Test at 9.5 weeks, ARS symptoms

[hmmm254]

Hello Doctor,

I have done extensive browsing through this site, but have found conflicting info on "conclusive" test results at different times.  I know inevitably similar questions get posted in this forum with similar replies, but please consider the nature of my symptoms.

Anyway, in December 2010 I had unprotected sex with a commercial sex worker in USA.  I tested negative via 2nd generation antibody test at 8 weeks exactly (Home Access HIV-1).  Then, at 9.5 weeks I tested negative again (via I'm assuming 3rd generation test through LabCorp--HIV-1 antibody with reflex to western blot, and HIV 1/O/2 abs qual).  Also, at that time all 7 other common STDs were negative.

I was feeling very confident and happy about my results, but now (at approximately 14-15 weeks post-exposure) I've felt very ill.  I have a pretty severe and diffuse rash on my chest, back, and arms that didn't respond to anti-histamines.  It is unlike anything I can ever remember, and really has no apparent cause.  Also, I've felt quite ill.  Mild fever and hot at night, headache, diarrhea, nausea, and malaise.  The rash is the most concerning, and is quite unusual for me... the rash on my trunk is what made me second-guess the situation.

I should note that I've been on corticosteroid nasal sprays each day (total of .2 mg of steroid/day), PLUS topical steroid ointment for skin issues (not at all like this rash), at about .1 mg daily.

1.  Could the steroids cause me a delayed seroconversion?
2.  How likely is it I have HIV?
3.  Do I need to test again, and should I wait till current symptoms resolve (assuming they are delayed ARS, so antibodies could form)?

I'd really rather not test again, but I'm pretty worried.  I just want some clear advice (from a conservative perspective) as to whether or not there is a real chance I still might have HIV and need more testing.  Please let me know if you need more details of exposure.

Thank you.

[Edward W Hook, MD]

Thanks for the additional information. It does not change my thoughts or recommendations.  Neither zyrtec nor amphetamines would keep your test from being positive (or delay a positve result) if you had acquired HIV (which you did not).

As far as the varying recomendations, the difference in 98%, 99%, "most" and "all" are semantic. We get asked the same questions repeatedly, sometimes on the same day. Sometimes the words come out a little differently.  Don't get hung up by it.

Finally, with regard to testing time, I will paste in a comment I made to another client explaing the situation - "We get many questions about the meaning of HIV test results at different time points.  This is now confused by the availability of a variety of different types of tests.  The traditional and most widely used tests for HIV are tests for antibodies to HIV which are available both as so-called "rapid" or point of care tests which can be done in the clinic and laboratory based antibody tests. For all practical purposes both of these types of test perform comparably and provide accurate information on the presence or absence of HIV infection in virtually everyone at 8 weeks following exposure.  The recommendations for testing at 3 and even 6 months are the result of two factors- data from older tests no longer used (you really do not need to worry about which generation of tests you were tested with, at this time virtually all tests are far more sensitive that they were even 2-3 years ago when the 3 month recommendation was made) and secondly, the fact that some, mostly governmental agencies which have to provide recommendations for virtually everyone without the sort of interactions such as those you get with your doctor or on personalized sites such as this one, feel the cannot "afford" to be wrong and therefore make recommendations and guidelines which leave most people unnecessarily nervous for 4-6 weeks longer than the 6-8 weeks it takes virtually everyone to develop HIV antibodies."

Hope this helps.  Take care. EWH  

[hmmm254]

What I meant by "conflicting info" was that sometimes you and Dr. HHH say "98%", "99%", "most", "all", etc.  Maybe its an issue of semantics.  Then again, I guess it depends on the nature of exposure, because it seems you both advise anybody with a known infected partner to wait till 3 months.  Also, other websites (i.e. thebody.com) seem to take a more conservative approach, but perhaps that is because that site seems to have a homosexual focus.

Anyway, I should add some things.  First off, rather than self-diagnose, I saw a doctor.  He thought my rash (which is now everywhere on body except for face), was scarlet fever or reaction to a skin-care product, and prescribed z-pack just in case (strep-test was negative).  The rash is sand-paper like.  He also gave me dyprazone cream, which is as of yet not working.  Just thought I'd bring that up as health sites say ARS is often "misdiagnosed."

Also, I was on zyrtec and amphetamine salts then, the latter causing some sleepless nights and poor nutrition.  I read those things can be immunosuppressive, and apparently the amphetamine salts are similar to what drug addicts use that is said to be the cause of "trashed immune systems."

I since stopped both medications, but wondering if while I was on those my immune system, and antibody production, was "halted."???  If so, would my "window period" start when I stopped the amphetamine and zyrtec use (late january)?

Forgive me if these are dumb questions; I just want to be sure.

[Edward W Hook, MD]

Welcome to our forum. You do not need re-testing and you do not have HIV.  Your results are conclusive and are to be believed.  I am surprised you think that we have provided conflicting information as we believe that we are consistent between the two of us and in the messages we provide.  We may use different words but the messages are the same.  A blood test for HIV antibodies taken 8 weeks after exposure is definitive evidence that you were not infected., there are rare exceptions of people who may have taken anti-HIV therapy but nasal steroid medications would not delay seroconversion.  The reasons steroids are given locally (i.e. via the nasal route and/or topically) is to avoid absorption.

I would add that the statistical likelihood of your being infected is quite low. It is unlikely that your CSW partner had HIV and even if she did, the likelihood of getting HIV from a single episode of unprotected vaginal intercourse is less than 1 in 1000.  

In answer to your specific questions

1.  No see below.
2.  You do not have HIV.
3.  You do not need to test again. the symptoms you describe are likely due to some other, coincidental process, not HIV

Hope this helps.  EWH