Need your help please

[happyindian]

Hello Sir – Thanks for taking my question.

I had an unprotected oral / vaginal exposure with an escort a month back. I got scared and had the escort tested at the 4 week mark. The results are below:

1. HIV-1 Antibody - < 1 - Negative
2. HIV 1/O/2 Abs, Qual - Non Reactive - Negative
3. HIV-1 DNA - Negative

After the results, my anxiety reduced. But exactly at the 5 week mark, I have fever and chest pain. The chest pain kind of started at the 3 week mark and has been there till now. I went to the Doctor who said that the chest pain and fever are due to a bacterial infection. The only thing that scared me is the WBC count of 15.3.

I have the following questions:

1. I see that you normally say that at the 4 week mark, DNA PCR + antibody testing is conclusive for HIV. Do I need to be concerned about HIV? I also know that DNA test does not cover HIV 2. Is this a problem or can I move on from HIV? Is any further testing required as the escort has tested negative?

2. Do I need to be worried about any other strains of HIV other than 1 and 2?

3. Can ARS symptoms come at 5 week mark? I assume not. Do my symptoms sound like ARS? Is Chest pain part of ARS?

4. Do I need to be worried about the WBC count? Does it go up during ARS like this?

5. My fever was not high. It was only 99.8 and only for a day. What is the normal fever temperature for ARS and how long does it last?

Thanks for your time sir.

[H. Hunter Handsfield, M.D.]

1) I see no need to repeat myself.  I haven't changed my mind.

2) The antibody test covers HIV-2, and iny case that virus is vanishingly rare outside very localized parts of Africa.  Nobody ever routinely tests for HIV-2; it would be a waste of time and money.

3) ARS symptoms usually start in 10-15 days and I doubt it ever takes more than 3 weeks.

4) I meant the temperature level, not duration.  

You don't have HIV.  Believe it.  Try to accept the scientific evidence and the reasoned reassurance you have had.  That will be all for this thread; I'll have no further comments or advice.

[happyindian]

Thanks for your comments and response Doctor. I have these last few questions before I wrap up:

1. Just to confirm, DNA + Antibdoy is conclusive at 4 weeks?
2. DNA test does not cover HIV 2. How can I be assured that she did not have HIV 2? I know that the 4 weeks is almost 90% sure. What if she had a recent exposure?
3. How late can ARS come? Is ARS not possible at 5 weeks?  I understand that my symptoms are not ARS. THis is just a general question please
4. When you say the amount of fever, do you mean the # of days?

Thanks again for your time and help sir

[H. Hunter Handsfield, M.D.]

Welcome to this forum.  Based on this question and the one on the STD forum last year, you seem to be in a pattern of occasional extramarital sexual adventures, followed by anxiety and a request for reassurance about HIV and STD.  Perhaps you need to reconsider your lifestyle!  But if you're not going to do that, for your extramarital exposures, for goodness' sake start using condoms consistently!

OK, lecture done.  To your questions.   The test results show your escort partner didn't have HIV.  So why are you worried?  For practical purposes, there is no window period for the combination of antibody plus antigen and DNA testing.  It is not possible your symptoms are due to HIV from that exposure.  If this and your STD forum quesation are typical, you tend to fear that just because a new symptom follows a new sexual event, it must be related to it.  Of course the kind of symptoms you describe are far, far more often due to garden variety viral or bacterial illnesses.  And apparently your doctor agrees.  To the specific questions:

1) It's not that "we say" such test results are conclusive.  They simply are; scientific fact, not a matter of opinion.

2) There are no HIV types other than HIV-1 and 2.

3) Five weeks is too late for ARS symptoms, and ARS doesn't cause sympotms of the sort you describe.

4) Elevated WBC count fits best with a bacterial infection.  HIV does not cause such high WBC numbers.  Discuss this with your doctor if you remain concerned about it.  

5) The amount of fever you have had says nothing about the cause.  HIgh or low, it doesn't suggest HIV.

I suggest you continue to work with your doctor about the causes and treatment of your current illness.  You can be sure it isn't HIV, and almost certainly it has nothing at all to do with your recent extramarital encounter.

I hope this has helped.  Best wishes--  HHH, MD