Is it anxiety or......?

Hello Drs.

5 weeks ago I was in Vietnam where I had sex with a bar girl. During sex my condom slipped to half the penis, which she noticed not me, she then rolled it back properly. We had sex for 5-10 mins. I pulled out and then we masturbated. During masturbation while I was still wearing the condom I noticed a milky liquid inside which made me scared as I was far from ejaculation at that point. I am not sure about the health of condom.

Until 2 weeks everything was fine, but one afternoon I got severe uncomfort in my right side of rib cage. My doctor told me it is a case of liver inflammation. I got my LFT&Ultrasound. My direct Billirubin was high. My total  Cholesterol came out 250. I sometimes feel like vomiting but it never actually happens.  I eat something and the upper part of my chest turns red and inflamate. This subsides after a while  But some part at the roots of chest hairs it keeps red. My whole face sometimes feel very warm. I feel mild ticklish pain almost any time of the day in my Lymph Nodes under jaw and behind ears and right side of groin, near right nipple and right armpit. My left testicle is smaller than the right one and it pained a lot yesterday. It has been small for past some years. It pains occasionally when I drink something cold.

I got tested HIV 1/2 Combo P 24 Antigen CMIA 17 days Non-Reactive. This time I also got tested for Hepatitis B & C. Both negative.

and then, same Combo P24.. CMIA test 26 days Non-Reactive.

Please could you help on following:

1) What can be the chances of my having HIV?

2) I tested in a lab but that was Rapid test or what I don't know. I got result the same day both times.

3) Are the results any less reliable when the blood is taken from collection point to a lab..say 10 miles away?

4) Do I require further testing for HIV or (given Liver condition and Lymph Nodes) any other STD?

Regards

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

I'm sorry to hear your first sexual experience (as described on the community forum) has become so stressful for you.  The responses there were very succinct, but they were accurate.

I can't judge the cause of your liver problem.  It might be viral hepatitis, but if it is, it's very unlikely it came from the sexual exposure you have described. As for HIV, the exposure you describe was entirely safe, and anyway it is statistically unlikely your partner had HIV. And acute HIV rarely if ever causes the sort of liver problems you describe.  Most important, your test results are nearly 100% reliable proof you don't have a recently acquired HIV infection.  The combo test (for both HIV antibody and p24 antigen) is completely reliable at 4 weeks, and 26 days probably is close enough.  To your specific questions:

1) The chance you have HIV?  Zero, or very close to it.

2) The rapid tests are highly reliable; and Vietnam is a medically sophisticated country; I'm sure HIV testing is of high quality.

3) Transport of blood to a nearby lab has no effect on test performance.  In fact, HIV blood specimens can be transported hundreds of miles for many days, in very hot climates, and still be tested accurately/

4) I see no need for additional HIV testing. But you should discuss your concerns with the doctor or clinic evaluating your liver problem, then follow their advice.

Bottom line:  Deal with the liver problem as your doctors advise.  But you needn't worry at all about HIV.

I hope this has helped.  Best wishes-- HHH, MD

[onenightworry]

Thanks a lot Dr. HHH.

Actually I am not saying my tests were Rapids, I just don't know. But they were for sure 4th Gen Hiv 1/2 Antibody + P24 Antigen. Nevertheless, your assurance about Rapids are very comforting.

At one of the renowned lab's websites I read that HIV test blood samples should be taken after fasting for a while! Honestly, it is very unsettling as I did not bother at all about fasting. Do you borrow this fact?

So can I take my 26 day (actually 26 days +12 hrs. exactly) as definitive?

[H. Hunter Handsfield, M.D.]

You had a lab based "4th generation" test, and you can definitely take your 26 day negative result as definitive.  Rapid tests are done in 20 minutes while the patient waits for the resultand would have used blood from a fingerstick or a swab in your mouth.

Fasting is standard advice because it makes a difference for several very common tests, such as blood sugar and cholesterol.  It makes no difference for HIV testing.  

[onenightworry]

Dr. HHH

I have just gotten my blood test report. I had also gotten blood test done on 8th Feb 2013.

08/2 TLC 6,800/cu mm
24/2 TLC 8,900/cu mm

08/2 Lymphocyte 36%
24/2 Lymphocyte 22%

I am freaking out why my TLC has increased and Lymphocytes decreased. Could this be HIV? I have started wondering if 2 days gap in testing could have been conclusive.

In one of the threads you said that Lymphocytes actually go high with new infection not low, but in another thread Dr. Hook is of the opposite opinion.

Please help.

[onenightworry]

Dr. HHH,

I was so p****d off that I got one more test today which is again HIV 1/2 Antibody Combo P24 Antigen (CMIA). The result has just come back Non-Reactive at 35 days. I hope this leaves no holes open as this test is quite well beyond the window period of 28 days. I also pray to God that this time I digest the result well and not think about it again.

Kind Regards and Thanks for being here for all of us

[H. Hunter Handsfield, M.D.]

Everyone's white blood cell and lymphocyte counts vary quite widely over the course of a normal day.  Both your tests were entirely normal; modest changes like you had are meaningless.  Your follow-up (35 day) HIV test once again proves you were not infected.

Do your test to ignore any further "what if" or "yes but" questions that come to mind.  The test results overrule all other factors, and there is no information that will come to your mind that could possibly change my opinion or advice, so there is no point in asking.  Forget HIV; follow your doctor's advice about the liver problem; and move on with your life.  

[onenightworry]

Hello Doctor HHH

Thanks again for your response. Just one question that came to my mind....Is my 35 day non-reactive combo test fully and  finally conclusive for HIV-2 also or for HIV-2 I must test again at between 6-8 weeks as there is no P24 for HIV-2? I hope my question is not redundant.

Thanks is advance.

[H. Hunter Handsfield, M.D.]

The test you had is equally valid for HIV-1 and 2.

[onenightworry]

Had 9 week combo test as non-reactive. I am happy!

Regards