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Symptoms vs. Testing- Which one to believe?
Dr HHH-
I am in need of your advice. Unfortunately I had unprotected vaginal and anal sex with Black CSW from a low class burdel in Europe in early Sept 2012 (? HIV status) Two-three wks later I developed a severe soar throat followed by a nasty rash in the inner aspect of my egs extending to my ankles- it was red , bumpy and quite itchi (urticaria-like rash) and lasted for 1 week or so. Becasue of these symptoms I decided to have a HIV 1&2 EIA , HIV RNA load, Hep B and C Antibodies, RPR, chlamydia and GC testing. These were done 5 weeks after my exposure and were reported as negative. I re-tested at 11 weeks post-exposure with hep B and C serologies (not including a RNA for Hep C), HIV 1&2 EIA and again RPR. All these negative again. Now I am wondering if I need to test for something else outside HIV or specifically for HIV again as I tested before the 90 days mark the CDC recomend. I know ARS does not last, however I continue having b/l submaxillary lymphadenopathy, muscle tenderness in arms and painful joints in shoulders and hands. My hands are alsoquite red (palms) and I began to itch throughout my body quite a bit + have RUQ discomfort. NO jaundice, or chnages in stool or urine. BTW, also had LFTs done at 11 weeks and these were normal as well.
My life is a complete mess becasue of this. I can not explain why I feel ill and have all these symptoms. Any input would be greatly appreciated. No matter what I rather now that continue living with the uncertainty of guessing an illness. Thank you
I am in need of your advice. Unfortunately I had unprotected vaginal and anal sex with Black CSW from a low class burdel in Europe in early Sept 2012 (? HIV status) Two-three wks later I developed a severe soar throat followed by a nasty rash in the inner aspect of my egs extending to my ankles- it was red , bumpy and quite itchi (urticaria-like rash) and lasted for 1 week or so. Becasue of these symptoms I decided to have a HIV 1&2 EIA , HIV RNA load, Hep B and C Antibodies, RPR, chlamydia and GC testing. These were done 5 weeks after my exposure and were reported as negative. I re-tested at 11 weeks post-exposure with hep B and C serologies (not including a RNA for Hep C), HIV 1&2 EIA and again RPR. All these negative again. Now I am wondering if I need to test for something else outside HIV or specifically for HIV again as I tested before the 90 days mark the CDC recomend. I know ARS does not last, however I continue having b/l submaxillary lymphadenopathy, muscle tenderness in arms and painful joints in shoulders and hands. My hands are alsoquite red (palms) and I began to itch throughout my body quite a bit + have RUQ discomfort. NO jaundice, or chnages in stool or urine. BTW, also had LFTs done at 11 weeks and these were normal as well.
My life is a complete mess becasue of this. I can not explain why I feel ill and have all these symptoms. Any input would be greatly appreciated. No matter what I rather now that continue living with the uncertainty of guessing an illness. Thank you
MEDICAL PROFESSIONAL
"I wonder what will take for the regulatory agencies in the US to change from that benchmark of 3 months to 8 weeks." It won't happen in the foreseeable future, maybe never. The research to prove to the FDA and other regulatory authorities that earlier testing is valid is just too expensive, and otherwise quite impractical.
That's definitely all for this thread. Take care.
That's definitely all for this thread. Take care.
Thanks again
I wonder what will take for the regulatory agencies in the US to change from that benchmark of 3 months to 8 weeks. It causes significant distress to consumers to keep a guideline that is not followed by HIV experts or health care providers with understanding of the disease.
I wonder what will take for the regulatory agencies in the US to change from that benchmark of 3 months to 8 weeks. It causes significant distress to consumers to keep a guideline that is not followed by HIV experts or health care providers with understanding of the disease.
MEDICAL PROFESSIONAL
"are there any specific circumstances where you would recommend me to get additional HIV Ab testing after the one negative result I had 11 week after exposure ? "
No, none.
That will end this thread. Do you best to move on without worry.
No, none.
That will end this thread. Do you best to move on without worry.
Thank you again dr. My question to you was incorrect. What I meant to ask you was - are there any specific circumstances where you would recommend me to get additional HIV Ab testing after the one negative result I had 11 week after exposure ?
I am somewhat satisfy with my results for HIV 1 due to the negative RNA load in combo with the Ab however due to the fact that the woman was AA from west Africa-y main issue is testing for HIV 2 after the 11 week mark.
From what I read it appears that the Ab does not have the same spec/sen for HIV 2 as it does for type 1.
Thx
I am somewhat satisfy with my results for HIV 1 due to the negative RNA load in combo with the Ab however due to the fact that the woman was AA from west Africa-y main issue is testing for HIV 2 after the 11 week mark.
From what I read it appears that the Ab does not have the same spec/sen for HIV 2 as it does for type 1.
Thx
MEDICAL PROFESSIONAL
1) You're right about that particular PCR. But HIV-2 is vanishingly rare in the US, and your antibody test covered both HIV types.
2) No, except to further assuage your anxieties.
2) No, except to further assuage your anxieties.
Thank you again Dr. H, I will follow your advice and see a doctor to further define my current symptoms. Just out of curiosity 2 final questions
1. How is possible that the HIV Quant RNA by PCR I had at week 5 post-exposure can capsure HIV-2.?
I thought this was specific for RNA for type 1 only - My results below:
Negative for HIV-1 RNA by PCR.
Comment: Linear range of assay: 20 copies/mL to 10,000,000 copies/ml.
2. Are there any circunstances where you as HIV specialist order a test for
HIV 1 & 2 Ab (EIA) after 3 months or 90 days ?
Lastly, if in your professional expertise I dont require additional testing for HIV or any other STD including Hepatitis, I wont bother testing again now that I am 3months out post exposure. I feel that by doing so, I would go against your professional opinion which at the end this was the main reason why I paid for the service.
In gratitude- All the best
1. How is possible that the HIV Quant RNA by PCR I had at week 5 post-exposure can capsure HIV-2.?
I thought this was specific for RNA for type 1 only - My results below:
Negative for HIV-1 RNA by PCR.
Comment: Linear range of assay: 20 copies/mL to 10,000,000 copies/ml.
2. Are there any circunstances where you as HIV specialist order a test for
HIV 1 & 2 Ab (EIA) after 3 months or 90 days ?
Lastly, if in your professional expertise I dont require additional testing for HIV or any other STD including Hepatitis, I wont bother testing again now that I am 3months out post exposure. I feel that by doing so, I would go against your professional opinion which at the end this was the main reason why I paid for the service.
In gratitude- All the best
MEDICAL PROFESSIONAL
As I said, I see no need for any further testing at any time. However, since official advice from CDC and other agencies still calls for 3 month testing, you might consider doing that (antibody test only) -- just to know that even with the most rigid guidelines you still tested negative.
The viral RNA/DNA ("viral load") tests rarely if ever miss HIV-2. In any case, that virus is pretty much nonexistant in the US except in immigrants from the parts of Africa where it is endemic, such as Cameroon.
We don't delve into hepatitis C diagnosis. Contrary to what you (and many) have come to believe, it's not an STD. The only situation in which HCV has been documented to consistently be sexually transmitted is among gay men who participate in traumatic (bloody) rectal sexual practices. Having said that, the symptoms/testing issue is the same as for HIV: the tests are far more reliable than symptoms. You don't have it.
It is irrational to delay health care for "fear to officially have these issues documented in my records". Under federal law, the penalties are very stiff for inappropriate disclosure of private medical information and it virtually never happens. Even your insurance company would not know any behavioral bits, only what lab tests etc were done. And even there, only a computer will "know"; humans rarely are involved in insurance payment decisions. So just do it. It is wasteful of your time and emotional energy (and indirectly of mine) to attempt to get answers any other way.
If I were in your situation, I would have been continuing unprotected sex with my wife ever since my negative 5 week HIV test results, without fear of infecting her with anything.
Thanks for the thanks. Take care.
The viral RNA/DNA ("viral load") tests rarely if ever miss HIV-2. In any case, that virus is pretty much nonexistant in the US except in immigrants from the parts of Africa where it is endemic, such as Cameroon.
We don't delve into hepatitis C diagnosis. Contrary to what you (and many) have come to believe, it's not an STD. The only situation in which HCV has been documented to consistently be sexually transmitted is among gay men who participate in traumatic (bloody) rectal sexual practices. Having said that, the symptoms/testing issue is the same as for HIV: the tests are far more reliable than symptoms. You don't have it.
It is irrational to delay health care for "fear to officially have these issues documented in my records". Under federal law, the penalties are very stiff for inappropriate disclosure of private medical information and it virtually never happens. Even your insurance company would not know any behavioral bits, only what lab tests etc were done. And even there, only a computer will "know"; humans rarely are involved in insurance payment decisions. So just do it. It is wasteful of your time and emotional energy (and indirectly of mine) to attempt to get answers any other way.
If I were in your situation, I would have been continuing unprotected sex with my wife ever since my negative 5 week HIV test results, without fear of infecting her with anything.
Thanks for the thanks. Take care.
Thank you for your prompt response and insight. Just out of curiosity, if I did not have the HIV load test at 5 weeks post exposure and only had the HIV1&2 EIA at 5 and 11 weeks, would you still recomend testing with a new EIA after 90 days? You seem to imply that in your response. Also is 12 weeks or 90 days or 24 wks or 180 days (for those who believe in the 6 months test)
Also isn't the HIV load I had specific for HIV-1? what about HIV 2 or other serotypes? Could we be missing one of those?
Withe the RUQ pain I developed, I wonder if a RNA load for Hep C is needed. As you saw, I had the Hep C Ab only + all Hep B serologies for acute and chronic infection at 11 weeks post exposure.
How about other viruses that could be transmitted sexually ? SOmeone in your forum has mentioned HTLV? -worth testing for?
To your question ref: seeing a doctor- No, I have not and it is a clear fear to officially have these issues documented in my records. I do understand I will have to do it.
ALthough I did not mention earlier, I have a long standing partner. I wonder if with all the testing done, I can be reassured that unprotected sex would be ok
Thank you again for your medical expertise and the great service you provide in this forum
Also isn't the HIV load I had specific for HIV-1? what about HIV 2 or other serotypes? Could we be missing one of those?
Withe the RUQ pain I developed, I wonder if a RNA load for Hep C is needed. As you saw, I had the Hep C Ab only + all Hep B serologies for acute and chronic infection at 11 weeks post exposure.
How about other viruses that could be transmitted sexually ? SOmeone in your forum has mentioned HTLV? -worth testing for?
To your question ref: seeing a doctor- No, I have not and it is a clear fear to officially have these issues documented in my records. I do understand I will have to do it.
ALthough I did not mention earlier, I have a long standing partner. I wonder if with all the testing done, I can be reassured that unprotected sex would be ok
Thank you again for your medical expertise and the great service you provide in this forum
MEDICAL PROFESSIONAL
Welcome to the forum.
Yours would appear to be one of those questions that can be answered accurately based only on the title, "Symptoms vs. Testing- Which one to believe?". One of the most consistent themes throughout the 9 years since this forum was established is that test results ALWAYS overrule symptoms, as long as testing is done sufficiently long (typically 6-8 weeks) after the last possible exposure. The same is true of exposure history. It doesn't matter how high risk your exposure was, and it doesn't matter how typical your symptoms seem to be for ARS. If you tested negative more than a few weeks after exposure or symptom onset, then for sure you don't have HIV.
Now I have gone ahead and read the question itself. Guess what? I nailed it above. The CDC recommendation for definitive testing at 90 days applies when only antibody tests are done -- but you had both antibody tests and an HIV RNA test. The combination of those negative results is definitive. For more information on time to reliable HIV test results, including discussion of why 90 day testing rearely is required, see the thread linked below:
http://www.medhelp.org/posts/show/1704700
I cannot say what is causing your symptoms; a forum like this is not intended to be, and never substitutes for in-person professional care. All I can say is that HIV isn't the cause, and also no STD is a likely explanation, and probably it's unrelated to the sexual exposure described. You don't mention seeing a doctor or clinic. If you did, what did they say? If not, that's obviously your next step.
I hope this helps ease your anxities about HIV. Best wishes-- HHH, MD
Yours would appear to be one of those questions that can be answered accurately based only on the title, "Symptoms vs. Testing- Which one to believe?". One of the most consistent themes throughout the 9 years since this forum was established is that test results ALWAYS overrule symptoms, as long as testing is done sufficiently long (typically 6-8 weeks) after the last possible exposure. The same is true of exposure history. It doesn't matter how high risk your exposure was, and it doesn't matter how typical your symptoms seem to be for ARS. If you tested negative more than a few weeks after exposure or symptom onset, then for sure you don't have HIV.
Now I have gone ahead and read the question itself. Guess what? I nailed it above. The CDC recommendation for definitive testing at 90 days applies when only antibody tests are done -- but you had both antibody tests and an HIV RNA test. The combination of those negative results is definitive. For more information on time to reliable HIV test results, including discussion of why 90 day testing rearely is required, see the thread linked below:
http://www.medhelp.org/posts/show/1704700
I cannot say what is causing your symptoms; a forum like this is not intended to be, and never substitutes for in-person professional care. All I can say is that HIV isn't the cause, and also no STD is a likely explanation, and probably it's unrelated to the sexual exposure described. You don't mention seeing a doctor or clinic. If you did, what did they say? If not, that's obviously your next step.
I hope this helps ease your anxities about HIV. Best wishes-- HHH, MD
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