Situation assessment please

[Philips343]

In March I had vaginal intercourse with a girl I later learned was high risk my condom broke and I was exposed for I think somewhere around 2 minutes. I had almost all symptoms related to ARS, began 1 week post incident and started to disappear at around 8 weeks. At 17.5 weeks, still have a white tongue (culture swab stated it was a heavy growth of bacteria no yeast cells), still have 2 lymph nodes in my neck (1 the size of a marble, second a pebble), still have folliculitis. I had the following tests: Elisa and rapid tests at 2, 3, 6, 8, 9, 13 weeks all negative.
-17.5 weeks ICMA AB 1/o/2 with a Western Blot = negative
-17.5 weeks RNA PCR for HIV 1 = not detected (under 48 copies)
-17.5 weeks CD4 count = 718

1) Is folliculitis a symptom of ARS or early HIV infection (4 months)? Some medical/dermatology sites state it is.

2) Is the size of my 2 lymph nodes concerning at all? Should you be able to feel lymph nodes even if there is nothing wrong with you? With ARS, are concerning lymph nodes based on the size they swell to and/or the number of lymph nodes that become noticeable?

3) How conclusive (in percentage) are all my test results? Are they conclusive even with my ongoing symptoms?
4) If I had any of the autoimmune system problems that would delay seroconversion, would my CD4 count test come back abnormal?
5) If I contracted a sub group or subtype of HIV that any of my tests were not designed to detect, would all my results still come back negative? Would any of my tests have detected that there is something wrong or would they all just give out a clean negative?
6) I spoke with an HIV specialist/Doctor from UCSD Owen clinic, she told me she once had a case where an individual progressed to AIDS in 5 years post infection, and between infection and AIDS repeatedly tested negative on blood tests. Have you ever heard/seen cases like this? How plausible is this case? How could they determine the person had AIDS if he never tested positive for HIV?

[Edward W Hook, MD]

Our statements that a single expsoure is relatively low risk refelects statistics, nothing more.  Most people do not win the lottery when they play it onece ( or many times)  either.  That is not to say there is no risk but that the risk is low.  Thus your scenario b is the more appropriate of the two. Stay safe.  This will end this thread.  EWH

[Philips343]

Hello Dr. Hook,

I hope it's ok, I just had a general question in regards to HIV;

I've read on this forum several times where Dr. HHH, and I believe yourself state that people don't get infected with HIV through sexual intercourse with one time exposures, that infections usually occure after repeated exposures.

Is this due to a) that multiple exposures, in a sense, weaken or make a person's body more susceptible to the virus to the point that after several exposures the virus can finally invade (I also read on a different but related website that most people's immune system can actually fight off and kill HIV to a certain extent, is this true?),

or b) that the HIV virus is relatively rare and/or in majority isolated to certain populations, and repeated exposures is indicative of a specific person's lifestyle where each act of risky behaviour only increases this person's chances of encountering the virus untill they finally one day do?

Thank you Dr.

[Philips343]

Thank you Dr. Hook,

All the best to you.

[Edward W Hook, MD]

I see no need to repeat what I have said.  I answered this question several times in my initial response and the facts have not changed.  eWH

[Philips343]

Great, thank you very much Dr. Hook!

I'm beginning to realize just how much conflicting/contradictory information there is on the internet about HIV, you've helped me sort alot of it out.

So I can definitely be at peace knowing that I am 100% HIV negative, no doubts or questions about it?

[Edward W Hook, MD]

1.  Not sure what symptoms you are referring to.  Acid reflux can certainly caused a lot of seemingly unrelated symptoms.

2.  Correct.   "Delayed seroconversion" is, for all practical purposes, an urban myth.

3.  You understand  it more or less correctly.  Remember that different strains of HIV differ from each other, at most by about 1% of their genetic make up and therefore even when different strains are present, many of the targets tested for using antibody tests are still present, therefore these so-call "different strains" are still detectable.  EWH

[Philips343]

Hello Dr. Hook,

Thank you very much for your prompt and reassuring response, it definitely helped.

My lymph nodes were actually confirmed by my doctor, after I noticed them. I've also done several general blood tests to look for other causes of my symptoms, every single blood test, x-ray, and ultra sound has come back normal!

1) Can a bad case of acid reflux cause similar symptoms?2

2) So it's not actually immune suppressing illnesses that delay sero-conversion, but rather medications for illnesses that cause immune suppression? so if an individual has never taken serious meds for a serious illness, delayed sero-concersion is not possible?

3) Just curious if I understand this information correctly after reading various posts on this site: There are 2 HIV strains (1 and 2) under them are 4 subgroups, and under HIV 1 s/g M are numerous subtypes. The DNA for all the sub groups and types differ therefore if a test was used to detect the virus itself (eg: PCR, antigent) it would only detect the virus if it were a test specific to that sub group/type. However, regardless of the virus specific DNA, the immune system develops 1 type of HIV antibodies for strain 1 and 1 type for strain 2, therefore if a person was infected with any sub group or type under strain 1, an antibody test will always detect the HIV virus antibodies (as long as the test is done beyond 8 weeks), do I understand it correctly?

Thank you again Dr. Hook for your time and help!!

[Edward W Hook, MD]

Welcome to the HIV Prevention Forum. I'm not sure what you mean by "high risk" but in my experience most so called "high risk" personas are really not all that high risk.  Irrespective of risk however, the lab data you provide conclusively show that you do not have HIV acquired from this encounter.  Any negative antibody test taken more than 8 weeks is conclusive and your HIVC PCR results just confirm this fact.  Other tests such as a CD4 test are non-specific and a waste of time to have gotten (yours however is normal).  Your symptoms and experience with ARS-like symptoms provide, once again, proof that even when people have symptoms of ARS, they are not due to HIV.  As for your own symptoms, they started sooner than is typical for ARS and lasted far too long to be due to ARS.  With this as background let's deal with your specific questions:

1.  There is a specific form of folliculitis which is sometimes seen in early HIV.  You however don't have HIV so if you have folliculitis, it is unrelated.

2.  Lymph nodes are also non-specific findings.  I’m surprised you feel you can detect the smaller lymph node you describe.  Detection of swollen glands is a medical "art form".  Clinicians train hard to detect subtle abnormalities and to try to detect them in yourself is fraught with error, both because you might miss them and, if they are present, interpretation of why they are present is difficult.  This is because "glands" are lymph nodes which can swell due to any of a large number of infections both viral and bacterial, as well as due to allergic reactions, due to autoimmune disorders and other problems.  For this reason we encourage clients who are concerned about swollen glands to check with their own health care providers rather than try to diagnose themselves and, if swollen lymph nodes are present, not to worry about them in relationship to HIV because they are such a non-specific problem.  When a person has swollen lymph nodes, the chance that they are due to HIV can be measured as a fraction of 1% except in your case where, since you do not have HIV, you can be sure that the swellings you have detected are not HIV.

3.  Totally conclusive.  Your symptoms are due to something else.

4.  Auto-immune problems do not delay seroconversion.  Unless you have taken immune suppressive medications or anti-HIV medication, your antibody tests are conclusive.  Further you have negative PCR tests which would be positive even if your immune response was suppressed.

5.  A rare subtype would have still been detected.  You do not have HIV.

6.  I cannot comment on the experience you speak of however such an occurrence would have been incredibly rare. further, I suspect the negative tests she referred to were antibody tests. Your PCR test negates that concern as well.

Hope these responses are helpful to you.  Your testing history indicates that you are concerned about having HIV from the experience you describe.  There is no evidence from anything you mention to serve as a reason for worry.  I hope my comments will help you to move forward.  EWH