HIV, Antibody, Mono, PCR, Viral Loads, and other uncertainties

I had unprotected sex with  a low risk, not promiscuous ex-girlfriend on Dec. 5. We dated years ago and known each other for 6 yrs. I started exp. symptoms 6 wks after the encounter w/ the onset of a genital sore, healed w/in 2 days to include < 2 wks of sore lymph nodes

[H. Hunter Handsfield, M.D.]

Wow!  That's a pretty comprehensive evaluation for an essentially zero risk sexual exposure.  As an indicator of HIV infection, your symptoms mean nothing in contrast with the negative HIV test results.   It sounds like you have an excellent physician who knows what he is talking about; his advice/opinion are definitely more valid than mine, since he has examined you and I have not.

1) Yes, your doctor was right.

2) Some but not all of your symptoms are typcial for primary HIV infection, mono, or both.  They also are typical for many other things.  As I said above, the lab test results are more important than your symptoms in making a diagnosis.

3) Zero, since you have been proved not to have HIV.  There is some chance you indeed have infectious mononucleosis, whether classical (due to Epstein Barr virus)  or "heterophile negative" mono (several causes, with cytomegalovirus probably the most common).

4) Zero.

5) Your liver enzyme abnormalities are quite mild, and typical for mononucleosis.

6) Nope.

Bottom line:  Follow up with your doctor and trust his evaluation.

Good luck--  HHH, MD

[SunnyFlorida1234]

I ran out of room!! I wanted to say that I sincerely appreciate your insight.  I

[SunnyFlorida1234]

Just to confirm, a negative ELISA test at 7 weeks (although I was experiencing ARS-related symptoms at this time of the test) and the PCR with a > 400 per ml result at 8th week means that there is 95% chance or greater that I'm HIV-?

I fear that I tested too early for the ELISA to pickup the antibody and too late for the PCR to detect the surge of viral loads

[H. Hunter Handsfield, M.D.]

You do not have HIV, period.  You were not tested too early.  Your doctor was right, and even an infectious diseases specialist told you this isn't HIV--trust them!  The majority of your symptoms are not suggestive of ARS, including the spots in your mouth, cough, "itchy pimples", and absence of fever--which is virtually always present in ARS.

Risk your partner had HIV, despite her negative test result = 1 in a million, tops.  That alone should have convinced you that HIV was impossible in your case, unless you have other risks you don't mention.  Risk you would have caught HIV if she had it = 1 in 1000.  Risk your 7 week ELISA missed HIV if you had it = 1 in 100.  Risk your PCR test also missed it if you had it = 1 in 100.  That makes your odds of having HIV now 0.0000001 x 0.001 x 0.01 x 0.01 = 1 in 100 billion, if I counted the zeroes correctly.  

So your obsession with HIV as a possible cause is quite irrational.   I strongly recommend against any further testing.

Please, no further "what if?" questions.  Nothing you can tell me will modify my assessment.

HHH, MD

[SunnyFlorida1234]

Thanks for your insight doc! I will post a contribution to assist you and your agency's endeavors, also on behalf of the chap that jumped a few threads today! LOL

VR/ Sunny

[SunnyFlorida1234]

My final question isn

[H. Hunter Handsfield, M.D.]

My HIV expertise is limited to transmission, prevention, and early diagnosis.  Consider asking on one of the forums at www.thebody.com.  But given the fact that you clearly do not have HIV, I do not understand why you are pursuing it.  (I am skeptical that you have no personal interest in the information.  The answers, whatever they are, will simply fuel your anxiety.)  

HHH, MD