HIV infection ?

I am a 22 year old gay male. Let me start by describing my situation which I believe is very high risk. I had about 8 sexual encounters with someone I now know to be HIV+ between March 07 and May 28, 2007. I preformed oral and receptive anal with out a condom, however, he never ejactulated inside of me. During June I was out of state. On June 16 I woke up with an enlarged lymph node in my neck and feeling like hell. I also had diahrea, upset stomach, and felt generally tired. I think stress/depression had a lot to do with it because I felt that for sure I had contracted HIV. These symptoms only lasted about 1-2 weeks. When I got back from being out of state in the beginning of July I felt fine, except that I was a little tired for the first week.I have been tested since then with the oral rapidquick antibody tests. I was tested one day after last exposure, and then at 3 wks, 4 wks, 6 wks, and 9 wks. All negative. I am waiting now  to take a 12 wk test next week. What drove me to finally post a question on here was this week (about 11 weeks after last exposure and about 9 weeks since symptoms began) I experienced a hot flash where I felt extremely sick (temp didnt pass 99 however) and then woke up with a large swollen gland about the size of a breakfast sausage on the inside if my thigh right next to my scrotum. I have also had swollen nodes on my neck and right under my left ear that are about the size of a pea and are sore and palpatate at times. I am not sure if I have any swollen glands in my underarm, but on the lateral side of my left breast I can feel something that feels like a large bubble. So my questions to you are:
1) If I began having symptoms at 3 weeks post exposure would my 3,4,6, or 9 week antibody test be too soon? Should I get a test other than antibody? What can I consider conclusive?
2) I have read about people would experience an "immune response" after being exposed to HIV but never test positive. Is this possible or true at all?

[H. Hunter Handsfield, M.D.]

You let yourself be topped by a known HIV positive man???  What were you thinking???  Even if you didn't think he was positive at the time, it is almost as risky to have such exposures to men whose HIV status is unknown.  Also, although some gay men believe anal sex without ejaculation reduces the risk of transmission, there is not a smidgen of data to suggest it and no responsible authority recommends the practice.  And how trustworthy is someone's stated intent to withdraw in time?  Sheesh.

OK, that's off my chest.  It appears you lucked out.  Although some of your symptoms indeed were consistent with ARS (although not entirely typical), the negative test results at 6 and 9 weeks are highly reassuring; most likely you were not infected.  To your direct questions:

1) The timing of symptoms is irrelevant; the only timing of importance is the interval from exposure to testing.  Although many people and website quote seroconversion rates at various intervals like 3, 4, 6, or 9 weeks, no precise data are available for any these intervals--only approximate estimates.  But most experts agree that with modern HIV tests, probably around 95% of newly infected people have positive results by 6 weeks and probably 98-99% by 9 weeks.  Given the nature of the exposure, you should go ahead with plans for a final test at 3 months to be absolutely certain, but you can expect another negative result.

2) The second question is beyond my expertise, the domain of laboratory researchers, not clinicians and prevention experts.  My understanding is that some research indicates that some persons might develop partial resistance to HIV due to exposures that don't result in overt infection or in positive standard tests.  But to my knowledge, this remains an area of uncertainty and controversy.  Certainly nobody should assume they are somehow immune or resistant to HIV just because they have been exposed and never got infected.

Keep those condoms handy and always know your partners' HIV status (and share your own), even when safer sex is planned.   And drop this withdrawal business, whether bottom or top.

Good luck--  HHH, MD

[mccodell]

Thanks Dr. for your comments. I did not know he was HIV+ at the time obviously. I began seeing him after internet chats and he told me he was HIV-. I only found out from a friend of his after the fact and thats when I began totally freaking out. The 2000 character limit for the  question sucks because I had to leave all this out and more...These past 11 weeks have been absolute hell for me. I have  never felt more stupid, gross, anxious, DEPRESSED, or scared in my entire life. There have been lots of nights I have cried  myself to sleep because I have been so obsessed with my HIV status and I NEED some kind of closure. This has been one of the defining moments of my life thus far. I dont think I will ever be the same person I was before and I know for sure that I lost a big chunk of my innocence that night.
  Also,  you didn't address the part of the first question asking if you think I should get another test besides an antibody test. Maybe one that looks for the mRNA or actual virus itself?

[H. Hunter Handsfield, M.D.]

At this point, there is no need for anything other than a final antibody test at 3 months.  The virus detection tests (DNA, RNA, P24 antigen) can pick up infection before antibody develops and therefore are useful up to around 4-6 weeks.  After that, there is no advantange to adding them to the test battery.

[mccodell]

Thanks again Doc and esp for the fast reply. Now that I have heard what you have to say all I can ask myself is whats the deal with all these symptoms I have been having? The swollen nodes in my neck and under my left ear are extremly perplexing as well as the bouts of feeling "not right" or "generally sick" (I dont know how to describe them as they come  and go but when I do have them I feel drained and kind of dazed). I wonder how much anxiety/stress comes into play in this equation. I am and always have been a very anxious person and this pretty muched pushed me off the deep end.
Also, something else I couldnt mention in the  first question because  of the character restriction was that around 7 wks post exposure I went to the doctor who tested me for mono (neg result) and put me on antiboitics. She also did blood work and said that my white blood cell count was "left shifted" meaning still in the  normal range but on the low side of normal and that that probably meant it was something "viral". Needless to say I was terrified.
I just wanted your thoughts on some of these other facts. Thanks for the help.

[mccodell]

One more thing. When you said this "My understanding is that some research indicates that some persons might develop partial resistance to HIV due to exposures that don't result in overt infection or in positive standard tests," it really confused me. You are saying that there might be some people who are infected with HIV but do not become HIV+? How is that possible? Would it mean your immune system fought it off somehow or maybe the docking protein on your CD4 cells or macrophages were mutated in a way such that it prevented the virus from entering those crucial cells? But most importantly, could these people still show ARS symptoms during the course of the exposure or would  it be asymptomatic? These questions might be more appropraite for a lab researcher but it would be interesting to hear what you have to say.

[H. Hunter Handsfield, M.D.]

I don't have a clue "what is the deal with these symptoms".  Only that they aren't due to HIV.  Whenever a person suggests his or her own symptoms might be related to anxiety, s/he is almost always right.

What is confusing?  My statement very clearly refers to "exposures that don't result in overt infection".  That is, such peole are not infected with HIV.  I made it clear don't know whether this happens or not, and cannot comment on the possible biological mechanisms.

Your anxiety is making you over-analyze everything and your comments are splitting hairs.  Presumably you came to the forum for reassurance that you don't have HIV. I gave it.  Stop trying to talk me (and yourself) into believing you are infected.