Generalized lymphadenopathy questions!

[WorriedVeryVery]

I have exposure 10 weeks ago via receptive unprotected oral sex with highly suspected HIV positive sex worker(from developing country and did not want to use condom,in the end, oral sex). I was on alcohol influence and had ejaculation in my mouth.2 weeks after the exposure. I develop first time in my life the worst Pharyngitis. I lost my voice, difficulty and PAIN in swallowing and when i sleep, i had to constantly clear my throat in order to ease the pain and feel better.(anyone know of this sore throat?). Followed by very dry cough 2 days after the sore throat. Slight fever and malaise feeling after 5 days. All these clear within 14 days. i.e acute retroviral syndrome?During the 5th weeks(35days), i realized i have generalized lymphadenopathy. 4 spot on my neck with 2 in posterior cervical lymph and 2 in submanicular lymph. One on the elbow and 2 on the armpit. During that time, i had 2 purplish dark red spot on leg and localized rash on trunk.I had the OraSure equivalent HIV 1/2 antibody test on the 6th and 10th week and was negative.
Question,
1)if the above i mentioned is ARS at 2nd week(sore throat and dry cough) and primary HIV infection symptoms at 5th week onwards(generalized lymphadenopathy, localized rash on trunk and 2 purplish dark red spot), would i have seroconverted? I.e Hiv positive with all the HIV early symptomatic signs. Would i be tested positive(if i am) by the 6th week or 10th week?
2) If i have generalized lymphadenopathy(let say), does it make me harder to seroconvert(that is, IF i am due to be positive) or it doesnt make a difference
3) Does anyone actually seroconvert at 11-12 or 13 weeks onward? I heard some people seroconvert late is due to compromised immune system. I have genetic eczema, does that mean i have compromised immune system?
4) Does stress equivalent to compromised immune system,i.e affecting hiv testing result?
5) Do i have to wait for the 12/13 week to have a conclusive verdict?

[Edward W Hook, MD]

Welcome to the Forum.  I am sorry to hear of your illness and concerns and hope that it makes you feel better for me to tell you that there is virtually zero chance that you have HIV.   Many experts doubt that HIV can even be acquired by oral sex and if it occurs at all, it is very, very rare.  In your case, your negative tests prove that you did not get HIV from the exposure you describe.  A negative HIV test at 10 weeks is proof that you did not get HIV and that the symptoms you describe were not due to HIV.  If they had been HIV, your OraSure test would be positive.  In answer to your questions:

1.  HIV tests become positive soon after the ARS so if your symptoms had been due to the ARS, your OraSure would have been expected to be positive when it was performed.
2.  No, persons with lymphadenopathy due to HIV typically have positive tests.  If you have swollen lymph nodes, 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%.  If you still have swollen lymph nodes you should discuss it with your doctor.
3.  Persons who seroconvert beyond 11-12 weeks have typically taken anti-retroviral therapy.  For others, this is not a concern for persons with eczema.
4.  NO!
5.  No, you do not have HIV.  You 10 week test shows this.  EWH

[WorriedVeryVery]

Thank you Doc for your advice. It is good to hear from you. I would need further clarification to ease my doubts,after which to confirm and move on if possible.

1)Pertaining to answer # 5, if you mentioned so, why did CDC recommend 3-6 months of window period for HIV antibodies test. (i am referring to those prelimnary walk-in 20mins hiv anti-body testing) Not any other form of laboratory testing, western blot,etc.

2)What is your view/take on CDC statement that HIV antibodies will generate differently in different immune system DEPENDING on HOST and the VIRAL Characteristics. What does CDC statement mean on this?(for my knowledge please).

3)Do you think because of CDC statement(Question #2) that i may be hiv positive in 12/13 weeks and suggest me to go for another testing at 12/13 or you still think i am hiv negative (tested at 10 weeks(once again, HIV 1/2 antibodies test, no labortory test) is conclusive). If you suggest me to go for another testing at 12/13 weeks, or even further lab test, i will gladly go do so. If not, i will not and move on with my life.

If there are any sisters and brothers who are hiv positive, feel free to comment. Thank you!

[Edward W Hook, MD]

My role here is not to engage in a debate or to try to explain why the CDC is so conservative in its advicer.  I will provide very brief answers but will go no further

1,  The CDC is overly conservative.  They feel the cannot "afford" to be wrong.
2.  Sorry, you need to ask the CDC this. Again, I think it is a defensive posture.
3. I do not think you need further testing.

EWH

[WorriedVeryVery]

Thank you Doc for replying. Yes you are right. This is a debatable question and it is my bad for asking in such a way.

I do have further question and hope you can help to answer. Thank you.

1)I read that after ars(if mine was, at the 2nd week), body will start to generate antibodies after 1-2 week,(recover from ars by then) which take it to the 3rd/4th week. Will there be any seroconversion illness at the 3rd/4th weeks? i.e antibodies generating?Or is ARS equivalent to seroconversion illness and typical takes 3-4 weeks as a whole?i.e feeling sickly twice with different symptoms over a period of 4 weeks? Please define difference between ARS and seroconversion.

2)U mentioned Orasure at 10th week is conclusive. I wont be asking on the 3-6 month window period as defined by CDC. Instead, i will be asking does the 10th week(exactly 10th week) is conclusive even on 2nd generation HIV antibodies test kit?i.e less sensitive test?i.e normal person will have enough antibody to be detectable on 2nd generation test kit at 10th week. Detectable is the word i am asking.

3)When you mentioned 10th week conclusive result, do you mean by doing a more detectable antibodies lab test like hiv duo(measuring antibodies and antigen) P24, western blotetc? Or just a HIV1/2 antibodies test like orasure will be conclusive?i am afraid when you mentioned a normal person will generate detectable antibodies at 10th week, you are referring to lab test like p24 antigen which are more sensitive. And i am afraid the 2nd generation Orasure test kit give me false negative at 10th week.

I appreciate your endless help and your professionalism in this forum. Thank you!

[Edward W Hook, MD]

I gave you my opinion and you seem to doubt it. The is your privilege.  It does not change my assessment however which was based on the information you gave me, including the test type you had.

In answer to your questions:
1.  The ARS is a seroconversion reaction which occurs as antibodies are being formed and antibody levels rise in the blood. Typically a week or less after the start of the ARS blood tests are positive.  People do not have ARS/seroconversion reactions twice.

2.  What a silly question.  Do you think I did not read that you were tested with an Orasure test?  My answer stands.

3.  Another silly, paranoid question. No change in my answer.  You can believe it or not but asking the same question again and again will not change my answer.  EWH

[WorriedVeryVery]

Hello Doc,

Thanks for replying. I am having periodic swelling of lymph nodes and tonsilitis at 11 week mark, after my HIV test negative at 10 weeks. Is this a sign of seroconversion illness? If it is, should i continue to monitor and test for hiv at 12/14 week mark as by then,antibodies will have been form? Am i right to think that way? Please tell me i am wrong. I have severe sore throat at the 2-3rd week mark.

Thank you Doc once again!

[WorriedVeryVery]

Sorry, just to add, it is GENERALIZED periodic swelling of lymph nodes and tonsilitis at 11th week mark, after my HIV test negative at 11 weeks.

[noster]

Believe your test and believe to Dr. Edward Hook, he is one of the best doctor in US.

[Edward W Hook, MD]

This will be the last answer.  You do not have HIV and the lymph nodes swelling of which you are concerned is due to something other than HIV.  What that might be, I do not know. This is something for you and your own doctor to sort out and not something that I can help with over the internet.

There will be no further answers.   EWH