics like these can be very easily misinterpreted.

In summary, it's important to understand that statistics and scientific reports can be easily misinterpreted, if a person only tells part of the data, rather than all of it. I hope this has cleared up some of the misunderstanding.