Highly Exposed Seronegative HIV Infection

[imwater]

I am not concerned with a single unprotected exposure, but worried about the conclusiveness of HIV duo plus pcr rna tests to a half-year heterosexual relationship with a female potentially HIV+ partner 4 years ago from which I have repeated unprotected exposures.
I have tested with HIV duo and pcr tests recently out to 9 months repeatedly after my last unprotected exposure with my last partner. Both results came back negative. Also, my CD4+ count is 790. With these results, I understand that HIV infection can be ruled out.
However, I have a lot of symptoms in these 9 months period including oral thrush with tingling feeling, recurrent upper respiratory tract infection, gastritis/esophagitis, persistent diarrhea, intermittent mild elevated liver enzymes levels, persistent chest/epigastric and upper back neural pain, numerous raised wart-like and angioma-like stuff over my body.
1. I heard about a term called “highly exposed seronegative HIV infection” by which HIV-1 can be transmitted but not causing disseminated infection or seroconversion. The infected person may have HIV rna levels remained below the detection limits of the sensitive assay and also antibody production may not be triggered to a detectable level. So, is that a chance that the infected person is not diagnosed by the routine HIV tests even they are taken far out of the window period?
2. Also, is there a notion that HIV replication can be restricted to the mucosal surfaces or their drainage lymphoid tissues or the viruses are stayed in the reservoirs of the resting cells so that there is a discrepancy between the immunity of the circulating blood and the mucosal tissues? So, one may have oral thrush with a CD4+ count of 790 because the viruses are replicated restrictedly in the mucosal surface on the tongue?
Doctor, would you comment if I am falling in this category.
And in my case, am I conclusive to be –ve with my HIV tests’ results regardless of my exposures’ history and symptoms?

[Edward W Hook, MD]

Your concerns have no scientific validity.  If there were viruses replicating only in mucosal lymphatics they would still generate antibodies detectable in the blood. Yoo need to believe your test results.  If you had HIV, you would have positve tests.  There are no special circumstances in which someone could have replicating HIV anywhere in their body and not have a positive test for HIV antibodies.  Believe your tests.  EWH

[imwater]

Thanks for your comment, doctor.

I would like to clarify that I'm not staying in the Internet for invalid information, but reviewing the relevant information from the respected journals or literatures. Yet I know that I'm not a doctor and may interpret the information incorrectly.

I understand that my repeated negative HIV tests are conclusive, and I know that an untreated HIV infected person the viruses are always present.

The fact that only a few % of viruses are present in the blood and vast majority of viruses are situated in the mucosal tissue in guts and their lymphatic drainages raise me a concern.

Due to some special circumstances, will the viruses replicated actively in the mucosal surfaces and their lymphatic drainages but not necessarily be detected in the blood?

While the viruses are replicating in the mucosal tissues/ lymphatic drianages, will antibodies be produced there? And will the antibodies produced there and the viruses replicated there released back to the blood stream?

[Edward W Hook, MD]

Welcome to the Forum.  I reviewed your earlier interactions with Dr. Jose and agree with all that he has said,  You do not have HIV.  Your tests are conclusive.  Thus you need to look for other explanations for your symptoms which are non-specific and could be caused by a number of other systemic processes.  I would suggest that you seek further evaluation form a trained clinician such as an internal medicine specialist.  there may be a unifying diagnosis that could become apparent with further history and physical examination.  

As to your specific questions:
1.  It sounds like you have been on the internet.   Bad idea. It is often misleading and the idea of a “highly exposed seronegative HIV infection” is an example.  there is no such thing.   HIV is a viremic illness and among infected, untreated persons the virus is always present.  

2.  Similarly, there is no instance in which HIV infection can infect mucosal surfaces and not lead to positive blood tests.  Plenty of people get thrush who do not have HIV, including people who are taking antibiotics, people who have diabetes and other persons with chronic systemic illness.  

Once again, you need to believe your test results.  When symptoms and multiple appropriate HIV test results differ, the symptoms are due to something other than HIV.  You need to look elsewhere for the cause of your illness.

I hope this comment is helpful.  EWH