Non Reactive HIV test

[cwill]

Hello Doc, I had unprotected vaginal intercourse with a female of unknown status. One week after I developed a sore throat with white spots all over my mouth. I tested positive on rapid strep test, I had already begun amoxillian a day earlier. Not sure if amoxil interferred with test. The white spots and sore throat dissappeared a couple of days after I began amoxil. I was also tested for HIV, not sure which test the paper the doc showed me just said non-reactive. Could this be the pcr test or the antibody test? I know it was too early for antibody test and I told the doc when the possible exposure occured.

One week later white spots and sore throat came back, still was taking amoxil, I went back in and rapid test negative for strep and negative blood test for mono. The doctor gave me a penicillin injection and single dose of azithromycin, he said for gonorreah or chlymidia, not tested. White spots and sore throat cleared up in a couple of days. Also rash that does not itch and has no redness also developed on my calf at about two weeks after possible exposure, i thought it was just dry skin but after several days of moisturizer is still persists. It has a burning sensation at times.
3 weeks into this I have a swollen and tender gland or lymph node on one side of my neck.

1.Are my symptons consistent with hiv infection?
2.Which HIV test did I take? Does the antibody test come back non-reactive or does it come back negative or positive?

Thank you

[H. Hunter Handsfield, M.D.]

1) You ask the question in a sort of biased way.  Are your symptoms "consistent with" HIV?  Yes.  Do I think you got HIV from the exposure you describe and that it is causing your symptoms?  No, it seems unlikely.  Everything you describe is entirely consistent with garden-variety, common things that are much more likely than HIV:  strep throat, standard cold virus, initial episode of oral herpes due to HSV-1, infectious mononucleosis, and others.  I'm not going to speculate further or try to make a diagnosis.  But HIV is extremely unlikely based on the exposure you desribe.  In any case, you have seen a health care provider; I can't compete with the diagnosis and advice of a provider who actually has examined you.  Follow up with him/her.

2) I'm sorry, but how can I know which HIV test you had?  Ask the doctor who did the test.  Probably one of the standard HIV antibody tests; I doubt a PCR test was done in the circumstances you describe.

See many other threads about the low risk of HIV from the kind of exposure you describe. Search the forum for "HIV anxiety", "HIV symptoms", and "time to positive HIV test".

Good luck-- HHH, MD

[scaredstraight68]

check this out... I got it from Dr. Bob forumn

It's from the U.S. Department of Health and Human Services (CDC, NIH) and was published in January of this year. Hopefully it will provide you with the information you require;

TABLE 1. Estimated per-act risk for acquisition of HIV, by exposure route*

Exposure route ----- Risk per 10,000 exposures to an infected source

Blood transfusion ---- 9,000

Needle-sharing injection-drug use ---- 67

Receptive anal intercourse ---- 50

Percutaneous needle stick ---- 30

Receptive penile-vaginal intercourse ---- 10

Insertive anal intercourse ---- 6.5

Insertive penile-vaginal intercourse ----- 5

Receptive oral intercourse ---- 1

Insertive oral intercourse ---- 0.5

[cwill]

The fact that the white spots and sore throat react ot antibiotics is a good sign? Not sure why amoxil and azithromycin doesn't knock it out for good? Also, I have a what I thought was a pimple on my limp but now resembles a cold sore, is this symptomatic of oral herpes?

[JohnnyV]

A non-reactive HIV test means that you're HIV negative. It means that the little stick that would "react" and change color if it was finding HIV in your blood sample, did not change color. There are no antibodies in your blood so therefore there is no HIV in your system to spur the production of antibodies. If you want even more assurance, just do the test 12 weeks after the date you had the unprotected sex. Therefore don't freak out when/if you read what I write below, because your HIV test rules out the possibility that you have it.

This is probably none of my business, but I hope you & others on the forum don't think that the "low risk of exposure" from having vaginal sex means that you can have a lot of it without a condom. Lots of people get HIV from vaginal sex. The low figures per 10,000 acts of vaginal sex reflect the fact that so many people around the world are having so much sex and few sex acts transmit HIV. This doesn't mean you can have vaginal sex 9,994 times without a condom and never get HIV; if that were the case no men would get it that way (which they do).

Also, there is one important caveat to those numbers Dr. Bob posted. In the first 2-4 weeks after someone gets infected with HIV, there is a deadly window period when the person is extremely infectious. It is unfortunately during this time that the person often won't test positive for HIV. So for instance, even though the rate of infection from vaginal sex is 6 acts per 10,000 on average, the figures are very different if one of the two partners got infected less than four weeks ago. The risk of infection from unprotected vaginal sex, with one partner carrying a recent infection, is actually somewhere between 1 in 10 and 1 in 30, from what I've seen.

If I understand, the reason for this is related to the fact that there are no detectable antibodies in the window period. Until the body creates antibodies, there is no way to keep the virus in check. The virus multiplies rapidly and the "viral load" spikes acutely; one doc told me that the person will never again have that heavy of a viral load until the advanced stages of AIDs some 15 years later. Within a few weeks the immune system kicks in and kills large amounts of the virus, though it cannot eliminate all of it.

Some AIDs specialists believe that this problem of the spike in the viral load is the key to how the virus spreads at all; there are those who think that almost ALL new infections are transmitted during this deadly window. Without that heavy viral load, the virus is frail and can't survive very long in transit, so if one sex partner has HIV but has been building antibodies for a long time, it is close to impossible for the HIV to travel, no matter what the sex act is.

What I wrote above explains the perplexing contradiction. The risk of HIV is so incredibly low "on average," even technically for gay men who take semen into their rectum, yet the virus is spreading among both gays and straights at an astonishing pace.

J

[Alias Lola]

That seems awfully low for IDU exposure.

[H. Hunter Handsfield, M.D.]

Good show, JohnnyV.  Your extended comment should be read by everybody concerned about sexual transmission of HIV.  The "1 in 1000" risk for vaginal intercourse that is so often quoted, by me and others, is only a rough approximation.  It is derived from simple calculations from the number of episodes of sex in various populations, the prevalence of HIV in those populations, and the rate of new infections.  But there are times when the risk of transmission is much higher, as well as times (the majority of the time, in fact) when it is much lower than 1 in 1000.

JV is absolutely right about the importance of early HIV infection, before antibodies develop, in transmission.  Also, during the course of a particular person's HIV infection, his or her viral load in blood or genital secretions periodically may go sky-high, sometimes because of hiccups in HIV replication per se, but probably most often from the influence of other infections, STDs, etc.

It is those relatively infrequent intervals of high viral load that drive HIV transmission at the population level.  In other words, the AVERAGE efficiency of transmission per exposure is less important in driving overall disease incidence than the than the fact that at any time there are a few people in the population for whom the risk of transmission is much higher than 1 in 1000, perhaps even 1 in 10. (Some of the premier researchers in exactly this area--for example, a group at the University of North Carolina--are close friends and colleagues of mine.)

Anyway, the odds work out as I have indicated in many, many threads on this forum:  Low risk per exposure, especially with condoms.  (By the way, the exceedingly low risk for oral sex probably applies regardless of viral load, stage of infection, etc.  I'm talking primarily about penile-vaginal intercourse.)  The actual risk depends on factors that typically the questioner doesn't know:  Is the partner actually at risk of HIV?  Is s/he an injection drug user or have partners who are?  (Not all sexually active people are at equal risk, even among commercial sex workers.)  Does s/he actually have HIV?  If so, what is his/her stage of infection?  Did s/he happen to have a high viral load at the moment of sex, or perhaps another STD?

The bottom-line, take-home message is the one you all have heard repeatedly:  If you're going to have casual, non-committed sex, use condoms.  They really do work.

HHH, MD

[cwill]

Thanks for your response, just one clarification if you will. What I call a rash, for a lack of better term is a non itchy non visible burning sensation. I had some tell me it is probably a pinched nerve in my back. I guess my question is a rash like above consistent with ARS by definition does it have to be visible? If not, the sore throat and one day of a one swollen lymph in my neck probably would not be a major concern. I have scheduled a std/hiv screening with the local health department at the 35 day mark. If negative would you advise another test at 3 months?

Thank You

[rohit107]

A related discussion, non reactive result was started.