HIV strains

[Very uncertain situation]

Dear Doc,

I fall in an unusual situation in Africa as you will see below. This episode made me very anxious.

I had an exposure to a HIV+ lady 8 weeks ago. It was low risk protected exposure, but there was a brief touch between her vagina and my penis (no penetration and no fluid exchange at all) before putting on the condom and some fingering too. Later on I noticed that she had swollen lymph nodes in the grion and that made me very suspicious. A week later I asked her to make a test and she tested positive for HIV-1 antibodies. Then another tests were done and her CD4 count was 240 and CD8 - 1050. I requested a viral load test for her as well. Then the big surprise came - the result was Undetectable. She claimed that she had neved taken any medications and didn't knew she is positive. Speeking with the doctor at the clnic he told me that viral load tests are very specific and that is why the test probable misses her load. He added that this can happen for HIV-1 strain O or some complex recombinant form of clade B or HIV-2. HIV-2 was excluded from the options as antibody test showed HIV-1. He also added that there is a chance that her body is maintaining the virus at very low levels. This sounded very illogical to me considering the cd4 count of 240 which is indicating a damaged immune system and I decided to test her at another hospital to repeat the test at different lab. Again the viral load came undetectable. Anyway they gave her some drugs to start medication.

Two weeks after the episode I had some very light sore throat, and light diarhea (diarrhea). I experienced 2-3 non subsequent night sweats, but no fever. The sore throat continued for about a month and finally healed, but the diarhea (diarrhea) is still here. 4 weeks after the episode I developed a stiff neck and some mild and changing headache. There were no swollen lymph nodes on my body, but I think touching too offen these on the neck I recently made one to swell for a week (was painfull). Now (8 weeks later) my neck is fine, no night sweats, no sore throat, but still some diarhea (diarrhea) and a lot of anxiety. Yeasterday I mentioned some vey small red dots on the left anf right side under my armpits placed at small areas. They are not more then 10 per side. Dont know if this can be classified as rash.
I was very anxious and tested myself at 3,4,5,6,71/2 weeks by 4th generation elisa tests - thanks god for now all negative. Intentionally I made tests in different labs to have different tests performed (Vironostika Uni-form ag/ab and last one ABBOTT Axsym Ag/Ab).

My question is considering the fact that apparently if I got HIV virus it would be of some unusual strain is the sensivity of the 4th generation elisa assays decreased and thus the possible positive result to be delayed?

Is it possible the antibody tests not to be able to detect a pcr undetectable strain at all?

Do you think the test I have done are useless in this situation?

Thank you for the wonderfull support you do to all who write here.
BB

[H. Hunter Handsfield, M.D.]

To my knowledge, there are no HIV-1 strains to which infected persons do not make antibody.  You can rely on your negative test result, especially those after 4 weeks.  Your symptoms don't sound particularly like primary HIV infection.

Having HIV with an undetectable viral load is entirely possible, even in an untreated persons with a moderately low CD4 count of 240.  (It would be pretty unusual if her CD4 count were, say, under 100.)  As a generalization, CD4 level indicates how damaged the immune system is; viral load measures how fast the immune system is likely to deteriorate, and also is a measure of infectivity.

So you can be confident your risk of acquring HIV during the exposure you describe was very low.  Just to provide peace of mind, you might want to get a final test at 3 months.  It will be negative.

Good luck--  HHH, MD

[wendo]

You had a VERY low risk encounter because you used a condom.  However, to put your mind at ease, continue testing out to 3 months, and you will have a definitive result. Good luck, and I am + you are fine!

Wendo

[scaredstraight68]

Correct me if I'm wrong doc, but I believe that if you were experiencing ARS your blood test would show poisitve on the Elisa test.  Your testing seems to be an indicator that your fine and most of the stuff you've listed is probably more stress related.  You can test at 13 weeks but your tests probably wont change. You'll be fine, have a little faith.

[opinion222]

From what I know ARS is a reaction by the human body to the HI Virus. Elisa detects antibodies. So it is possible that you can have ARS but your HIV antibody levels are below detectable levels. Dr.Handsfield has said that he can't recall a person testing negative at six weeks and then going on to test positive later on (in recent times). Being a fellow African one sometimes is skeptical of the testing reliability in Africa but you should remember that very few (if any) tests are manufactured locally in Africa, which means these tests are invariably donated/bought from reliable manufacturing companies. I have been pleasantly surprised by the knowledge that African doctors and laboratory staff have about HIV (not that I am in any position to judge, but its not difficult to assess whether somebody knows what they talking about or not), but I suppose this should not come as a surprise as they are dealing with this disease on a daily basis. I think your negative test (at one or many laboratories) at seven weeks can really be reassuring.

[Very uncertain situation]

Thank you for your answer. Lets hope for the best. The tests done are of very good quality and my concerns are mainly of the fact that the virus can be a complex recombinant form and the produced antibodies could be different and thus not detected by them. Can I conclude from your answer that antibody tests catch the recombinants too? Both tests are declared to catch HIV-1, HIV-1 clade O and HIV-2.

Thank you again.
BB

[Very uncertain situation]

Thank you all for the encouraging replies.
Just to mention that my tests were not done in Africa, but in Europe and I have no reason to suspect any unprofessional handling. These labs are very trustworthy.

Can add here that the event happened in Kenya (Mombasa).

All the best to everybody here and lets hope for negative test results :).

[scaredstraight68]

From most of the readings I have done if ARS symptoms are happening current tests are picking up the antibodys.  The doc can correct me if Im wrong.  It is however possible for someone to test neg before any symptoms and still be +.

[worriedtodeath]

Please help me I am so scared. About 5 months ago, I had a unprotected experience with a "traveled" woman. There were no signs to follow at all. However recently I was in Las Vegas and had a protected experience with a lady from Brazil, the sex was protected but there were hours of touching and heavy open mouth kissing. About a week after returning from the trip, I experienced a weird feeling in my mouth, almost as if I had not brushed my tounge hard enough and there was scum on the back of very back of my tounge. Later that same night I ran into the girl that I had been with 5 months ago and began to wonder if I had caught anything from her. The next day and for a couple days to follow, in the morning I had some very sharp stomach pains that hurt real bad, and then they were gone. No diaherra but more trips to the bathroom. Then they became a smaller pain that would come and go throughout the day. After that I jumped on an HIV website and lost it, I was certain that the symptoms were from HIV. All day that is all I could think about and do was go on HIV sites and panic.Finally this Saturday I lost it and went to the ER for an HIV test. I have been a mess, I have no appetite at all, crying and screaming all day, yesterday I had a salty taste in my mouth for no reason, and my tounge looks very hairy. Monday I recieved my results and they were negative,but my White Blood Count was elevated. I have been seen by two different doctors that both think I have a bit of extra white on my tounge and irritated tounsils, but say it is not trush. I am loosing my mind, I can not function what so ever. I keep asking does the test eliminate the 5 month old experience or not, did I get HIV from kissing, did the condom in Vegas break, is my WBC high because the body is fighting the virus. I am lossing my mind, please help



P.S. I forgot to mention that my temperature has been crazy. One min it is 97.8 then 99.4. I am also cold then hot all day long. I feel like I am cold on the skin level so I need a sweater, but inside like I am burning up and going to start sweating. Also thickness in my mouth where I keep spitting. I have gas like crazy, and stomach pain and burning on and off all day like diaherra is coming, and go to the bathroom so much more then usuall. Please help me, I can not understand it. We made out pretty hard core for hours with tounge and lip sucking. We both touched each other all the way to orgasim, and then we had protected sex. I was a littlle drunk and remember putting on the condom wrong then flipping it over, also I did not check if it broke. Please help me, I can not understand where else all these issues just happen to come from a week later unless I am +

[H. Hunter Handsfield, M.D.]

Very uncertain:  I am not aware of anybody being infected with a recombinant HIV virus that would not give a positive blood test; I believe you are worried about a theoretical and extraordinary unlikely possibility.

Worriedtodeath:  New question, to which I will be happy to respond in a new thread.  But your question has been answered anyway; read other threads on "HIV anxiety" and "HIV transmission risk".  Undoubtedly there will be replies from other STD forum participants as well.

HHH, MD

[JohnnyV]

Hi,

I'm not a doc but I'll take a stab at some of your questions.

Your anxiety is causing you to combine two risk events as if they're equal, but they are not equal. Step #1: Separate the two encounters and analyze them objectively.

The first event, unprotected vaginal sex, had a low level of risk at the time it happened, though it was not zero. Five months have passed, which is far beyond the necessary window to test positive for HIV; you tested negative. Therefore, even though there is some risk with unprotected vaginal sex, you are 100% certain that that particular incident did not infect you with HIV. So you can forget about her and it and move to analyzing the second event.

The second event, protected vaginal sex and kissing--we would be able to say it was zero, if it were not for the fact that you say you were drunk and cannot remember if the condom broke. You also say you're not sure if you took the condom off at some point. I'm not sure how "drunk" you mean, but it sounds like it is more likely that you did use a condom and it probably did not break, since condoms rarely do. The virus cannot pass through latex and kissing has never been a mode of transmission. The risk of this event is so close to zero, most people will tell you to write it off.

Therefore, it goes to reason, the chances are overwhelmingly that you do not have HIV; one event has been ruled out by the HIV test and the other event is extremely close to zero.

If you want to exclude any doubt, get an HIV test at 4 weeks after the SECOND event. If it is negative, you should live your life as you normally would and put it out of your mind. Just as a standard procedure, get tested again at 12 weeks. Think of the 12-week test as the equivalent of getting checked for testicular cancer. VERY FEW men get testicular cancer, but everyone should get checked for it at some point; and nobody falls apart with stress before a physical, imagining that he already has testicular cancer, merely because there's an upcoming exam for it. Apply the same calming and serene logic to HIV testing.  If you're negative at 12 weeks, the ordeal is over. Close the file, let it go, and move on.

Deal with your thrush or other health problems for what they are. Maybe you do have a strange tongue condition or a stomach problem. Maybe it's stress. Just see a doctor and have it checked out. Then be ready to deal with the mundane problems of your life, all the stuff that's less dramatic than HIV, for a long, long time; because you probably do NOT have HIV, and you will have 70 years ahead of you, full of boredom, anger, jealousy, frustration--you know, that stuff we call the human experience.

J

[eddy84]

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