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Avatar universal

Help! In a panic!

Hi, I'm a male who has sex with men, and I have an HIV-related concern. My last negative HIV test was on 4/7/08, which was 45 days after an unprotected encounter with another guy who I know fairly well and who claims to be HIV-. (I was both the penetrative and receptive partner then - i.e., we switched.) I had sex with him again around 4/3/08, and this time we briefly did the same thing without a condom before we realized it was stupid and stopped. On both occasions, nobody came inside of anyone, although there obviously could have been pre-*** exposure for whoever was on bottom at the moment.

Other than that, my only unprotected encounters have been oral sex, and I've not allowed anyone to ejaculate into my mouth.

On 5/2/08, about four weeks after my last brief unprotected encounter with the guy, I developed a fever, ranging anywhere between about 99.5 and 101.8, a fever that has continued for a week. I also have had slightly swollen lymph nodes in the neck and groin (which I get whenever I have a cold), fatigue, and night sweats (which I always get with fever). I also have a lot of nasal congestion and drip down the back of my throat, something that I don't think is common with ARS. A little bit of nausea and loss of appetite, but no vomiting or diarrhea. Some very slight muscle pain, some very, very slight sore throat. And lots of fatigue - I just feel tired all the time, although it doesn't keep me from getting my work done each day. And maybe a small rash with reddish dots about the size of the head of a pin on my upper right arm, basically on top of the bicep. But nothing too noticeable.

I went to the doctor today and had them run a CBC, and it revealed thrombocytenia (low red blood platelets) and lymphocytosis (high lymphocyte counts). The first is consistent with ARS, while the second is not so common - more common to see lymphocytes drop in ARS, not go up. The doctor said that a mono test came back negative, but that mono tests often take up to two weeks after symptoms start to become positive, but that the CBC results were consistent with either mono or CMV, and not as much with HIV. Still, I am debating doing a (very expensive) viral load RNA test just for my peace of mind.

I know no one can diagnose HIV based on the symptoms I am describing and that it's quite likely I have something else, but I thought I'd look for some reassurance on here. Or if I have real reason for concern, that would be good to know too. I don't know much about interpreting the CBC results, but the doctor said it's clear that whatever I have is viral, which I kinda knew already.

Based on the high lymphocytes and congested nose with lots of drip down my throat, along with some sinus pressure, I'm inclined to think it's not ARS. But there is still the low red platelets, the fever that has lasted about a week, and slightly swollen lymph nodes, and the slight rash on my upper arm (although I know ARS rash is usually face, neck, and torso). But if anyone here has any ideas, I'd appreciate it.

I'm taking anti-anxiety medication but find it hard to function due to my paranoia. So let me know - does it look like I'm totally screwed.
71 Responses
451075 tn?1210258648
A doctor told me that CBC is never a good indication for HIV. Symptoms are not either, since a lot of people do not have symptoms of ARS and are HIV+, while some experience ARS symptoms but they are caused by something else. I would say definitely invest money in the expensive RNA test and have a peace of mind, because obviously you are going to spend much more living with this stress.

Get tested because your risk was very high. I hope your results are good and wish you the best.
Avatar universal
Why not just have your partner and yourself go and get tested, that would clear this up really quick?
461503 tn?1212066010
a 45 days test is 95% accurate, the odds are in your favor just take the test 3 months after the last exposure, the syumptoms like said thousands times are useless and meaninless, so dont worry about them.

Good luck
219662 tn?1223858560
Forget the RNA and CBC tests. Simply take a regular HIV test sometime in July, it will be accurate. Obviously do not repeat this mistake in the future, whether you're positive or negative
Avatar universal
Thanks for the advice. However, waiting until July for any additional work seems very foolish. First, because I am a nervous wreck, and I really don't want to stay a nervous wreck until July. Second, and more importantly, if I would turn out to be positive, it's better to get an early diagnosis, during the the primary infection phase, so one can discuss the wisdom of starting anti-retroviral medication.
461503 tn?1212066010
So just take a test at 6 weeks 95% accurate and then at 3 months for a conclusive result
Avatar universal
I've already gone to the county health department to get a test done. The state where I live combines the antibody test with an RNA viral load test. If the antibody test is negative, they re-test for the virus itself. So I should know something one way or another in two weeks, once the test results come back. Obviously, an undetectable viral load during primary infection would tend to indicate that I was not infected, since viral load is always through the roof during primary infection. Thanks for the advice.
219662 tn?1223858560
In terms of early diagnosis and treatment it makes very little difference if one is diagnosed at 2 months or 3 months. If your anxiety is getting to you - like ECN said, you can test a couple of weeks from now and get a pretty reliable result. PCR is also an option as you already know, but is overkill in my opinion.
Avatar universal
Thanks, and I'm sure you're right. Really, I know my symptoms could be caused by a thousand other things, as could the CBC blood test results. And I know that even the behavior I engaged in is not a guarantee for HIV transmission, especially since the riskiest encounter was 45 days before my last test. My problem is that I start with the symptoms and conclude, based on them, that it must be HIV. And I know it's not a smart thing to do, but I also find myself doing it pretty compulsively.
Avatar universal
PCR's are kind of flaky too, should have just waited it out for an antibody test.
219662 tn?1223858560
I think you are overanalyzing a little bit.  The point is that you had receptive anal intercourse and a bad viral infection 4 weeks later.  That's not good, whichever way you try to analyze it.  Since you can't change the past, the only thing to do now is wait and get tested. If you test negative, try to stay negative: always use condoms. I wish you all the best.
Avatar universal
Yes, but my receptive anal intercourse four weeks before lasted about 10 seconds before I pushed him out. Not safe, obviously, but not as dangerous as doing it longer or letting him ***. Thanks for the good wishes. I certainly need them.
Avatar universal
Sorry to dredge up an old post, but I'm still kind of freaking out. And constantly researching stuff on the Internet is not helping. My fever and other symptoms have lessened, although I remain fatigued and have an absolutely horrible runny and stopped up nose with tons of sneezing - not allergy-related, I don't think. As of last Friday, my CBC said that my platelet count was only 90 (145 is the low end of normal). I got another CBC done Monday, and they were back up to 140, or almost normal. Some slight lymphocytosis, some slight leukocytosis, but nothing very far at all above normal. And I had a 20-minute rapid test (34 days after my potential exposure), which came back negative.

My doctor let me know today, however, that my most recent blood work also showed elevated liver enzymes - ALT, ALS, and alkaline phosphatase were all high. He said it could be caused by alcohol, mono, or even all the acetaminophen I have been popping over the last week for my fever. So of course I instantly started researching online if elevated liver enzymes are associated with primary HIV infection, and of course I found out that they sometimes are - because basically everything you can think of is sometimes associated with primary HIV infection.

Anyway, this has sent me into freak-out mode again, and I'm trying to figure out if these liver enzyme tests justify my panic. I'm guessing people are going to tell me that elevated liver enzymes, low platelets, and high lymphocytes and white blood cells can all be caused by a thousand other things than HIV, and if I'm gonna be freaked out, it should be over the fact that I had unprotected sex, not over my symptoms.

But I wanted to ask anyway and see if anyone has any input. I'm a nervous wreck, as you can undoubtedly tell. Thanks!
Avatar universal
Well your 34 day negative rapid is good news, average time to build detectable antibodies is 25 days. Plus you had a test 45 days prior to sex with the same guy. Seems as though that would be the equivelent of a 79 day negative test which isnt going to change in the future.

Your concerns would appear to be not HIV related.
461503 tn?1212066010
Relax some studies said that from the 50% porcent of infected people only 14% had some ARS related with liver, thats 7% from the total so is not really an ARS symptom since around 5% of infected people also have Hep B coinfection it almost sure that the liver ARS symptoms are more related to Hep.
Avatar universal
Your 34 day negative test result is good. Wait for 3 motnhs and ge tested again. Please use condom everythime you are involved in anal/vaginal sex. Wish you all good luck, just try to relax a bit.
And I think ECN is right, please also test for HEP B or C.
Avatar universal
I am vaccinated against Hepatitis-B, although there isn't a vaccination for C, I don't think. If I'm too freaked out, my doctor is suggesting I see an infectious disease specialist who can run every possible test you can think of to figure out what (if anything) is wrong with me.
Avatar universal
Then you are in good shape for HEPB. Try to relax a bit. Wait for 8 weeks and do another blood test to be 98% sure about your status. Once that come negative you will be in much better shape mentally. All the best.
Avatar universal
So I went to see the infectious disease specialist today, who deals frequently with people with HIV, and he kind of freaked me out. He said that all my symptoms and blood work are consistent with primary HIV infection, although antibody tests (today 41 days post-exposure) continue to be negative. He claims that I should not be encouraged by my 41-day negative test today, since he claims that a large number of people seroconvert after six weeks. Most disconcerting of all, he said that he was not willing to say that he thinks I don't have HIV.

On the other hand, based on the risk I described (very brief unprotected anal sex with a male who claimed to be HIV negative and with whom I had had sex many times), as well as receptive oral sex without ejaculation with partners of unknown status, he said that if it does turn out to be HIV, he'll consider me remarkably unlucky, since he does not consider my potential exposure to have been a horribly high risk.

So now I'm just confused, because the doctors on the doctor forum, as well as lots of people on here, all insist that oral transmission is ridiculously rare, especially without ejaculation, and that a six-week (well, in my case, one day less than six weeks) test is 95% accurate. And everyone insists that symptoms are not an accurate way to predict infection. Yet this infectious disease specialist insisted that virtually everyone who comes to see him with my symptoms turns out to be infected - that is, if they make it as far as an infectious disease specialist, other possibilities have often been ruled out. And he claimed my blood work (elevated liver enzymes, low red blood platelets, slightly high lymphocytes) pointed in that direction too. So he was really ambiguous and hard to read, and it wasn't a very satisfying appointment.

I had a combined antibody-viral load test done at the county health center a week and a half ago, and I'll get my results Friday. He told me to call him and come back next week if the results show a viral load (obviously the antibody part will be negative). Of course, I'm busy trying to figure out if maybe I got infected orally more recently. (After all, if the odds are 1/10,000, and if 10,000 HIV-infected people get oral sex in a day - something that seems likely since there are probably 700,000 HIV+ men in this country - that would mean that one of them would probably pass it along every day. Probably with ejaculation rather than without, but hey, it does still happen.)

What do people think of his apparent belief that symptoms, and especially CBC and CMP provide clues to HIV infection? And what about his apparent doubt that a six-week negative Ora-quick result meant anything at all? He told me that the only thing a six-week negative would be good for would be to make me feel better, but that it didn't really mean anything. Is the guy a quack? Unknowledgeable? And finally, what about my fears of oral transmission without ejaculation? Am I a nut too?

Thanks. I promise I won't dredge this up again til I get an antibody/viral load result on Friday. I'm obviously going to be an emotional mess til then.
Avatar universal
Although the test was a little bit early, I would highly doubt it will turn positive later. Like Dr HHH and Hook said they never seen a 6 week negative go positive, I would take that for whats its worth, those guys are respected in the field.

Avatar universal
Unless, of course, I somehow managed to catch it after the unprotected anal sex through uprotected oral sex without ejaculation. Doubtful. But I'm paranoid, LOL.
Avatar universal
Is he a doctor?  HIV transmission if you are the one giving oral is extremely rare, if you have recieved oral, well there are no cases of transmission.  If you have a negative in 6 weeks, its extremely hard that this will change to a positive in 12.  You are not a nut, you dont have HIV and unfortunately you went to some moron who has a) no idea how to deal with people and b) no idea what in the hell he is talking about. You realize its hard to detect HIV through blood work, the only way to detect it is through an HIV test, that said, if your blood work was pointing in that direction, then you would have tested positive by now.  Your anal unprotected is high risk, but if at 6 weeks you tested negative, I highly doubt that will change, though you realize you need to test again at 12 weeks, your test at 6 weeks is a good indication youwill be negative.  As if this guy is a quack, I know a lot of people even in the health care field that have no clue as to how HIV is transmitted even.  If he is giving you ambigious answers then he can t be much of a specialist can he, you dont see the two guys in the doctor's forums giving people ambigous answers as to this subject.
Avatar universal
See, that's one thing that makes it so tough. This guy is a doctor with an M.D. from the University of Virginia who has been practicing in infectious diseases and internal medicine for nearly twenty years. He has a ton of experience dealing with HIV infection. But I guess none of that is any guarantee that he knows what he is talking about or has read any of the recent research on seroconversion time or the usefulness of blood count and metabolic function testing in indicating HIV infection. I don't know. He just really scared me with his noncommittal attitude and unwillingness to say that I probably don't have it. He seemed to think that I'm very likely screwed. I guess that doesn't mean anything til I have my viral load test back on Friday. But it was still a very troubling meeting, that's for damn sure.
Avatar universal
May be he is just being a bit conservative and wants to ensure that you test at the 12 week mark.  That too could be a possibility, he does not want to reassure you until you are truly 100% out of the hole.
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