Worried

[thomasp41]

Doctor

I have gone through a number of old and current posts trying to get information as it relates to my situation.  I felt pretty comfortable with what I was seeing until symptoms started.  Here is my situation.  I am 41 years old and bi sexual.  I am always very careful and asks people about their hiv status.  I had unprotected oral sex performed on me about 3.5 weeks ago.  This guy performed the oral for about 4 minutes until I ejaculated and then for about a minute longer.  The guy told me he was clean.  I had a rapid hiv test at 2 weeks after the encounter just for my normal annual routine test.  It was negative.  I then heard that the guy I was with was actually hiv positive.  I emailed him and after arguing a bit he admitted that he was!!  He said he felt he did not put me at any risk!  He said he was NOT on meds but his viral load was a little less than 1400.  Its now been 3.5 weeks since and I have lymph nodes swelling.  I began feeling under my arms and just yesterday found one node under my left arm and one under my right arm. They are sore and swollen no doubt.  I also think I have them behind my knees and behind my ears.  I am also starting to get a sore throat.  I am afraid this is the beginning of ARS and now feel I am infected.  I do not want to have sex with my girlfriend because I do not want to infect her.  

1) do you think I may have hiv?
2) should I be tested?
3) could this be ARS?
4) should I not have sex with my girlfiriend

Thanks so much for your help.

[H. Hunter Handsfield, M.D.]

1,3,4) Your result is conclusive, you don't need any more testing, and you can safely continue unprotected sex with your gf.

2) There is no "second window period".  You (and perhaps the articles you read) misunderstand how the duo test works.  See my December 25 follow-up comment in this thread:

http://www.medhelp.org/posts/HIV---Prevention/Are-my-test-conclusive/show/2064508

That will end this thread.  Take care.

[thomasp41]

Dr Handsfield

I received my results today on the 4th generation test with rfx and it says non-reactive which they told me means negative.  My blood was drawn on day 35 after the possible exposure. I have a few questions for you please.

1) Is this test conclusive at 35 days after the fact?
2) I have read a couple of articles that say the p24 antigen disappears after one month and that there maybe a second window period for this test after one month where the antigen is gone and the antibody's have not developed enough to be detected.  It says around 5 weeks to 7 weeks. Is this true?
3) Should I have other test done and if so which ones and when?
4) If I am conclusively negative, can I have unprotected sex with my girlfriend again?

Thanks so much

[H. Hunter Handsfield, M.D.]

Yes:  HIV tests are virtually always positive in the presence of symptoms due to HIV.  And no, I have never seen a patient like that.  It occurs rarely, if ever.

Stay mellow.  You can expect a negative test result.

Definitely no more comments unless/until you post a test result.

[thomasp41]

Dr Handsfield

I apologize for bothering you again.  I am now at 4.5 weeks since the possible exposure and am planning to go in and get tested.  They told me that I would not get the results for 3-5 days which will be the longest wait of my life.  If I did not have the swollen lymph nodes I could breathe a little easier but the fact is I do. I will not post again until my results come in but as I am waiting could you please answer 2 questions?

1) can I assume that my 26 day negative rapid test would have been positive had my swollen lymph nodes been due to hiv?

2) have you ever seen ARS with only one symptom or without the presence of fever?

Thank you

[H. Hunter Handsfield, M.D.]

This information doesn't change my opinions or advice above.  Your additional symptoms don't sound like those of ARS.  And repeatedly probing for lymph nodes definitely can cause soreness and maybe even help enlarge otherwise normal nodes.  Stop doing it.

1) COULD the symptoms be due to HIV? Sure -- see above. Is it likely?  No; see my replies above.

2) There are no medications or illnesses known to interfere with HIV testing. There are theoretical reasons why potent chemotherapy or immune suppressing drugs and very serious (mostly fatal) illnesses might do so, but even these are rare if they occur at all.  There are NO reported cases that it actually happened.  Certainly your recent bronchitis or steroid treatment 2 months ago could have no effect.

3) The rapid blood tests are just as reliable as the lab based antibody tests.  The rapid oral fluids test may take a bit longer to turn positive; it is the least reliable for early HIV testing.  When you return from your travels, have a lab based 4th generation (duo) test.

Feel free to report your test result when done.  But I won't have any more comments or advice until then.

[thomasp41]

Thank you Dr. Handsfield.  Your comments and encouragement helped me to at least sleep the last 2 nights.  Today is day 28 and unfortunatley I was called out of town for my job so now I am 1000 miles from home and will have to wait until next week to test. I did find a Lapcorp that will do the test for a charge but I am willing to pay it. So I have to wait a little longer.

I am still concerned about my symptoms.  I know anxiety can create things but I would guess lymph node swelling is not one of those.  I have nodes under my arms and behind my ears for sure and not really sure if what I feel are nodes behind my knees.  Can pressing on nodes make them sore and even possibly swell more?  I have not had a fever, sore throat, or rash as of today.  As I mentioned earlier, I am having some loose stools (not diareea) and there is a smell of a virus when I have a bowel movement.. Sorry for the graphic description. I am not sure if that is a symptom of ARS or not.  I have seasonal allergies and the part of the country I live in is experiencing high pollen but I do take Zyrtec every day so doubt that has anything to do with what I am experiencing.

I had bronchitis back in February and a bad cough that developed that I could not shake after it was over so my primary care doctor put me on a steroid pack that lasted a while and probably for 10 days into the start of this event I was still on it. I have read that things like that could slow down antibody production and if so, my 26 day rapid test may not be as accurate. Correct?

So, in summary
1) could the symptoms I am having be ARS related?
2) could the steriods I took slow down antibody production?
3) is a rapid blood test as accurate as a standard test?

Thanks so much

[H. Hunter Handsfield, M.D.]

You're overreacting.  Settle down, re-read my comments carefully, and think objectively.

Based on the analysis above, I would put the chance you have HIV at under 1 in a million.  And I absolutely agree it was not medically necessary for you to be tested; I suggested it purely for reassurance purposes, which is clear in my comments above.  Further your current negative rapid test at 26 days is at least 90% reliable, dropping the chance you have HIV to 1 in 10 million.  You are not going to need tell anyone you have HIV.  You do not.

I'm sure you can find a duo test without waiting 2 weeks for a result.  If nothing else, find your local Quest or Labcorp outlet and get tested there; you'll have the result in a day or two.  (It may cost you quite a bit, whereas it will be low cost and perhaps free at the health department.  Make your choice.)

[thomasp41]

Thank you, I was not expecting such a quick response.  After sending my message, I went to the local HIV clinic where I get my annual test.  The counselor said they do not do the HIV Duo test but he thinks our county health department does something called the 4th generation test which takes 2 weeks go get results back. Not sure I can hold out that long!  Anyway, he wanted to do a rapid test Oraquick today which came back negative. However, it has only been 26 days since my possible exposure so not sure if that tells me anything.

I was alarmed at your comments on my symptons being posslibly ARS.  The nodes under are arms are small but they are there.  My throat was scratchy this morning but actually feels better as the day as gone.  Also I have what I would describe as a "virusy" smell when I have a bowel movement so not sure if that is a symptom or not.  I have not had a fever to date.

I have read a number of posts on this site and a couple are very similiar to my situation.  In one of those, the doctor even said it was not medically necessary to get a test.  I was surprised by that but maybe because of my symptoms you are recommending I get more test.  

I cant begin to describe how scared I am and how I am going to tell my family and friends I have this virus.  I guess I will have to deal with that when the time comes.  

Any additional advice or information you can provide me while I wait would be appreciated.  I will go Thursday (the 4 week mark) to get the test at my health department.  

Praying that I am OK.

Thanks again

[H. Hunter Handsfield, M.D.]

Welcome to the forum. Thanks for your question, which arrived while I was logged in myself. Most users shouldn't expect immediate replies!

You are at little or no risk of HIV. Nevertheless, your partner behaved extraordinarily badly and I hope you'll tell him I said so. He is correct that the risk of transmission by oral sex is minimal if any at all, and that with a very low viral load of only 1400, he probably is minimally infectious.  (Even with unprotected vaginal or anal sex, transmission is uncommon without viral loads of 50,000 or higher. I'm not sure I've got the number right, but you get the idea.) Still, it is highly unethical to not tell partners about having HIV before having sex with them, even safe sex. Protecting partners from fear and anxiety, as you are experiencing yourself, is sufficient reason.

Still, your risk was extremely low.  There are few if any proved cases of HIV tranmission from an oral to penile partner, and only a small handful in the opposite direction.  While your symptoms are consisent with ARS, they started late (usually 10-14 days), fever is usually prominent, and lymph node inflammation is generally more widespread.  And self-assessment of inflamed lymph nodes is highly unreliable, especially by non medical professionals.  And even with the most "classical" cases of ARS symptoms, the large majority have causes other than HIV.

However, given your symptoms and timing, for reassurance I recommend you not resolve this by further testing on your own.  See a doctor or clinic with experience in HIV prevention and treatment for in-person assessment and testing advice.  I imagine that advice will include a duo test (for both HIV antibody and p24 antigen), or antibody plus NAAT to look for viral dna or RNA.  Either of these test combinations is definitive by 4 weeks after the last possible exposure.

To your specific questions:

1,3) It is extremely unlikely you have acquired HIV or that your symptoms are due to ARS.

2) You should indeed be tested, but mostly for the reassurance you will gain from negative results, not because your risk is high.

4) You should probably hold off on sex with your partner until this is sorted out. Not because there is a high chance you are infected or will infect her, but because your uncertainty and fear about it probably would be overwhelming until testing proves you aren't infected.

I'll be interested to hear the outcome after you have been professionally evaluated and tested.  In the meantime, try to stay relaxed.  Not only are the odds strongly in your favor for the reasons above, but in the the 10 years (almost to the day!) since this forum was initiated, there has not been a documented case of HIV in a forum user.  You aren't likely to be the first!

I hope these comments have been helpful.  Best wishes--  HHH, MD