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Condom Broke, MSM, Top Partner HIV Risk

Question:

I had Anal Sex with an HIV positive person twice. The first time, the condom didn’t break, but the second time the condom broke for 3-4 second. I can say the exact time and I took my penis out. After that, I put on a new condom and continued. This time the condom didn’t break. Only the head of my penis touched the inside of his anus. Does this type of exposure put me at risk for HIV? Please help. I am scared. My life is very disturbed.

1st) One AIDS center told me that my negative DNA PCR is accurate after 8 days and also after 28 days. Are they correct or incorrect? If this test can detect virus, then how reliable is it after 28 days? What is rate of false negative results on the DNA PCR?

2nd) How reliable is the 12 week (3 month) window period? Some sites recommend 6 months or even up to one year. Does this refer to the DNA PCR or another test? My 28 days negative DNA PCR is very encouraging to me but I’m worried that some of the sites say to wait 6 months or 1 year.

3rd) After my condom broke, we only had sex for about 3-4 more seconds before I put on a new condom. Am I safe or not? I am circumcised and I have no cuts my penis or any other STDs. I’m just worried because my penis touched the inside of an HIV positive person. Also please answer this: what is the risk of a top partner acquiring HIV from an HIV positive bottom partner?

4th) Lastly, do you think I need to do further testing if I have come back negative on a 28 day HIV DNA PCR and a 12 week ELISA test?

Sorry for all the questions, but I am very worried and my life has been very disturbed lately. Thanks for your help.

Answer:

You mentioned that the condom broke during one of your contacts with this person. This does put you at risk for HIV, although you did mention that you were the top partner, so this lowers your risk slightly, assuming that you didn’t have any type of genital ulcer disease (like herpes or syphilis), legions, or breaks in the skin of your penis.
What are more important are your consistently negative test results. An HIV DNA PCR test doesn’t really tell you much at eight days after exposure, although the results are considered conclusive at 28 days after exposure, per manufacturer’s standards. In most cases the reliability of this test at 28+ days is upwards of 99.99%, making the rate of false results <0.01%. They say that the window period for the PCR test is 28 days.
The window period for an ELISA/EIA test, on the other hand, is three months, so about 99.9% of the population will show up positive at 3 months, if they are, in fact, positive for HIV. In other words, a negative result on the HIV ELISA test is about 99.9% reliable. The 6 month recommendation is an outdated number.
The risk of acquiring HIV, even from a positive partner through unprotected sex is fairly low, if you are the top partner, or inserting partner. This is assuming that you are a healthy individual, with no breaks in your primary boundary to the outside world, your skin. This is due to the fact that HIV must bind to CD4+ T-cells, which are only present at the surface of the skin when there is a legion or break in the skin, because your body recruits immune cells to try to fight off any incoming bacteria or viruses while it is also healing the area. HIV is also a non-motile virus, so it cannot propel itself up your urethra, and get into your body that way, so your penis, when healthy, provide a great barrier against HIV.

I hope this helps,
SMK