antibodies and seroconversion illness

[dread1]

g'day doc,
i'm pretty distressed right now. I'm a 38yr old gay male whose last exposure was 50 days ago, and one 58 days prior to that. in both cases I'm concerned about bleeding gums and receptive oral sex without ejeculate. 36 hours after last exposure i had nausea and one bout of diahrea. also felt sensitive to light, low grade fever, throat glands swelled for two days and then groin and underarm swelled. neg pcr dna and elisa antigen at day 9(day 15 for 2nd last ex). then groin and faint underarm swelling continued to come and go and one bout of high fever (around four days after test). neg pcrdna and elisa antigen at day 23(day 30 for 2nd last ex). then a few red dots that came and went and some flakey patches on palms. groin and underarm swelling still comes goes on a daily basis. neg elisa antigen at day 47(day 55 for 2nd last ex). these symptoms have dragged on now for seven weeks (incl. the muscle spasms and an itch that shifts) I might add I'm writing from syd australia, and am dealing with a doc who deals with this everyday in the midst of the gay ghetto. re the swelling glands, on the numerous times i've been to him they are never up which has driven me crazy. wouldn't antibodies begin to kick in by now? or do these symptoms need to resolve first? I get bad tonsillitis about twice a year, does this mean my immune system is compromised??  

[H. Hunter Handsfield, M.D.]

As you probably were told by your own obviously knowledgeable doctor, your negative test results show with near certainty that you weren't infected with HIV during the exposures you describe and that your symptom cannot be due to HIV.  The antibody tests almost always are positive within 4-6 weeks of exposure, and always positive within 2 weeks of onset of symptoms.  Further, you describe a relatively low risk exposure, regardless of bleeding bums.  Your earliest symptoms at 36 hours could not have been due to HIV anyway--  too soon -- and your other symptosm don't sound particularly like HIV anyway.  Repeated tonsillitis does not suggest immune deficiency.

Recheck with your doc if your symptoms persist and follow his/her advice about further diagnostic testing.  The odds are good s/he knows just as much about all this as I do, probably more.  (I actually provide personal care to very few patients with suspected early HIV infection; your doc probably does it all the time.)  Or if uncertain about his/her expertise, visit the excellent Sydney Sexual Health Centre. It is one of the world's premier STD/HIV clinics.

Bottom line:  Relax.  Putting together all the evidence and probabilities, your chance of having HIV is zero or close to it.

HHH, MD

[dread1]

I forgot to add I've also had some mouth ulcers. So i've pretty much ticked off most of the symptoms. I tested positive to hsv 1 and 2 in the middle of all of this but to my knowledge have never had any of the symptoms. yep,i'm a worried one.

[dread1]

sorry about this, I keep remembering things I've been wanting to ask. If I am in fact hiv pos, in this highly infctious stage would it be dangerous to be kissing people hello on the lips and drinking from the same cup and sharing food etc - I know all these things are deemed safe ordinarily, but I'm wondering during acute hiv infection whether it would be different? apologies for sounding like a crazy man - seven weeks ago I was a really normal happy dude! i did say my last test was two days shy of seven weeks didn't I? ....there I go again.

[dread1]

you're really gonna kill me now, but a couple of key things I forgot were in that first week I lost about six kilograms (mind you I was seriously stressed, which clearly I still am) and thoughout the seven weeks I've been almost unable to control my burping and gas, which has been constant. signing offff

[massguy]

Isn't fellatio without ejaculation extremely low risk anyway?  Somewhere in the range of 1 in 10,000 - and that number is with a confirmed person with the virus and ejaculation?  

Here in Boston at the Fenway, they tell me oral without ejaculation is VERY, very low risk.  They also follow your advice Dr. H. - ask status and STD status before you suck - some people lie and some people don't, but a good portion will give you an honest answer....and of course use condoms always for anal!  If you follow these rules and NEVER stray from it - you will be fine and dandy...his words not mine!

[dread1]

thanks doc, that was a quick reply, esp considering its 11am in sydney on a sunday morning - god knows what time it is in america! Your comments have calmed me, I think I'll go and get another antibody test in two weeks (9 week test). these ongoing glands are a worry. by the way, your vice president is causing traffic chaos here at the moment!

[dread1]

gotta say, these glands aren't going away - you sure about that two weeks AFTER onset of symptoms tests will pick up detectable antibodies....even if symptoms continue for more than six weeks?

[H. Hunter Handsfield, M.D.]

Self-diagnosed lymph node enlargement is pretty unreliable. But even if your doc confirms your nodes are enlarged, there are lots of things besides HIV that cause the same thing.  In any case, follow your doctor's advice and trust his diagnosis and advice.

HHH, MD

[dread1]

Just thought I'd mention I went to see another doc today, again an hiv specialist in the middle of sydney's gay district to get a second opinion. After telling him everything, he too was adamant I was hiv free. He says he has never seen a patient(and he's seen gadzillions, and all gay)that was experiencing a true seroconversion illness ('ars'symptoms for you americans)that didn't show something on the western blot - 'something' meaning the faintest band of any type. Interestingly, he was repeating what my first doc (who also deals with hiv all day with mostly gay patients)said the same thing word for word. They both say within a week of onset of true seroconversion illness symptoms (no wonder you guys just call it 'ars') something is going to show on this test. I had two full sets of tests, (dna pcr, elisa antigen and western blot) at 7days and 21 days after the onset of symptoms, all the while experiencing symptoms, and in particular a big fat fever (that left me so listless I couldn't even think what my name was) for a good five hours that occurred four days after the first round of tests. He said the fact that your second round of tests was around 10 days after the big fever didn't register anything on any of those tests, proves you've got nothing to worry about. Further, my neg elisa antigen test at seven weeks(minus two days)post last sexual exposure (and 45 days after onset of symptoms)was further proof. I asked him about the six week thing, and he said(as did my first doc AND the people from the Sydney Sexual Health Centre that DR H regards as one of the premier STD clinics in the world)six weeks is where its at for the window period BUT 3 months for legal reasons. It certainly gives one heart.

[dread1]

don't know whether you'll answer this question or not, but I just read that hay fever sufferers mean they have a compromised immune system. I get hay fever bad, and am allergic to some dogs, does this mean I would have a **** immune system that is going to affect my bodies production of hiv antibodies?