Need your help

Hello doctor, I am a 25 year old male who made a terrible mistake. I had unprotected vaginal sex with a prostitute. In the past 3 months i have had all the symptoms related to hiv. I had sore throat, an apisode of fever (3 days), my transaminase were elevated, i had a little coat of white in my tongue. I had a hiv duo test done at 8 weeks post exposure and it was negative. I had an antibody test 12 weeks post exposure and once again it was negative. My real concern is that after reading questions in the forum i found out that a weak imune system can delay seroconversion. I have read a lot and found out i have many symptoms of a weak immune system. I get really frecuent episodes of colds and sore throat, and i do suffer from respiratory and eye allergies. Do you think i am a case of delayed seroconversion because of this. Or can i believe my tests and be 100% sure that i did not contract hiv? I would really apreciate your quick response since i am very stressed out. How badly affected would the imune system have to be in oreder for it to delay seroconversion?

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Bottom line:  You had accurate replies on the community forum, and for sure you do not have HIV.

Here are our routine responses to essentially identical questions, all of which are directly applicable to your case:

Most sex workers don't have HIV.  If she did, the average risk of transmission for a single epsiode of unprotected vaginal sex, female to male, has bee estimated at 1 chance in 2,000. Your symptoms don't sound like those of HIV, which does not result in increased frequency of colds or allergy symptoms.

Most important, the tests never lie, especially with the multiple kinds of test you had.  HIV test results always outweigh symptoms or exposure history in judging whether or not someone is infected.  With the standard HIV antibody tests now in routine use, there is no such thing (any more) as seroconversion delayed beyond 3 months.  There is no such thing as a "weak immune system" that prevents development of HIV antibody.  And even if antibody seroconversion were a problem, you have also been tested for HIV itself, i.e. p24 antigen (part of the duo test) and HIV DNA by PCR (according to you comment on the community forum, which for some reason you decided not to mention here).

In other words, your test results prove you do not have HIV.  That conclusion would be the same if you had experienced the highest imaginable risk of HIV acquisition or classical HIV symptoms -- and you have neither of those.

You don't have HIV and should stop worrying about it. All is well.

Regards--  HHH, MD

[helpasp]

Thank you doctor for your words yo do a great job helping out people. Your words really helped me with my anxiety. I only have one last question so that i can move on. The RNA PCR test was done about two weeks after my exposure since i went to the emerhency room and thoguth to have acute hiv symptoms. If the symptoms i was experiencig were really hiv would the PCR test have to be positive? Does this types of test give frecuent false negatives? So even if i have signs of a weak imune system it wouldnt be a reason for delaying seroconversion and a 3 month test post exposure be 100% conclusive? Finally i want to know how long does it take for antibodys to be positive after a person is experiencing acute hiv symptoms? I promise these are my last questions before i leave this whole issue behind me. Once again let me tell you, you do a great job helping out people, and thank you in advanced for your answers.

[H. Hunter Handsfield, M.D.]

You're re-asking the same questions, with a "yes but" and "did you really mean?" spin.  The answers are obvious from my reply above and I haven't changed my mind.

The PCR test is always positive in presence of true HIV symptoms and always positive 2 weeks after catching the virus.  Your symptoms do not suggest a "weak" immune system.  Just the opposite:  the symtpoms of colds and and allergy are caused by the body's immune reaction to the cold virus or allergen -- such symptoms indicate a strong immune response, not a weak one!

When someone has acute HIV symptoms, the antibody test always becomes positive within 2 weeks or so.

Those indeed are your last questions; I won't have any further replies.  Accept the reassurance and move on.

[helpasp]

Thank you very much doctor!!! you do a great job!!!

[helpasp]

Doctor i was wondering if you could help me clear out this doubt. I know that after aproximatly after 2 - 3 weeks of contracting the virua, the p24 antigen becomes detectable. Until when is this antigen detectable? Is it true that once the body produces antibodies, the antigen disapears. My question then is if there is a period of time when the p24 antigen becomes undetectable and there the body hasnt formed antibodys so the duo test might be a false negative? Or one of them has to be positive since the antigen becomes undetectable once antibodies have been formes? Please help me clear out this doubt since i searched it in the forum and it hasnt really been answere and i know it will be of great help for many people to understand how th duo test works. I will very thankfull to you if you can help me this last time by clarifying this.

[H. Hunter Handsfield, M.D.]

OK, I agree these are legitimate questions.  However, these comments definitely are the last for this thread.

p24 antigen usually appears in the blood (in measurable quantities) 1-2 weeks after catching HIV, rarely up to 3-4 weeks.  As antibody is produced, it attacks p24 and removes it from the blood; as antibody levels rise, p24 levels decline.  After a while -- usually 2-4 weeks, maybe up to 6-8 weeks after exposure -- detectable p24 disappears from the blood.

By 4 weeks the blood of everybody with a new HIV infection has measurable p24, antibody, or both; here are virtually no exceptions:  either p24 or antibody will be detected.  Some people may have both antibody and p24 antigen for several weeks, but eventually p24 disappears altogether.  But for diagnostic purposes this doesn't matter:  a negative combination test at 4 weeks or greater shows the person isn't infected.

Yesterday I posted a follow-up comment an another thread that goes into more detail about why some authorities continue to advise up to 3 months for definitive testing, despite newer tests that shorten the window period as well as evidence that even antibody-only tests are nearly 100% reliable by 6-8 weeks.  I hope everybody reads it:  http://www.medhelp.org/posts/HIV-Prevention/-A-Question-on-Testing/show/1347755