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Mono and HIV
Hello Doctor,
I was recently scheduled to have my gallbladder removed because of multiple gallstones and gallbladder attacks. A week prior to the surgery, I began to have extreme fatigue, mild fever (99.7 highest) and muscle aches mainly in my legs. I also had a two very small mouth sores that appeared, but cleared up within 24 hours. My doctor ran a complete blood test for my cell counts which all came back normal, except for the lymphocytes, which were elevated within the range of a diagnosis for mono. My Liver enzymes were also slightly elevated. I had a mono spot test which came back positive for mono.
I requested a HIV test because I received unprotected oral sex from a male about 11 weeks prior to the test. I have participated in oral sex (receiving only) several times over the past 10 years (approx. once every 2 months). I did have unprotected anal sex with a man over a year and half ago and visited several prostitutes during that same time frame (all sex was with a condom). But my last encounter was 11 weeks ago. The HIV antibody test was negative.
Since the antibody test (3 weeks ago), I have had persistent fatigue, night sweats, abnormal tongue feeling, and swollen lymph nodes in my neck. This past week the lymph nodes in my groin have become swollen and painful, but the lymph nodes in my neck are only slightly swollen. I was also diagnosed with HPV and have visible warts around my penis. I also had a mild case of mono in college. Finally, I had a pimple like rash on my forehead, but was able to clear it up by washing with soap and blotting it with rubbing alcohol.
My questions are:
1. Could this be acute HIV symptoms and not Mono?
2. Could a recent HIV infection cause a reoccurrence of mono during the onset of HIV?
3. How accurate is an blood antibody test 11 weeks after the exposure? Advice on more testing?
4. Am I more susceptible to HIV through oral sex with visible genital warts?
Thank you!
I was recently scheduled to have my gallbladder removed because of multiple gallstones and gallbladder attacks. A week prior to the surgery, I began to have extreme fatigue, mild fever (99.7 highest) and muscle aches mainly in my legs. I also had a two very small mouth sores that appeared, but cleared up within 24 hours. My doctor ran a complete blood test for my cell counts which all came back normal, except for the lymphocytes, which were elevated within the range of a diagnosis for mono. My Liver enzymes were also slightly elevated. I had a mono spot test which came back positive for mono.
I requested a HIV test because I received unprotected oral sex from a male about 11 weeks prior to the test. I have participated in oral sex (receiving only) several times over the past 10 years (approx. once every 2 months). I did have unprotected anal sex with a man over a year and half ago and visited several prostitutes during that same time frame (all sex was with a condom). But my last encounter was 11 weeks ago. The HIV antibody test was negative.
Since the antibody test (3 weeks ago), I have had persistent fatigue, night sweats, abnormal tongue feeling, and swollen lymph nodes in my neck. This past week the lymph nodes in my groin have become swollen and painful, but the lymph nodes in my neck are only slightly swollen. I was also diagnosed with HPV and have visible warts around my penis. I also had a mild case of mono in college. Finally, I had a pimple like rash on my forehead, but was able to clear it up by washing with soap and blotting it with rubbing alcohol.
My questions are:
1. Could this be acute HIV symptoms and not Mono?
2. Could a recent HIV infection cause a reoccurrence of mono during the onset of HIV?
3. How accurate is an blood antibody test 11 weeks after the exposure? Advice on more testing?
4. Am I more susceptible to HIV through oral sex with visible genital warts?
Thank you!
MEDICAL PROFESSIONAL
Yes, that's a viral load test. The negative result definitively rules out HIV. You can continue to work with your ID doc on all these issues; he probably is at least equally expert as I am in both EBV and HIV.
Just a quick clairfication. The results were less that 20 for the total viral load test.
Just wanted to follow up as requested. I did speak with an ID doctor and he recommended the RNA/DNA test (is this the total viral load test?). The results were undetectable (>20). The nurse said this was good and I believe this test with along with the negative antibody test confirms that I do not have HIV?
Thanks
Thanks for the clear up.
Like you say, there are alot of anxious people here with tests at slightly over 6-8 weeks, and when they read something like what you stated, eyes perk up.
Thanks for the clarification.
Like you say, there are alot of anxious people here with tests at slightly over 6-8 weeks, and when they read something like what you stated, eyes perk up.
Thanks for the clarification.
MEDICAL PROFESSIONAL
I knew someone would latch onto this issue, but didn't expect it within 5 minutes of my reply!
Nothing has changed, either in the science of HIV testing or Dr. Hook's and my approaches to questions on the forum. There are no absolutes in biology and medicine, and there is always the extremely unlikely chance that a test result could be wrong despite the testing interval. While we often or usually respond to anxious questions with absolute statements, especially for people who are at little or no risk for HIV, it isn't practical to repeat the cautious qualifications every time. However, in other threads and discussions we regularly have acknowledged the rare exceptions.
In this instance, scared713 asks an unusual question, which gets to potential interractions between HIV and EBV; and the fact that the symptoms and lab abnormalities for the two infections are very similar. But the main take-home message is consistent: it is exceedingly unlikely he has HIV, but an ID consultant would be in the best position both to confirm that fact and evaluate the possible active EBV infection.
This isn't intended to initiate a continue discussion or debate on this topic; I won't have anything more to say about it.
Nothing has changed, either in the science of HIV testing or Dr. Hook's and my approaches to questions on the forum. There are no absolutes in biology and medicine, and there is always the extremely unlikely chance that a test result could be wrong despite the testing interval. While we often or usually respond to anxious questions with absolute statements, especially for people who are at little or no risk for HIV, it isn't practical to repeat the cautious qualifications every time. However, in other threads and discussions we regularly have acknowledged the rare exceptions.
In this instance, scared713 asks an unusual question, which gets to potential interractions between HIV and EBV; and the fact that the symptoms and lab abnormalities for the two infections are very similar. But the main take-home message is consistent: it is exceedingly unlikely he has HIV, but an ID consultant would be in the best position both to confirm that fact and evaluate the possible active EBV infection.
This isn't intended to initiate a continue discussion or debate on this topic; I won't have anything more to say about it.
Not intending to hijack any threads here, but Dr. HHH's response was a little puzzling.
Ive been reading your boards here for a while now, included archived conversation. You usually say 6-8 weeks should be considered conclusive.
You're telling Scared713, after an 11 week negative test, he should test again?
From a side note, I am feeling more and more from your responses that they are becoming much more conservative in nature over time.
Again, not hijacking, just wanted an explanation about testing, and how your advise seems to change.
Ive been reading your boards here for a while now, included archived conversation. You usually say 6-8 weeks should be considered conclusive.
You're telling Scared713, after an 11 week negative test, he should test again?
From a side note, I am feeling more and more from your responses that they are becoming much more conservative in nature over time.
Again, not hijacking, just wanted an explanation about testing, and how your advise seems to change.
MEDICAL PROFESSIONAL
Welcome to the forum.
First and most important, you can be confident you do not have HIV. As long as an HIV test is done sufficiently long after the last possible exposure, the results are 100% reliable -- and with very rare exceptions, 11 weeks is sufficient for the HIV antibody tests. Your negative result therefore overrules symptoms, lymphocytes, exposure history, or anything else. And in any case, oral sex carries little or no risk. However, if you want still additional reassurance about HIV, you could have another antibody test at 12+ weeks, or have a DNA/RNA test or p24 antigen test.
Second: the positive monospot test suggests you have an active infection with Epstein Barr virus (EBV), the cause of infectious mononucleosis. Over 90% of us carry EBV, whether or not we had a diagnosed case of mono when young, usually without symptoms. New infections with EBV don't happen in people who already carry the virus, as far as we know. It seems likely your latent EBV infection has reactivated, explaining some or all of your symptoms and lab abnormalities. EBV reactivation is uncommon in otherwise healthy persons, but not unheard of. (It is also possible the past diagnosis of mono was wrong, and that you now are infected with EBV for the first time. However, new EBV infections are rare beyond age 20 or so.)
You should discuss all this with your primary care physician. If s/he isn't up to speed in these areas, you should see an infectious diseases specialist, who will also be in the best position to recommend test(s) to confirm that you do not have HIV.
As for your genital warts, they of course can be treated and will clear up. They should be viewed as a minor inconvenience, not a serious health problem, and probably not evidence of immune deficiency of any kind.
Those comments answer most of your questions. To be explicit:
1) For the reasons above, almost certainly you do not have HIV. But a specialist might recommend additional testing to confirm it.
2,3) Yes, this could happen, but not with a negative HIV antibody test at 11 weeks, when the antibody tests are virtually 100% reliable.
4) Genital warts are not known to increase susceptibility to HIV. This is a little controversial, but if there is any effect, it is minor. Given the near-zero HIV transmission risk by oral sex, your warts make little or no difference.
Although I remain convinced you do not have HIV, I will be interested to hear how all this sorts out. Please return with a follow-up comment after you have spoken again with your primary care provider, or if you have an ID consultation.
Regards-- HHH, MD
First and most important, you can be confident you do not have HIV. As long as an HIV test is done sufficiently long after the last possible exposure, the results are 100% reliable -- and with very rare exceptions, 11 weeks is sufficient for the HIV antibody tests. Your negative result therefore overrules symptoms, lymphocytes, exposure history, or anything else. And in any case, oral sex carries little or no risk. However, if you want still additional reassurance about HIV, you could have another antibody test at 12+ weeks, or have a DNA/RNA test or p24 antigen test.
Second: the positive monospot test suggests you have an active infection with Epstein Barr virus (EBV), the cause of infectious mononucleosis. Over 90% of us carry EBV, whether or not we had a diagnosed case of mono when young, usually without symptoms. New infections with EBV don't happen in people who already carry the virus, as far as we know. It seems likely your latent EBV infection has reactivated, explaining some or all of your symptoms and lab abnormalities. EBV reactivation is uncommon in otherwise healthy persons, but not unheard of. (It is also possible the past diagnosis of mono was wrong, and that you now are infected with EBV for the first time. However, new EBV infections are rare beyond age 20 or so.)
You should discuss all this with your primary care physician. If s/he isn't up to speed in these areas, you should see an infectious diseases specialist, who will also be in the best position to recommend test(s) to confirm that you do not have HIV.
As for your genital warts, they of course can be treated and will clear up. They should be viewed as a minor inconvenience, not a serious health problem, and probably not evidence of immune deficiency of any kind.
Those comments answer most of your questions. To be explicit:
1) For the reasons above, almost certainly you do not have HIV. But a specialist might recommend additional testing to confirm it.
2,3) Yes, this could happen, but not with a negative HIV antibody test at 11 weeks, when the antibody tests are virtually 100% reliable.
4) Genital warts are not known to increase susceptibility to HIV. This is a little controversial, but if there is any effect, it is minor. Given the near-zero HIV transmission risk by oral sex, your warts make little or no difference.
Although I remain convinced you do not have HIV, I will be interested to hear how all this sorts out. Please return with a follow-up comment after you have spoken again with your primary care provider, or if you have an ID consultation.
Regards-- HHH, MD
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