Undetectable worries

[hopetogodiamok]

Dear doctor

I have read (and was assured before) that someone who had been tested for HIV by PCR and the virus was undetectable was confirmed negative.  However, I have come across a contradictory post that highlighted the case of a HIV + person who had an undetectable load despite not being on treatment.  If someone is symptomatic is it more likely (or highly likely) that the virus will be detected via pcr?

My situation is unusual - my HIV specialist is monitoring me over 2 years with 3 monthly pcr and cd4 tests given I had a high risk situation in a region where there is a risk of contracting type O.  It is 9 months since my exposure and my main continuing symptoms are follicular rashes and excessive saliva, both of which of doctor confirms are indicative of early infection.  My acute infection was seen by 3 doctors who all expected the tests to turn postitive but to date they have not.  My PCR and ELISA tests have been negative at 3,6 and 9 months.  

[Edward W Hook, MD]

It is not more cautious.  It is an effort to not directly contradict the other doctor yo ahve seen.  You have nothing to worry about.  EWH

[hopetogodiamok]

Doctor

I just came across a previous post of someone asking about genetic variants in which you state that the worst-case scenario would be that an indeterminant result would flag any issues and therefore negative is always a definitive result.  In my case, your advice is much more cautious - could you please clarify why?

Thanks

[Edward W Hook, MD]

I don't think his opinion is different than mine.  You do need to include whomever your health care provider is in your decisions however.  Take care.  EWH

[hopetogodiamok]

Doctor

I saw another (more senior specialist) yesterday who gave a different opinion which was:

1. I can't possibly have HIV as I all retroviruses are essentially derivatives so at least 1 of the 12 tests I had would have detected it

2. He confirmed there is nothing wrong with my mouth and what looks like a coating is neither oral candida or OHL

3. He said I do have a skin problem but it's got nothing to do with HIV and referred me to a dermatologist

4. He said my CD4 count is normal (although seemed low to me) and pointed out that stress can be the cause of low lymphocytes

In essence he told me to get on with my life, put in behind me (and that i had been given bad advice).  Therefore, there wont be any positive results here - I have learned my lesson and am MOVING ON.

Thank you for your help

[Edward W Hook, MD]

I would.  At the same time, I would also pass it by your HIV specialist doctor.  Your patient/physician relationship is with him/her.  EWH

[hopetogodiamok]

Would you consider me safe to now have unprotected sex with a new girlfriend?  I just want to put this behind me.  She has had 2 Duos and 1 Western Blot and 1 rapid test - all negative.

[Edward W Hook, MD]

Symptoms have little relationship to PCR results other than in the ARS when PCR results are virtually always positive..  I am not aware of any suggestions that excessive salivation is a manifestation of HIV. On the other hand, there can be a rash with the ARS.   When it occurs it is not follicular.  EWH

[hopetogodiamok]

Thank you and I will update you on my results.  Could you just pls confirm if the PCR is more likely to be positive when you have symptoms and also whether you would recognise follicular rashes and excessive saliva as being typical of an early infection?

[Edward W Hook, MD]

You are in a most unusual situation.  If you had HIV, I, like your doctor, am confident that your HIV test would have turned positive by now.  My guess is that the ARS-like problem you had was some other type of virus.  Your doctor is being quite cautious and conservative which, given your circumstances is appropriate however with the test results you now have, that chances that you have HIV form the exposure you mention are getting lower and lower and are now close to zero.  If you have a positive test, please let us know.  My guess is that this will not be the case.  EWH