Persisting lymph nodes 10 months after exposure, seronegative

Dear HHH, I had an exposure in Thailand 11 months ago. Some days
after, I had a fever that lasted one night, nightsweats. Then I got diarrhea that lasted days. I kept being tired and
8 weeks after exposure I fell sick. Started to feel extremely tired, some of my lymph nodes hurted, I had pain when swallowing,
, got many aftae in the mouth, extremely dry throat and mouth, etc.
I started to feel progressively better, but the lymph nodes kept hurting (changing locations depending on the day), and I used
to wake up without being able to move the fingers in my hands. Weeks later I felt stiff and I have had arthalgia for
some months, as well as geting aftae sporadically.
Of course, I had a great amount of anxiety during that period, and I tested repeately HIV negative, as well
as for many other STDs.I got several ELISA tests, being the last one as well negative after 9 months from the
exposure. The doctor made me 2 ordinary bloodwork analyses (when I first got sick and some months after), where
I got a mild lymphocitosis (45%).The doctor asked for a CD4 count (9 months after
the exposure) I had more than 1300, and a 45%.

What conditions could lead to a history like mine?
Have you known of cases where no antibodies could be detected and that showed high CD4 and normal percentage after 9 months? I understand that this, if possible, is extremely unlikely, but, I
am interested in being extremely sure of not having HIV, and for the time being I have not found what could be causing these symptoms. I understand
that you doctors see things statistically, and would not be inclined, for example, to order tests that in the overwhelming majority of the cases would
be useless. But I am interested in ruling out any option, as well as finding what I have. Should I consider doing a PCR? In that case, what type of PCR should
I use, considering my exposure was in Thailand?
Could you recommend me any other test, or combination of measured that could help??

[Edward W Hook, MD]

Welcome to the Forum.  Dr. Handsfield and I share the forum.  You got me.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.  I'll address your concerns about the possibility of HIV and other STDs but will not go beyond that to make medical recommendations. This Forum is designed to provide information and direction but not to practice medicine over the internet. To try to do so would be inappropriate.  

First things first.  You do not have HIV.  The symptoms you describe are very non-specific and could be caused by any number of problems, most of which are not sexually transmitted. At this time you appear to have ruled out one important possibility, HIV.  further testing for HIV, including a PCR test is really a waste of time and money and will only delay moving forward to identify the source of your continuing symptoms.  You should believe your blood tests and seek other explanations.  

If you have persistently swollen lymph nodes, you should seek other causes.  Swollen lymph nodes are a non-specific response to any number of stimuli including infections due to bacteria and viruses, allergic reactions and autoimmune disease.  Of all persons with swollen lymph nodes only a tiny proportion of them have HIV.

The combination of athralgias, apthae, swollen lymph nodes and morning stiffness suggest a rheumatologic basis for your problems.  My advice would be to seek consultation with a rheumatologist who can examine you, take a detailed history and order the sorts of tests which are warranted based on his/her findings.  

I hope these suggestions are helpful. This is not HIV related to your distant exposure in Thailand.  I say this with confidence.  EWH