Time to move on?

[rallph]

Hello good doctors,

I had unprotected vaginal sex on Feb10, 2012 with a woman I know, but don't know about her sexual history. About a week after that, I developed a flu-like illness i.e. sore throat, night sweats, extreme fatigue, migratory muscle and joint pains, random rash all around my body, and also UTI like symptoms. A few days after these, I developed peripheral neuropathy, i.e. tingling, burning, numbness and extreme pain on my feet and hands, also an eczema like rash on my hand which had hardened raised skin and puss coming out of my follicules. Had no fever or swollen lymph nodes at all.

In three months all symptoms vanished one after the other except peripheral neuropathy which still lingers on and giving me a hard time. I also developed some canker sores on my upper gums and also a white patch on the left side of my tongue. The pain on my soles and palms are just unbearable.

I had 4, 6, 9, 12 (VIDAS HIV DUO ULTRA) and 13 weeks (COBAS) HIV DUO tests and also 14 week HIV-1 PCR RNA test, which were all NEGATIVE. My ID doctor says there's no way I have HIV, my tests are 100% conclusive and whatever symptoms I show are irrelevant, and he advised me to move on and get professional mental help. I'm already getting professional psychiatric help (4 sessions till now) and on medication but my state haven't improved one bit yet. The thing is, although I'm quite anxious now, when I developed the primary symptoms I had no anxiety at all.

Anyways,

1) Do you think I might be infected some rare variant of HIV which cannot be detected by current tests?
2) Is it true that in case of an infection; with a DUO test either p24 or AB portion of the test or both are positive, there 's no secondary window where p24 has dropped to undetectable levels while there's not enough ABs either?
3) What are the chances that I might be infected with HIV-2 and not yet have enough antibodies for it, where p24 portion of the DUO tests, and also the HIV1 PCR RNA is useless.

TY.

[Edward W Hook, MD]

Welcome to our Forum.  As is the case with Dr. Handsfield, there are some questions for which I suspect I will be able to provide an answer upon reading the title and before reading your entire post.  Yours is such a question- I presume the answer to your questions will be an emphatic YES.  Having said that, I'll now go on and read the question and address any specific questions you might have.

Indeed, having read your situation and questions, the answer remains yes-absolutely.  The encounter you describe was low risk. Few heterosexual women have HIV and most unprotected encounters with infected persons do not lead to transmission of infection.  Further, the symptoms you describe occurred before we would expect a person with early HIV to have symptoms.  Finally, your persisting symptoms are not a sign of early HIV but occur in persons with HIV either as a medication side effect (and you are not taking medications for HIV) or as a very late complication of the infection, occurring years after a person has become infected. Thus, even before I considered your test results, I was confident that you do not have HIV and, having read of the testing you have had, can say with complete confidence that you did not get HIV from the encounter you describe, just as your own doctor has informed you.  


Let's now discuss your specific questions

1) Do you think I might be infected some rare variant of HIV which cannot be detected by current tests?
No, no way.  Variants are just that, variants on the definiing organism. They reflect small variations in the make-up of the organism but the overall characteristics of the virus remain the same.  You have been tested for antibodies, antigen and viral DNA- 3 different broad classes of organisim components all of which would have been positive if you had HIV.  That NONE of the tests is positive is proof that you are not infected.

2) Is it true that in case of an infection; with a DUO test either p24 or AB portion of the test or both are positive, there 's no secondary window where p24 has dropped to undetectable levels while there's not enough ABs either?
Yes, once the DUO test is positive, it remains positive.  In your case, this is all confirmed by your PCR results as well.

3) What are the chances that I might be infected with HIV-2 and not yet have enough antibodies for it, where p24 portion of the DUO tests, and also the HIV1 PCR RNA is useless.
Zero.  When persons have HIV it is not that their tests are negative.  Rather they are typically indeterminant- leading to further evaluation which leads to the diagnosis of HIV-2.

I'm pleased for you to hear that you are working through these issues with a mental health professional. that's just the right thing to do.  In the meantime, please don't waste your time or money on additional testing. You did not get HIV from the February encounter you describe.  

I hope that my comments are helpful to you in your efforts to move forward.  EWH

[rallph]

Your comments helped me a lot to move forward. Thanks a lot. Take care.

[Edward W Hook, MD]

Lymphocyte testing of this sort is a waste of time and money in persons who do not have HIV- you do not have HIV.  Your results are fine.

Further questions will be deleted without comment.  EWH

[rallph]

Hello again Dr EWH. One last follow up, if you let me. Before I posted my question I had left my blood to the lab for a CD4/CD8 count (most probably useless and irrelevant, I know) and just got the results about an hour ago. The results are:

WBC 7700
Lymphocyte 2450
Total CD3 1266
Total CD4  671
Total CD8  580
CD3 51,71(L)
CD4 27,4 (L)
CD8 23,69
CD4/8 1,15
CD45 97,31

Do these results look normal to you? Can I feel even more assured with these? Those "low" remarks near CD4 and CD3 percentages got me a little bit worried, to be honest.

This will definitely be the last question from me. Thank you.

[rallph]

Fair enough, dear doctor. No further questions, as I promised.

Thank you for your help. I will concentrate on my therapy to leave this whole thing behind.

Be well.

[Edward W Hook, MD]

I do not agree that PN is a manifestation of early HIV.  

You don't have fast moving HIV- there is no evidence whatsoever that you have fast moving, or any other sort of, HIV. There are a small number of persons in whom the infection progresses quickly but they all have positive tests, you do not.  For you to have some anomalous HIV would require evidence of some sort that you have HIV and there is so such evididence.  

Take care. EWH

[rallph]

Thank you very much for your fast and clear response Dr. EWH.

I have read some scientific articles (not public forum rubbish) which claim PN can be an early sign of HIV, which made me quite nervous. I guess you don't agree with those claims, neither does my doctor.

Another scenario in my mind is that I might have a fast progressing HIV infection causing some advanced stage symptoms, which is mentioned as "exceptionally rare" on some medical articles. Someone has to be one of those exceptionally rare cases after all. The obvious question is: Why not me? :)

I would like your final comments on these and I promise not to go on with any "what if"s and "yes but"s and concentrate on my therapy as I'm already trying to do.

Thanks a lot once again.

[rallph]

I have to add some more details due to character limit: I sometimes have digestive system troubles, diarrhea, nausea, stomach ache, and also this weird headache, which is dull and pressure-like, usually on my forehead and behind my eyes.