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Infection probability and sympotmatic hiv
Dr. I am worried about possible HIV infection and confused by propability rates. I have had maybe 75-100 protected vaginal sex episodes with sex workers over the last 7.5 years. Most of these in Latin America and the Caribbean but one in Southern Africa and one in Sri Lanka.
I have never tested because I always used protection though sometimes drunk. So it is possible that I have been infected for up to 7 years. Given my sordid history I am not asking about ARS symptoms but about what I fear may be HIV symptoms and that I may have lived through the non-symptomatic phase. And of course I will get tested, but I am hoping to grasp at some straw that what I am experiencing may not be HIV after all.
I would like you to comment on my risk probability. I have seen the 1:1000 figure for a single act. Not withstanding all the other factors (especially those in Africa) should I assume that if all the sex workers were HIV+ my risk is 75-100:1000? In other words about 1 in 100? And that if half of them were my risk is .5:100? Or is it much higher?
Please also comment on the symptoms I am having.
1. Ongoing diarhea every few months - GP can find no cause.
2. Fever + night sweats a couple of times in the last 2 or 3 years.
3. Lower leg cramps at night - last couple of months.
4. New warts that are hard to get rid of - last 2-3 yrs
5. A couple of molluscum like spots on my face - resolved in 2 weeks.
6. A fungal nail bed in the last month or two - something I've never had before.
7. And most worrisome - an outbreak of small red raised spots, many with tiny pimply center, on my legs and trunk. Looks like pictures of PPE. I have had a few small outbreaks over last 3-4 yrs - now widespread.
While it looks like a list from the web, it is what I am experiencing. Before I get tested, is there any reason to hope either b/c low probability of transmission or b/c these symptoms could be from psychological stress caused by fear and guilt?
Thanks.
I have never tested because I always used protection though sometimes drunk. So it is possible that I have been infected for up to 7 years. Given my sordid history I am not asking about ARS symptoms but about what I fear may be HIV symptoms and that I may have lived through the non-symptomatic phase. And of course I will get tested, but I am hoping to grasp at some straw that what I am experiencing may not be HIV after all.
I would like you to comment on my risk probability. I have seen the 1:1000 figure for a single act. Not withstanding all the other factors (especially those in Africa) should I assume that if all the sex workers were HIV+ my risk is 75-100:1000? In other words about 1 in 100? And that if half of them were my risk is .5:100? Or is it much higher?
Please also comment on the symptoms I am having.
1. Ongoing diarhea every few months - GP can find no cause.
2. Fever + night sweats a couple of times in the last 2 or 3 years.
3. Lower leg cramps at night - last couple of months.
4. New warts that are hard to get rid of - last 2-3 yrs
5. A couple of molluscum like spots on my face - resolved in 2 weeks.
6. A fungal nail bed in the last month or two - something I've never had before.
7. And most worrisome - an outbreak of small red raised spots, many with tiny pimply center, on my legs and trunk. Looks like pictures of PPE. I have had a few small outbreaks over last 3-4 yrs - now widespread.
While it looks like a list from the web, it is what I am experiencing. Before I get tested, is there any reason to hope either b/c low probability of transmission or b/c these symptoms could be from psychological stress caused by fear and guilt?
Thanks.
MEDICAL PROFESSIONAL
With this additional information, I modify my prediction. It will be very surprising if your HIV test is positive.
The "PPE" you describe does not suggest HIV. Such rashes are common in initial HIV infection, i.e. associated with ARS in the first 2-4 weeks of HIV. Such rashes do not hint at advanced HIV.
And yes, if HIV were responsible for your recurrent diarrhea, possible facial molluscum, etc, you would feel and look sick and probably would have lost weight. It would be obvious to any casual observer that you were in poor health. Without such systemic symptoms, advanced HIV/AIDS is extremely unlikely.
There is no inconsistency in my comments about molluscum contagiosum. Genital area molluscum never suggests HIV; facial lesions in adults always does.
I'm not going to comment on your statistical analysis of the odds you might have HIV. You need to be tested, not to speculate based on very soft data and uncertainties. I now predict a negative result. Feel free to report it if and when you are tested, but let's hold of on other comments until then.
The "PPE" you describe does not suggest HIV. Such rashes are common in initial HIV infection, i.e. associated with ARS in the first 2-4 weeks of HIV. Such rashes do not hint at advanced HIV.
And yes, if HIV were responsible for your recurrent diarrhea, possible facial molluscum, etc, you would feel and look sick and probably would have lost weight. It would be obvious to any casual observer that you were in poor health. Without such systemic symptoms, advanced HIV/AIDS is extremely unlikely.
There is no inconsistency in my comments about molluscum contagiosum. Genital area molluscum never suggests HIV; facial lesions in adults always does.
I'm not going to comment on your statistical analysis of the odds you might have HIV. You need to be tested, not to speculate based on very soft data and uncertainties. I now predict a negative result. Feel free to report it if and when you are tested, but let's hold of on other comments until then.
Dr., any further comments particularly as regards the PPE like rash on my legs and trunk as a symptom of advanced HIV infection. It has all but disappeared now just leaving an itchy feeling all over my legs.
Also I thought I asked you about what appears like a discrepancy between your comments on molluscum only being seen in HIV pos adults and the comments of the other Dr. on this forum who responded to a question about molluscum by saying that the vast majority of people with molluscum are neg. I don't understand why there is that apparent inconsistency; could you explain that, please?
As for testing, I am not anywhere I can be tested, but will test asap.
Grateful for a response.
Also I thought I asked you about what appears like a discrepancy between your comments on molluscum only being seen in HIV pos adults and the comments of the other Dr. on this forum who responded to a question about molluscum by saying that the vast majority of people with molluscum are neg. I don't understand why there is that apparent inconsistency; could you explain that, please?
As for testing, I am not anywhere I can be tested, but will test asap.
Grateful for a response.
Dr. Thanks for your forthright answer. No, I am not happy about it, but it doesn't surprise me.
One slightly hopeful thing is that the molluscum was self diagnosed so possibly incorrect. (I see in your second post to "expendable" that you noted that and modified your answer a bit).
PPE is the abbreviation for Papular Pruritic Erruption which is also a self diagnosed condition based on multiple recurring small red papules with pimple like centres that have appeared on my legs and trunk. (I described these in my initial question.) PPE is the only thing I could find on the net that resembles what I have.
These started about 3 or 4 years ago with small outbreaks of 6 or a dozen once every few months, but in the last month they have broken out much more vigourously on my thighs, lower legs and trunk (sides and stomach) for no apparent reason. Right now they have mostly but not entirely disappeared.
One other thing, if I have advanced HIV or AIDS, shouldn't I be feeling fatigue and generally unwell? Except for the symptoms described and the extreme stress they are causing me I feel quite healthy and fit.
Even though I heard what you said I want to ask again about probability estimates. I read from UNAIDS and others that the rate of infection among latin american FSW is about 3-4%. Let's say 10% to be conservative. Condom failure is by some estimates about 18%. Let´s say 20%. If 10% of the FSW were positive and the protection failed 20 times in a hundred, I would statistically have had 2 HIV exposures in 100. That is, 10% of the times protection failed it (statistically) would have been with an HIV+ FSW, right? While these are guesses, and once is enough to be infected if probability of infection per episode is 1:1000, that would make my probability 2:1000 or .2%.
Of course in the 50% or more estimate you have factored in the MC and other symptoms so I guess the stats are irrelevant but I'm grasping at straws, and I'm sure you understand why.
As for your advice to get tested, I will.
Thanks again.
One slightly hopeful thing is that the molluscum was self diagnosed so possibly incorrect. (I see in your second post to "expendable" that you noted that and modified your answer a bit).
PPE is the abbreviation for Papular Pruritic Erruption which is also a self diagnosed condition based on multiple recurring small red papules with pimple like centres that have appeared on my legs and trunk. (I described these in my initial question.) PPE is the only thing I could find on the net that resembles what I have.
These started about 3 or 4 years ago with small outbreaks of 6 or a dozen once every few months, but in the last month they have broken out much more vigourously on my thighs, lower legs and trunk (sides and stomach) for no apparent reason. Right now they have mostly but not entirely disappeared.
One other thing, if I have advanced HIV or AIDS, shouldn't I be feeling fatigue and generally unwell? Except for the symptoms described and the extreme stress they are causing me I feel quite healthy and fit.
Even though I heard what you said I want to ask again about probability estimates. I read from UNAIDS and others that the rate of infection among latin american FSW is about 3-4%. Let's say 10% to be conservative. Condom failure is by some estimates about 18%. Let´s say 20%. If 10% of the FSW were positive and the protection failed 20 times in a hundred, I would statistically have had 2 HIV exposures in 100. That is, 10% of the times protection failed it (statistically) would have been with an HIV+ FSW, right? While these are guesses, and once is enough to be infected if probability of infection per episode is 1:1000, that would make my probability 2:1000 or .2%.
Of course in the 50% or more estimate you have factored in the MC and other symptoms so I guess the stats are irrelevant but I'm grasping at straws, and I'm sure you understand why.
As for your advice to get tested, I will.
Thanks again.
Thank you for sharing your memories Doctor Hansfield.
MEDICAL PROFESSIONAL
It is a bit off topic, but allows me to make an important point -- mostly for the worried well who might misinterpret the implications of the present question and my reply.
I well remember the first AIDS patient I saw personally, in consultation (first diagnosed by another doc), who at the time was Seattle's first known AIDS case -- although a few months later we learned there had been another case a couple months earlier. My own first HIV/AIDS patient came a few months later. Both of these were gay men. But that doesn't mean much, since all of Seattle's first couple hundred cases -- indeed almost all cases during the first 1-2 years of recognized HIV/AIDS in the US -- were in gay men. Even now, men having sex with men account for >90% of new HIV infections in the western US.
Here is the important point: If by "ordinary" you mean the general popluation, or heterosexual men and women without known high risk factors, there still are almost no such cases in the US -- a relative handful at best, and most of those acutally have had typical risk factors other than just dating opposite-sex partners. In my 30-year career, I have never had (or been personally aware of) an HIV infected person who didn't have obvious high risk behaviors. As I said above, if worriedinpty had only the behavioral risks described, I would put his chance of having HIV in a very low range.
To worriedinpty: I might have over-emphasized the molluscum business. I first thought you were describing a likely diagnosis, but you actually said "molluscum like spots", presumably not professionally diagnosed. As I think about it, most likely it wasn't MC at all, especially since it cleared up -- in which case his chance you have HIV is far below 50%. But still, please see a health professional, have an HIV test, and come back to let us know.
I well remember the first AIDS patient I saw personally, in consultation (first diagnosed by another doc), who at the time was Seattle's first known AIDS case -- although a few months later we learned there had been another case a couple months earlier. My own first HIV/AIDS patient came a few months later. Both of these were gay men. But that doesn't mean much, since all of Seattle's first couple hundred cases -- indeed almost all cases during the first 1-2 years of recognized HIV/AIDS in the US -- were in gay men. Even now, men having sex with men account for >90% of new HIV infections in the western US.
Here is the important point: If by "ordinary" you mean the general popluation, or heterosexual men and women without known high risk factors, there still are almost no such cases in the US -- a relative handful at best, and most of those acutally have had typical risk factors other than just dating opposite-sex partners. In my 30-year career, I have never had (or been personally aware of) an HIV infected person who didn't have obvious high risk behaviors. As I said above, if worriedinpty had only the behavioral risks described, I would put his chance of having HIV in a very low range.
To worriedinpty: I might have over-emphasized the molluscum business. I first thought you were describing a likely diagnosis, but you actually said "molluscum like spots", presumably not professionally diagnosed. As I think about it, most likely it wasn't MC at all, especially since it cleared up -- in which case his chance you have HIV is far below 50%. But still, please see a health professional, have an HIV test, and come back to let us know.
Doctor Hansfield sorry for bothering you. You are the icon on HIV field and I have one question. Do you remember your very first HIV+ patient in your carrier? I know, this question is off topic and I hijack someone else thread but....
Was he gay? Drug user? Or just a ordinary man or woman?
Was he gay? Drug user? Or just a ordinary man or woman?
MEDICAL PROFESSIONAL
Welcome to the HIV forum. I'll try to help, but I'm afraid you won't like what I have to say.
The bottom line is that I am quite concerned you may have HIV, perhaps advanced -- i.e. overt AIDS. I hope not -- but you need to be tested immediately. Do not do it by online or other independent testing on your own. See a doctor or clinic with knowledge about HIV/AIDS then follow the advice you receive.
Your sexual lifestyle, conisidered by itself, gives mixed messages on risk. Heterosexual with consistent condom use suggests low risk. But the nature of your partnerships, especially with many commercial sex workers in the Caribbean and southern Africa, are very high risk.
You cannot read a list of HIV symptoms, see that you have a lot of them, and then conclude that HIV is likely. The identical list of symptoms applies to many conditions, perhaps hundreds -- most of which are more common than HIV. You are correct that your symptoms don't suggest acute HIV infection, but some of them are consistent with significant immune deficiency. The greatest concern is facial molluscum contagiosium. If that diagnosis is definite, i.e. if it was professionally diagnosed, then there is a very good chance you have AIDS. I have never heard of facial molluscum, in an adult, who didn't have advanced HIV infection. On the other hand, facial MC in AIDS is unlikely to clear up in 2 weeks; indeed even with aggressive treatment, it is very hard to control until immune deficiency is effectively treated with anti-HIV drugs. Perhaps the diagnosis was wrong -- which I hope is the case.
Your other symptoms don't help much one way or the other -- chronic recurrent diarrhea and intermittent fever and night sweats are consistent with advanced HIV, but also with innumerable other explanations. (I don't know the abbreviation PPE, so I can't comment on that one.)
As for a statistically oriented judgment of the chance you have HIV, it really isn't relevant. Without the molluscum, I might have guessed at a 0.1% to 1% chance you have HIV, i.e. 1 in 100 to 1 in 1,000. If the molluscum is real, the likelihood you have HIV probably is at least 50%. Either way, testing is necessary ASAP.
I'm sure this is not what you wanted to hear. I hope the MC diagnosis is wrong and that you don't have HIV. Please return with a follow-up comment to let me know the result of testing and medical evaluation.
Good luck-- HHH, MD
The bottom line is that I am quite concerned you may have HIV, perhaps advanced -- i.e. overt AIDS. I hope not -- but you need to be tested immediately. Do not do it by online or other independent testing on your own. See a doctor or clinic with knowledge about HIV/AIDS then follow the advice you receive.
Your sexual lifestyle, conisidered by itself, gives mixed messages on risk. Heterosexual with consistent condom use suggests low risk. But the nature of your partnerships, especially with many commercial sex workers in the Caribbean and southern Africa, are very high risk.
You cannot read a list of HIV symptoms, see that you have a lot of them, and then conclude that HIV is likely. The identical list of symptoms applies to many conditions, perhaps hundreds -- most of which are more common than HIV. You are correct that your symptoms don't suggest acute HIV infection, but some of them are consistent with significant immune deficiency. The greatest concern is facial molluscum contagiosium. If that diagnosis is definite, i.e. if it was professionally diagnosed, then there is a very good chance you have AIDS. I have never heard of facial molluscum, in an adult, who didn't have advanced HIV infection. On the other hand, facial MC in AIDS is unlikely to clear up in 2 weeks; indeed even with aggressive treatment, it is very hard to control until immune deficiency is effectively treated with anti-HIV drugs. Perhaps the diagnosis was wrong -- which I hope is the case.
Your other symptoms don't help much one way or the other -- chronic recurrent diarrhea and intermittent fever and night sweats are consistent with advanced HIV, but also with innumerable other explanations. (I don't know the abbreviation PPE, so I can't comment on that one.)
As for a statistically oriented judgment of the chance you have HIV, it really isn't relevant. Without the molluscum, I might have guessed at a 0.1% to 1% chance you have HIV, i.e. 1 in 100 to 1 in 1,000. If the molluscum is real, the likelihood you have HIV probably is at least 50%. Either way, testing is necessary ASAP.
I'm sure this is not what you wanted to hear. I hope the MC diagnosis is wrong and that you don't have HIV. Please return with a follow-up comment to let me know the result of testing and medical evaluation.
Good luck-- HHH, MD
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