Continuing Health Problems

[Mikiemike]

Dear Doctor:  I am a 44 year old man.  13 months ago I had sex with a male of unknown hiv status.  I engaged in anal receptive sex.  I did have the individual put on a condom and I did check the condom afterwards and it was NOT broken.  However, I now wonder if the condom stayed on.  A week after this encounter I had two nights of drenching night sweats, a low grade fever, extreme fatigue.  After that I had several other symptoms (achiness, naseua, loose stool, dry skin, aching joints, night sweats around my neck and shoulders).  I was very fearful of hiv.  I went and had several hiv antibodies tests taken since.  One at 6 weeks, 10 weeks, 3 months, 6 months, 9 months and 13 months - all of the results were negative.  I have not had sex since that night, now nearly 14 months ago.  I continue to have the sweating around my neck and shoulders at night.  I just don't know what to make of it.  The room is cool and I am not under any covers.  I have been to my doctor, he ran the normal blood panel back in October (3 months after the sexual encounter).  Everything was in the normal range except: my thyroid became slightly hypothyroid (on a scale of .5 to 5.5 mine is an 8 for the TSH), my lymphocytes were below normal (on a scale of 20 to 43% mine was 17), my testosterone was below normal (on a scale of 241 to 827 mine was 191), and I would run a temperature of 99.5 off and on.  I am on thyroid meds and when I went back for more blood tests my testosterone went up to 393.  My concern is that the night sweats are continuing most everynight.  I had tests run for TB, Syphilis and Hep back in October, all negative.  I went on vacation this past summer to Nashville and developed a terrible cough while there.  Upon returning home I went to the doctor as the cough didn't clear up and I was getting wheezing.  The doctor said it was some kind of respitory infection, gave me some antibiotics and it cleared up in about two weeks.  It's just that I NEVER used to get sick at all, now I feel run down most of the time.  I have to say I feel MUCH better than I did a year ago.  Last year at this time it was all I could do to get out of bed each morning.  I've ask to see an infectious disease doctor (I've called them).  But they won't see a person until they have tested positive for hiv.  Is hiv now conclusively ruled out (since I've tested negative out to a year)?  I have called the National CDC AIDSHOTLINE and the California AIDS Hotline.  Both tell me current testing says to only test for hiv out to six months.  So here I am, wondering why I continue to have these night sweats, and what could be the cause of it.  I would greatly appreciate any insight you can give me.

[Kevin Pho, MD]

With 6 negative HIV tests, the chances of HIV are miniscule.  The sensitivity of these test range from 99.3-99.7 percent.  You also have been tested pretty extensively, including TB, hep, and thyroid tests.  All were not revealing (except the low thyroid - which should not be causing your symptoms).  

I would want to further rule out insiduous causes - such as endocarditis and lymphoma.  The first can be evaluated with several sets of blood cultures as a first step.  The second disease can be evaluated with a chest and abdominal CT scan.  

You may want to discuss these options with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[Cindylou]

I would think this would be anxiety kicking in now.  The fear of HIV is probably what is causing all your symptoms.  Maybe talk to someone about it to put you mind at ease.  After all the tests and you are negative, this would be the next step to take.