ARS?

[LosA90]

I had sex with two different Asian CSW on 8/12 and 8/13 in Los Angeles. We had unprotected oral sex and protected vaginal sex (although in one of the instances the condom did not appear to cover the entire length of my penis -- the base was left exposed).

About 3 weeks later my body temperature ran about 99 degrees. I normally run about 96 to 97 degrees.

About 4 weeks later I had a rash on my chest and on one side of my neck which continues to this day. The rash looks like acne (a few red pimples here and there right in the middle of my chest).

My body temperature is now in the 98 degree range.

I know I sound a bit paranoid but the fever and rash is making me very worried....

1) What is typical ARS fever like? Is it very high?

2) Does this sound like an ARS related rash?

Thanks for any assistance.

[LosA90]

The test was done at the Aids Healthcare Foundation's main clinic. I believe they are one of the non-profit Aids organizations in the country.

I don't believe they are run by the health department but the county health department's website directs the public to go there as one of the options to get tested for free (all services were free).  The counselor also notified me that the county would be made aware of the results if the test were positive.

I am still waiting for my results (2 week turnaround), but I'm anxious and worried about the possible result as this test seems to have been unnecessary.  Why would such a large county related organization use this test as a diagnostic tool?  I felt great about the original rapid result but the fact that I took this NAAT is really freaking me out....

Thx.

[Edward W Hook, MD]

I cannot tell you why the clinic would be using this test. There are some clinics which do this as a competitive factor, claiming this somehow makes them a better clinic.  the test is useful in a few selected situation but few would recommend its routine use.  Were you tested at a private laboratory or one run by the health department?  Did you pay for the test?  

Your hepatitis B should not influence you results.  EWH

[LosA90]

For peace of mind, I went and had a final rapid test (using blood) 7 weeks after the last possible exposure at the AHF clinic in Los Angeles. It was negative.

However, the counselor said I also needed to take another test, a NAAT test. They indicated that the window period is up to 6 months and that this would catch anything the antibody test missed during the window period.  They drew 2 vials of blood for the test

After reading through the forums, I now realize this test is not recommended as a diagnostic test and suffers from false positives and I regret taking this additional test. I am waiting for these results and freaking out thinking about what it might reveal.

Why would this clinic use this test if it's not approved for diagnostic testing?  

I have chronic Hep B. Would this increase the likelihood of a false positive?

Thank you.



I

[Edward W Hook, MD]

The performance of rapid tests such as the OraQuick is statistically equivalent to the blood test for HIV detection.  At five weeks the OraQuick would detect close to 95% of infections.  In your case, since your expsoure was no risk to start with, you should accept the OraQuick result as proof that you did not get HIV from your encounters of concern.  EWH

[LosA90]

Ok, so at 39 days (5 1/2 weeks) after possible exposure, I took an Ora Quick Advance oral test at a clinic.

The test was negative.

I've read now on this site that the Ora Quick Advance oral fluid test is not as accurate in detecting early stage infections and that there are a large amount of false negatives.

Should I retest again with a blood based test at 6 weeks?

Please advise.

Thanks

[Edward W Hook, MD]

To be honest, you are being a bit paranoid.  Your exposure was no risk- the vaginal sex was condom protected and the quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.  You do not even need HIV testing following an exposure of this sort.

Furthermore, you may have missed our repeated statements that the symptoms of the ARS are TOTALLY non-specific and when people experience "ARS symptoms" they are much more likely to have something else, usually some other, more typical virus infection.  When this has been studied in the US, less than 1% of persons seeking medical care for "ARS symptoms" are found to have HIV, the remainder having symptoms due to other processes. In contrast, over a given year, there is almost no one who has not had a viral illness, night sweats or both (sometimes on multiple occasions).  For a person to try to judge their HIV risk based on "ARS symptoms" is a waste of time.

In answer to your specific questions:
The fever of classical ARS is rather high and is often accompanied by muscle aches and chills as well as a rash..  You rash sounds nothing like an ARS rash which is generalized and would not last for more than a few days.

As I said, typically for an exposure of this sort I would not even recommend testing.  If you are concerned go on and get a single HIV test, if your symptoms were the ARS it will be positive.  when the result is negative as I am confident it will be, be assured that you did not get HIV from the exposure you describe.

Hope this comment helps.  EWH