HIV Group P

Dear Doctor H

In April 2010 I had unprotected sex with a female sex worker. She was French and a visitor to Australia. It was a high risk exposure.  72 hours after I became sick. At three weeks I became very ill. I had most of the symptoms of acute HIV seroconversion (headache, malaise, lymphadenopathy, fever, aseptic meningitis, sinusitus, splenomegaly, nausea. green stools/diarrhoea and a rash).. The illness eased after seven days, but fultuated in intensity until mid-July 2010.
Since August 2010, I have developed symptoms of 2nd phase HIV (oral ulceration, sinusitus, papular pruritic eruptions, excessive sweating, weight loss, tender lymph nodes, excessive fatigue, seborrhoeic dermatitis, recurrent diarrhoea, skin disorders and muscle pain in shoulders and lower back).  

I have had HIV testing (at 2, 7, 12, 24 and 52 weeks) through 4th gen ELISA Ag/Ab and one HIV1 Proviral DNA PCR (Roche HIV Amplicor). I have also had a CD4 count taken at 52 weeks- 49%, 1440 u/L. All of these tests have not indicated a positive result for HIV1/2.

I am concerned about possible exposure to the rare HIV Group P.  I had sexual contact with a sex worker who has had exposure to immigrants from France's West African colonies. I understand only 2 confirmed cases of HIV group P have been identified in Mar 09 (Paris) and Nov 10 (Cameroon).

I would very much appreciate if you could answer the following:

Is HIV group P detectable through conventional HIV ELISA Ag/Ab testing?  There appears some conjecture about this.  
If HIV goup P is not detectable through ELISA, what is the testing regime used to identify known cases?
How infectous is this strain of HIV?  What is known about its course of development and treatment?

I realise that my hypothesise offers little medical basis, but am unable to explain why I am frequently sick.
I hope you may offer some direction on where to seek effective assistance. I would be very grateful of any advice you could render.  

regards C

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

From your own research, you apparently know more about HIV group P than I do.  However, for all other such rare groups, the occasional case in an industrialized country does not indicate the strain is common in that country.  I would guess the case identified in Paris was not in a Frenchman, but more likely in an immigrant from an endemic area in Africa, or perhaps in that person's sex partner.  To my knowledge, sustained transmission of such strains has not been documented outside the areas where they evolved, i.e. typically in parts of tropical Africa.

Test results for HIV always are more reliable in judging whether someone is infected than are exposure history or symptoms -- more about which below.  But even without the test results, I don't see a big worry about HIV.  Regardless of her French origin and being a CSW, it is exceedingly unlikely your partner had such a rare HIV type (indeed, statistically unlikely she had HIV at all).  Your initial illness could not have been HIV, the symptoms of which cannot start sooner than ~10 days after exposure.  Onset at 3 days makes HIV impossible.  And although the symptoms described are consistent with some of those associate with acute HIV, they are also consistent with any number of other infections.  Your "second phase" symptoms, however, are not particularly suggestive of HIV.

Finally, your test results show you aren't infected with group P or any other type of HIV.  Although in theory the antibody tests may miss some some HIV-1 subgroups (I don't know specifically about P), it's actually quite uncommon, i.e. the standard test likely would have been positive even with a subgroup P infection.  And equally important, the DNA/RNA tests definitely detect every HIV-1 type.  HIV-2 is a different story; the HIV-1 DNA/RNA tests will miss it.  However, the antibody tests in current use definitely detect HIV-2 antibody.

For all those reasons, I agree that your own objective analysis, that your "hypothesis offers little medical basis".  I also cannot explain your ongoing symptoms, but that doesn't mean HIV is responsible.  My advice is that you seek out a specialist's advice.  If you're still in Australia, take advantage of one of that country's excellent sexual health centres; in my opinion the Australia SHCs, collectively, are the world's best network of STD/HIV clinics and prevention services.  There also are excellent private sector infectious disease and HIV/AIDS specialists.  Undoubtedly one of them could sort this out for you.  In the meantime, I recommend you stop testing for HIV.

I hope this helps.  Good luck--  HHH, MD