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Am I missing something?
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Am I missing something?

Dr I am in need of your medical expertise.
9/29 Was drunk/passed out in European strip club and only remember pulling my pants up with an AA sex worker. Since I have assumed I had unprotected sex.
9/30 back in the US, treated empirically with Azytro and Cefixime
10/2 Tested for HIV, RPR, HBsAg/HCV EIA, CMP, LDH and CBC - all negative,  however my ALC was 1000 (previous years @1500's)
10/12- Tested again - all negative and ALC -1300;
During  that time I had flu-like symptoms with a burning sensation in my skin in chest/back and shoulders.
10/26- Retested for (HCV, HBsAg, HIV, CBC and CMP- all normal)
10/31 - my spouse (monogamous relationship for 12 years) developed a skin rash in her inner thighs extending to below the knees (we had unprotected sex on 10/12 and 10/20 = 2 and 3 wks after my incident) She also had a sore throat. This made me concerned about ARS.
11/5 (37 days after the incident) I retested with HIV ELISA, RNA quant PCR and HCV and HBsAg, CBC and CMP again; All negative included the viral load. I was told not need further testing was needed however I continued to experience malaise, fatigue and my hands feel stiff /palms of my hands feel blushed with white and red spots +/- some itching +/- tingling. Therefore, I retested at day 82 after my incident. HIV ELISA; HBsAg, core and IgM and HCV EIA –all negative. Did also a viral load for Hep C but lab said insufficient material. RPR negative also.
My ALC is 1300 (again lower than my average in previous years) and now my LDH is elevated at 242. Never in the past had an LDH greater than 150's.
1. Is the any possibility this is atypical HIV
2. Do I need to test again for HIV
3. Can this be Hep C-retest for the viral load?
4. Why my ALC dropped 3 days after the incident /now normal- however not as high as my previous years
5. Why is my LDH rising now?
6. Is there anything else that you think it is worth for me to be tested for that could account for my symptoms- especially in my hands?
1024580_tn?1331577721
Hello,
Thank you for your post and welcome to our forum.  Apologies for the delay in replying to your post.
I will try to answer each of your questions here below:
1.) I doubt this very much so.  The combination of the Elisa with the PCR RNA at 37 days would have picked it up.
2.) Bearing in mind the relatively low risk sexual encounter, with all those negative test results, we can consider it conclusive and exclude the possibility of HIV.  However I have to add that current guidelines do not consider those tests final and conclusive at those periods of time.  The quantitative PCR RNA is not considered diagnostic, and the Elisa is conclusive after 12 weeks.  On the other hand, guidelines are always conservative.  In my experience, the combination of these tests together with your low risk, we could conclude that you are negative and that you would not require any further tests.  If your symptoms had anything to do with HIV sero-conversion, the tests would have definitely picked it up.
3.) Hepatitis C is rare and is not usually transmitted through sexual intercourse.  Therefore I would not worry about this.
4.) Your absolute lymphocyte count has always remained normal, normal levels vary between 800 and 2,600.  I do not beleive that those changes have any clinical implication as they can vary frequently.  It is certainly not an indication of HIV infection.
5.) Elevated levels of LDH usually indicate some type of tissue damage, including muscular damage after exercise.  It is not a very useful parameter in isolation and has to be correlated with other blood tests and clinical symptoms.  Normal levels range between 150 to 350 IU/l.  Your levels are normal; no need to be concerned.
6.) Your symptoms might not be related to this incident.  If they persist, you need to be seen and examined by a doctor.
Best wishes,
Dr José
7 Comments
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Avatar_m_tn
would greatly appreciate a response to the question I posted few days before
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Avatar_m_tn
Muchas Gracias (Thank you very much) Dr.

You have provided reassurance. I am not sure if you also saw that I had a HIV1&2 Ab (EIA) at day 82 (few days short of 12 weeks or the 90 days you mentioned). I work on healthcare so I beleive I am quite objective. However my spouse's rash in legs 2-3 weeks after we have unprotected sex (2-3 weeks after my possible HIV exposure in Europe) it what concerns me the most. First, because I cant not explain that and perhaps because the timing of it & relation with my previous exposure.

1. With that in mid and with the fact that I had a repeat test at day 82 (as above), should I retest again now that we are 12 weeks out?

2. Is there a  possibility that this could be HIV-2 as the sex worker was from African origin ? If so, is there a specific test that would r/o HIV-2 or any other atypical serotype.

3. Based on your expertise, could the current symptoms -based on the history provided be related to an atypical viral infectin such EBV vs. CMV or orther virus alike?

4. Do you think that my spouse should be tested? or my testing should be enough for the two of us- by that I mean, if I did not contracted HIV or any other STD she should not have any of them either.

I think answering these questions will provide closure. I really need to move on. The last 3.5 months have been awful just thinking that I single ETOH related mistake can compromise my life and the ones closest to me.

Thx for your time
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Avatar_m_tn
Dr. I would greatly appreciate if you can address the f/u questions posted after your initial response. I am anxious and have been waiting for your response.... Thanks
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1024580_tn?1331577721
I think that my first answer was clear enough.  I will answer th additional questions here below:
1.) No, 82 dyas is good enough.
2.) HIV-2 is extremely rare, and it would have been picked up by the test that you had anyway.  The test was negative for both, HIV-1 and HIV-2.
3.) It is certainly possible.
4.) If you have been tested for all STDs and all the tests have been negative, there is no need for your partner to be tested.
Best wishes,
Dr José
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Avatar_m_tn
Thank you for your response. To finalize the thread, can you please expand on what additional testing for atypical virus should be done.

You mentioned that it is possible to have acquired atypical viruses.

EBV, CMV, HTLV testing? or what other virusesif so, what are the appropriate tests??

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Avatar_m_tn
Dr. Would greatly appreciate if you can review my final message so we can conclude the thread. Thank you
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