Question:

I had a risk exposure ... I had sex with a prostitute (I don't know her status) I used condom for the intercourse and I didn't perform oral sex to her.

I had been taken ELISA tests in several occasions all of them had come negative (56, 70 and 83 days after exposure). But during those period of time I developed several sings that can be related to HIV such as diarrhea, my hands hurts also my arms, and I think in several occasions I had swollen gland in the back of my neck and under my arms.

So my question is: how many people develops HIV after a 12 weeks negative result?

Thanks for all you're help.

Answer provided by:

Rodger MacArthur, M.D.
Wayne State University
Division of Infectious Diseases

The chances of acquiring HIV infection from sexual intercourse (anal insertive and/or vaginal insertive) approach 0% in persons who properly use a latex condom. Hence, there is very little likelihood of acquiring HIV infection in the scenario described by the questioner. In addition, the subsequent symptoms described do not sound typical for the acute retroviral syndrome. Specifically, pain in the armpits would not be typical, and fever (usually high, and apparently not present in this case) would almost always be present. Furthermore, the symptoms of acute retroviral syndrome occur 2-6 weeks after exposure. A negative HIV ELISA, 54 days (8 weeks) after exposure would be unlikely to be falsely negative. An antibody response (indeterminate, weakly positive, or positive) usually is seen within a month after the onset of symptoms of the acute retroviral syndrome (4-12 weeks after exposure).

While commercial sex workers ("prostitutes") have a reasonably high prevalence of HIV infection (5-10% in the United States), there is no indication that this particular sex worker is HIV infected, nor is there any reported exposure to sex fluids (infected or not). Consequently, the episode described would be considered a "non-exposure" for the purposes of recommending against further testing or post-exposure prophylaxis with antiretrovirals. However, for peace of mind, a negative HIV ELISA obtained 6 months after exposure would conclusively (>99%) exclude ever acquiring HIV infection from this particular encounter.

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