Question:

I just have a couple of questions that I hope you can answer. I have tested negative at 6 weeks, 3 months, 6 months, 7 months, and 9 months following an exposure. I should feel confident that I am HIV negative, but I keep questioning the results for the following reasons:

1. From this same exposure I contracted genital warts, which my doctor has been treating for 6 months without complete success.
2. Recently I keep getting canker sores on my tongue (at least I think that's what they are - either that or irritated taste buds, but painful nonetheless).
3. I had a yeast infection for the first time in years with no apparent cause that I can see.

Because of these reasons I keep thinking that I am in the less than 1% group of people that will test positive after 6 months (and 9 months). I plan on getting tested again in 3 months, which will be exactly a year from my exposure, but until then my questions to you are:

1. Do you think I have cause to be concerned that my 1 year test will be positive, regarding my reasons above, even after testing negative 9 months from my last exposure?
2. Do you think I have any reason to worry about HIV-2? I live in Massachusetts and to my knowledge the person that I slept with hasn't been with anyone from West Africa (he is also from Mass), but I'm still worried.
3. If I were infected with HIV-2 would the five standard HIV-1 tests I've taken have picked up that type?

Thank you so much for taking the time to read my long email. I think my excessive worry stems from all-consuming guilt because I am married and my exposure (read: infidelity) took place at a party after having too much to drink. I would certainly appreciate any thoughts that I am worrying needlessly.

Thank you.

Answer provided by:

I can certainly understand the anguish you are feeling, and I hope I can help you a little.
The prevalence of HIV-2 is so low in the US that typically, HIV-2 is not looked for with standard tests for HIV antibodies in the patient care setting. In general, specific tests are done when there is a history of possible exposure to HIV, or the patient has clear signs suggestive of HIV disease, and a negative test for HIV-1. Blood banks and such use tests which detect both HIV-1 and HIV-2, however.

Now, there is nothing in the medical problems that you describe that would really shout out "HIV" to me. Venereal warts are very common; it is possible that you had them, or sub-clinical infection, for years. "Canker sores" also are present in such large numbers of people that they don't point at anything, except, possibly stress. A mild yeast infection may even argue against HIV infection, as in that setting, it's more than an inconvenience. (By the way, I am making the assumption that you are a female who had sex with a male?- not that important).

You should also remember that health problems associated with HIV typically arise YEARS, not months after infection. It would be very unlikely to have signs of HIV infection 9 months to a year post exposure.

I would add that you don't seem to know the serostatus of your partner, and that of course, is an important consideration. Obviously, if he's negative, that ends the story.

In short, there is nothing in the clinical history that you give that would make me very worried about HIV-2 infection. You have been thoroughly tested for HIV 1 disease, and I think it very very unlikely that at one year, you will test postive for that disease.

You do seem, as you know, to be suffering from guilt and anxiety. You might want to discuss your feelings with a counsellor or someone from your church or synagogue. If you thought it would help you, your doctor could order a test for HIV-2. Might help you sleep at night.

Take it easy on yourself. We all make mistakes. That's ok, as long as we learn from them.

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