Every Possible HIV Symptom

[goingnuts101]

12 wks ago I had my 1st sexual encounter, receptive anal sex with another man. Although it was protected at 1st, he took off the condom when he went soft and put it back on again. The next day I found some pills in his cabinet and later found out that they were anti-HIV pills 'Truvada'.

I freaked out and went to the hospital where i was prescribed a 28 days course of PEP which I completed.

3 wks post exposure I had some rash on my inner thighs, followed by nausea and vomiting which went away after 4 days.

At wk 4 my right supraclavicular lymph node began to swell.

At wk 6 I noticed that my submandibular and parotid glands were swollen.

I had on/off night sweats from right after the exposure till wk 8, although not the drenching type, more like a layer of sweat on my chest and inner thighs. I dun recall having fever.

My right supraclavicular lymph node and salivary glands are still swollen now after almost 2 months.

I had HIV tests performed at wks 4, 8 &12 and all were negative. All tests were done using a combination test for P24antigen and 4th generation ELISA for HIV 1 & 2 antibodies.

My doc insists that the swollen glands are not due to HIV because the tests would have shown it. He said if the swellings were due to HIV, lots of HIV antibodies would have been produced and the test would have picked it up.

He told me not to worry as there has been no cases of PEP failure in Australia and the swollen gland are likely due to other causes and we should just monitor and consider biopsy at the 6 months mark if they are still swollen.

My questions are
1) How long after symptoms appear would the test be positive?
2) Is it possible to have all these symptoms and yet be negative? Is it true a swollen node due to HIV would show a positive test?
3) What else could cause these symptoms, esp swollen lymph node and salivary gland?
4) Is it true that with the p24 antigen/ 4th gen ELISA tests, it is extremely unlikely for anyone to test positive beyond twelve weeks?

[H. Hunter Handsfield, M.D.]

Welcome to the forum. I'll try to help. But the first thing is for you to calm down, think objectively and calmly, and listen to and trust your doctor.  He is exactly right.

You had a sexual exposure that could have resulted in HIV, but the test results prove it didn't happen.  Your symptoms are meaningless with respect to HIV; test results ALWAYS outweigh symptoms. As for the specific questions:

1) If your symptoms were due to HIV, your test would have been positive a week after they started.
2) It is not only "possible" you don't have HIV.  You definitely do not.
3) A number of other common, minor viruses. Or allergies. Or cancer, for goodness' sake.  (But that's no more likely than HIV.)
4) Yes, that is true.

Here comes the lecture, maybe particularly appropriate to someone just starting his sexually active "career" with othe rmen:  The two main safe strategies for men who have sex with men are 1) condoms for anal sex and 2) know your partners' HIV status.  You followed the first -- good move.  You ignored the second -- very bad move.  Continue to do that and you should assume that HIV is in your future. You must never, ever have sex with another guy without first asking about and sharing your own HIV status.  Avoid sex, or at least anal sex, for those who have HIV or who are evasive or uncertain about it.  Even if safe sex (mutual masturbation, oral sex, etc) is planned, or when you expect to use condoms, remember that condoms fail and that intentions to remain safe often disappear in the course of the events -- just as happened here.  Let me repeat:  follow this rule and you likely will remain free of HIV forever.  Consistently fail to follow it and HIV probably you will have it someday.

But you don't have it now.  Listen to your doctor; it sounds like he knows what he is talking about.  If you are getting your care in a sexual health centre, you're definitely in good hands; Australia's SHCs are probably the best network anywhere of STD/HIV clinics.  Even in the private sector, most likely you are in very competent hands.  As a group, the HIV treatment physicians in Australia are among the best in the world.

Best wishes.  Stay safe--  HHH, MD

[H. Hunter Handsfield, M.D.]

Definitely you did not catch HIV.

A single swollen parotid gland does not suggest HIV.  Continue to follow up with your provider if you remain concerned, but you can put HIV out of your mind.

That's all for this thread.  I won't have any further comments of any kind.

[goingnuts101]

Just had another test done at 18 weeks post exposure (14 weeks post PEP) and the result was negative. While I am relieved I still cant put my mind to rest due to my still swollen parotid gland.

Is the test at the 18 weeks mark reliable and should I stop worrying about HIV and check other causes of parotid swelling instead?

[H. Hunter Handsfield, M.D.]

There has been little or no actual research on the effect of PEP on subsequent diagnostic test results.  Most likely PEP delays the development of positive antibody tests, but certainly not by 3+ months; and I cannot imagine that it has any effect on p24 antigen testing.

Continue to follow up with your doctor.  He likely knows as much or more about all this than I do.  I won't have any further comments or advice for you.  Take care and stay safe.

[goingnuts101]

Thanks for the prompt reply and advice.

The past 12 weeks have been overwhelming for me and I still have to wait in agony for the next 12 weeks to pass before I get an official 'all clear'. I do not ever want to be in this position ever again and have thus promised myself to abstain from casual(unsafe) sex.

I do have a lingering query though...could being on PEP affect the test results? Will it delay the antibodies production despite the symptoms? Or is the 6 months guideline for those who received PEP just a conservative measure? My doctor seem to think that the 6 months measure is just 'for legal purposes' but I still have some anxiety about it.

Thanks once again