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

[SunnyFlorida1234]

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 “armpits, neck, knees, groin”, 3 nights w/ night sweats, loss of appetite, lost 7 lbs, 2 small blue dots in mouth (lasted 1 day.),slight sore throat(2 wks), occasional cough with intermittent mucus (2+ wks), no fever, but slight chills during day (lasted >1 wk) and change of skin color (small visible capillaries), few, itchy small pimples on back & stomach, but only a handful (occurred 3 days ago). An infectious disease specialist said the rash or skin wasn’t symptomatic of ARS. Also, he said the symptoms were anxiety-related. He was concerned about the night sweats! I freaked out, so I contacted my ex-girlfriend and we had an ELISA test which were (both) neg! This was approx. 7 wks (48 days) after the encounter although I had symptoms at this time of the test. She never had symptoms.  She had unprotected sex with a long-term boyfriend of 3 years in mid-November.  My guess is her AB test was 9 to 13 weeks after her encounter.  She had another neg. antibody test in November 7, 2005. My doctor suggested a PCR, at 8 weeks/ 55 days to relieve my concerns, didn’t register any viral loads > 400 per ml.  My doctor said I “could hang my hat” on these results since both tests didn’t show positive.  Also, during my second week of symptoms and the 8th week from contact would have shown significant viral loads during this period, enough to register.  He said the viral loads would be sky high during this time. Hepatitis & Herpes test/ biopsy were all neg. I forgot… my current girlfriend just tested positive for mono by a mono stat test after the routine blood work has shown high liver enzymes (AST-36/ Range 3-35 U/L; ALT 59/ Range 3-40 U/L ) and normal WBC count (4.6/ Range 3.8-10.8 thous/MCL) on Feb 2.  She also had a negative HIV antibody test but this isn’t relevant since we never had sexual relations only kissing. My CBC blood work on Feb 3 indicated that I had a high liver enzymes (AST-30/ Range 0-40IU/L; ALT 65/ Range 0-55IU/L) and high WBC at 11.4/ (reference interval 4.0-10.5UL).  I’m waiting for an Esptein-barr result, and I’ll take another Western Blot/ ELISA test on the 3rd and 6th month.
1. Was the doctor correct about detecting viral loads during ARS? If I had HIV during symptoms w/ ARS, is it very probable the PCR would have detected a viral load greater than 400/ml?
2. Are these symptoms typical for mono or HIV? Are my CBC labs consistent with seroconversion or mono?
3. What are the chances of begin dually infected with HIV & Mono?
4. What are my possibilities of HIV infection?
5. If my current girlfriend and I have elevated liver enzymes, is this a typical for mono? If so, what’s up with the elevated WBC?
6. Any other interesting insight?
We appreciate the advice!

[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’m dreadfully worried, but I prefer to know now instead of waiting for 3 more weeks to 3 more months.  I feel my doctor is a little evasive and not 100% truthful about his prognosis.  

Cheers, Sunny


Sometimes the truth hurts, but it is what it is... "the truth".

Thanks again for an honest assessment!

[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….  

At what duration of time does the viral load decrease significantly to yield an undeterminable PCR result? (i.e > 400 ML).  I read some journals that state the viral loads will decrease after or during ARS to an immeasurable amount.  (i.e. 8-10 weeks) Do you have any knowledge of this?  

You said some of the symptoms were not suggestive of HIV, which were you referring to?  

[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’t related to me personally since I have my doctor and you reassurance. I will not pursue further testing…

I read several studies including the Ho/Shaw papers that tend to be contradictory. Moreover, I also read the amount of viral loads have a direct coorelation to the onset of AIDS.

Just for my edification and possibility for the benefit of others:

If a HIV+ individual doesn’t seek antiretroviral treatment and test their viral loads through RNA or DNA PCR, would the individual experience dramatic increases and decreases of viral loads over duration of time from initial infection, seroconversion, to the onset of AIDS?  

If so, when will the viral loads decrease/ increase? Is it possible to decrease to an immeasurable amount in some patients?

I’m simply curious about this subject matter since some of the online educational materials are all over the map.   Respectfully, Sunny

[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