Recently diagnosed with high levels of CMV and Epstein-Barr, could this be HIV related?

[27andsick]

I had a very risky one-time exposure with a female of unknown HIV status, on 4/14/08.  We had unprotected vaginal sex and she was on her period.  Two weeks after my exposure I got hit with flu-like symptoms so severe I had to miss three days of work.  These flu-like symptoms have continued with less severity for 9 weeks now.  I took a baseline blood test for HIV a week after my exposure and it was negative.  Five weeks after my exposure I got a viral load test which came back negative.  All of this was good news, but my symptoms persisted, so I went to an ENT and she tested for CMV, HIV, and Epstein-Barr.  This test was done 8 weeks past exposure.  I was negative for HIV, but I was told that my CMV and Epstein-Barr levels were high.  This diagnosis is partly reassuring as far as HIV is concerned but what I am wondering is, how common is it to have high levels of both of these viruses at the same time?  Isn't it probable that I have had these viruses dormant for a long time, if so what would cause them to be at such high levels that they are making me experience such severe symptoms now?  Could it be that I have contracted HIV and the HIV virus is overwhelming my immune system, so that it can not fight the CMV and Epstein-Barr virus?  Is the diagnosis of high levels of CMV and Epstein-Barr an indicator of a more serious immune system infection(HIV)? Do you have any statistics of acute HIV infection and the prevelance of CMV, Epstein-Barr in those patients?  Thank you for taking the time to consider my questions.  I apologize if they are completely irrational, I hope they are.

[27andsick]

Thank you for your firm approach to what is obviously a very anxious and stressful  situation for me.  

[H. Hunter Handsfield, M.D.]

Many anxious people tend to read between the lines for hidden meanings.  I'm not that devious.  I said your tests show you didn't catch HIV; if I felt otherwise I would have said it directly, and not just drop a hint.  The ID specialist idea was exactly for the reason I stated, to help sort out why you had continuing symptoms and whether CMV or EBV might be involved.  Nothing more.  In general, ID specialists understand EBV and CMV better than most otolaryngologists.  But even this is necessary only if you remain concerned about your symptoms.

"High" antibody levels, without detecting the virus itself, probably say nothing about the likelihood that either virus caused your symptoms or that either infection is recent.

You came to the forum for reassurance about HIV.  Please accept it and move on.  Don't try to talk me (and yourself) into believing you have it.  You don't.

[27andsick]

Thank you for your comment.  I would like to clear up one more thing though.  You mentioned an infectious disease specialist, would this be because you feel I do have a legitamate concern for HIV?  I am not positive if they tested for the virus or antibodies, but I believe it was the antibodies and I was told the CMV, Epstein-Barr levels were "high".  

[H. Hunter Handsfield, M.D.]

Responding first to the question as posed in the title:  If HIV testing is negative, then your CMV and EBV are not related to HIV.  Such infections do not alter HIV test results.

Now having looked at the question itself:

Your symptoms probably were consistent with infectious mononucleosis (caused by Epstein-Barr virus, EBV); cytomegalovirus (CMV) is less likely but possible.  It would be statistically pretty unusual to catch both viruses simultaneously.  However, both viruses persist for life and half of all adults have been infected, mostly acquired during childhood, so your positive tests might have nothing to do with your symptoms.  That said, I cannot say how common it is to have "high" levels of test results for both CMV and EBV.  The strength of the positive test can vary a lot, without indicating whether an infection is recent or old.

In other words, you could have had both infections and that they were (and still are) dormant; your symptoms aren't necessarily due to either EBV or CMV.  However, this depends a bit on the specific kinds of tests that were done, i.e. whether you were tested for antibody or for the viruses themselves.  Your ENT doc should be able to tell your.  If you remain ill, you might ask her about possible referral to an infectious diseases specialist for further evaluation.

As to the ancillary questions:  No, it is not possible that you really have HIV that the tests missed.  There are no statistics of the sort you request, except that among people with negative HIV tests like you have had, nobody has HIV -- and that is the only statistic that matters here.

Finally, if your symptoms, either initially or now, were due to EBV or CMV, you can be sure they will continue to improve; it's just a matter of time.  Those infections are unpleasant but rarely serious and will clear up entirely.

I hope this helps. Best wishes--  HHH, MD