Does this sound like ARS? Very Scared

[BBAA]

Short synopsis - 30 yr old, 33 days ago, tongue kiss, protected brief oral and vaginal sex with CSW in Asia, robbed and passed out due to heavy intoxication and possibly drugged. Hazy recollection, think I woke up with condom on, all I know for sure is there were 2 used condoms in my surrounds. Naturally, experienced loss of appetite straight away for 40 hrs & continuing on through week. Upon my return home experienced night sweats, diarrhea for 2 days, tingling & burning sensation in legs etc all within the first week. The second to third weeks saw me have a whole week of feeling nausea but no vomiting, off my food, white coating of the tongue (comes & goes) & various other symptoms not significant enough to mention as I'm sure they're caused by stress and anxiety.

Now, one month on, still have white coating of the tongue, mild throat infection, green stools, rash on upper torso (about 6 faint blotches which look like a tinia or exchma type rash and I have lost 5-8 kg in 2 weeks. Further, I'm now again experiencing the burning in my legs and back of neck and night sweats, tingling fingers etc. I tested neg to all STD's 4 days post incident. Oral swab of white coating on tongue came back fine over 10 days ago. I tested neg on an ELISA at Day 26 or 27 and my bloods have been perfect as have my CD4 count. I'm very aware of any slight change in my body and my stress and anxiety levels have hit the roof. I am awaiting results on an ELISA post one month and will again test at 6 and 12 weeks.
1. Does time frame & symptoms sound like ARS in your prof opinion?
2. Is my ELISA at Day 26 a good indication? If I had symptoms right from Day 1 wouldn't antibodies appear by now?
3. If it is not HIV, what could it be? All symptoms seem very coincidental? Could tummy virus produce these symptoms?
4. White tongue - if tested OK post 2 weeks is it therefore not thrush/candida?
5. How accurate is 1 mnth ELISA in % terms?
6. Based on ltd facts, can you assess my risk, worried sick?

[H. Hunter Handsfield, M.D.]

"To help quell my anxiety and fears, could you please help me assess my risk."  I already did that and am not goint to repeat myself.  

It is not possible to have HIV with a negative antibody plus p24 antigen test at 6 weeks.  Those results prove that something other than HIV is the cause of your symptoms.  See a provider to learn the acutal cause.  Please accept the reassurnance you have been given.  You can test for HIV whenever you want, it doesn't matter to me.  You don't have it.

This indeed is the end of this thread.  Any more and the entire thread will be immediately deleted without further reply.

[BBAA]

Thanks again for your assistance, it is much appreciated and sorry to trouble you further. Obviously I am highly anxious and somewhat pre-occupied with my health.

My 6 week ELISA was negative. It was a combined test including P24 antigen and is considered near enough to conclusive at 6 weeks in my country (apparently). The rash has been diagnosed as tinea versicolor and is on my face, neck and chest. I continue to have the white tongue coating (another swab at 6 weeks came back OK), infected throat and tingling/numbness in my hands and fingers causing me to wake every night and have unbroken sleep. I also fear that I have swollen nodes in my neck - like most worried folks I gather. This is all despite me having taken a course of antibiotics. I am still feeling unwell and have symptoms remaining after 9 weeks, which is the impetus for my continual questioning.

To help quell my anxiety and fears, could you please help me assess my risk. Given I have little to no recollection of events, let us assume the very worst and say unprotected heterosexual intercourse occurred with a high risk person, which I understand from previous posts carries a 1 in 2000 risk, provided the partner is HIV+. Combine this with my test results and what are we looking at? I am thinking about testing now at 9 weeks, would you consider this conclusive and not advise re-testing (provided it is negative of course)? I can wait the 12 weeks, however I have important events occurring in the next week or so and I would rather put this issue to rest as soon as possible.

Thank you in advance and I understand that this will be the end of this thread.

[H. Hunter Handsfield, M.D.]

Not only is unlikely you were exposed, but your negative HIV test at 4 weeks is strong proof you were not infected.  The 6 week test also will be negative.  As for your symptoms, see my comment above about coated tongue.  The rash you describe doesn't sound like the typical ARS rash and the other symptoms don't suggest HIV.

It doesn't matter whether or not I have seen patients who were negative at 4-6 weeks and had positive results later.  I have not, but that doesn't mean it can't happen.  The time to positive HIV test results has been discussed innumerable times on this forum; use the search link for lots of discussions.

If your symptoms continue, see your provider for diagnosis.  It isn't HIV.

[BBAA]

Thanks for your response, it is much appreciated and reassuring.

I had a 4 week ELISA that came back negative and I am due for a 6 week ELISA in a couple of days.

I still have the white coating of the tongue and skin rash which is concerning me as it is now appearing on my shoulders and facial cheek but is not overly prominent. The only other symptoms I have been experiencing is the slight throat irritation and tingling in the fingers which is causing me to have unbroken and disruptive sleep.

Assuming one does not put themselves at further risk since a questionable incident, have you ever had patients test negative on an ELISA at 4 weeks and positive on a subsequent test at 12 weeks? What about a negative ELISA at 6 weeks and positive at 12 weeks?

Thanks for your assistance, it has been very helpful.

[H. Hunter Handsfield, M.D.]

Thanks for the comprehensive information and clear description of symptoms.  Some general comments before I go to the specific questions. First, you are a better judge than I can be about whether or not there was a potential sexual exposure to HIV, but since condoms were in the picture, most likely there was no serious risk.  Second, the initial symptoms came on too soon to be due to HIV.  Third, althoug some of the symptoms that came on later could be caused by HIV, the identical symptoms are caused by many other viruses and other conditions that are far more common than HIV.  And fourth, the negagive HIV tests at almost 4 weeks after exposure are highly reassuring that you didn't catch HIV.  (I'm intrigued that you had a CD4 count, however.  It would not be recommended in this situation by any professional familiar with HIV/AIDS.  If abnormal, it would not have meant anything in the absence of a positive HIV test.)

To your questions:

1) Nope.
2) Yes, that result is very reassuring.
3) Any number of viruses or metabolic conditions could be responsible, mostly with no long term health implications.
4) White tongue occurs with almost any illness suffered by humans, from common colds to cancer and everything in between. It is not a helpful diagnostic sign for anything.
5) Opinions vary, but with modern HIV tests a negative result at 4 weeks is probably around 90% reliable.
6) All things considered, it is almost impossible that you have have HIV.

Continue to work with your health care provider if your symptoms continue or you otherwise remain concerned.  But really, you can put HIV aside.  It's extremely unlikely.

Best wishes--- HHH, MD