Possible ARS symptoms

[sunny83]

Hello Doctor,

I had brief unprotected sex with CSW for about 10 seconds. Though i am not sure whether penetration happened or not but my penis definitely touched her vagina . I didnt ejaculated and also i didnt felt any vaginal fluid . Then i wore condom when I came to my senses . I also gave oral to her for about 5 minutes.

2 days after this incident, I started feeling tierd, lost appetite , developed loose stools and slightly sore throat . Doctor gave me antibiotic on 4th day and 2 days after that I started having mild diarrhea and severe gastric problems.3 days after taking medicines, my stomach came to normal but I am experiencing some kind of swollen node on right side of my neck. Also, I have developed slight cough but my throat seems fine now. Today is my 12th day after exposure and feeling like normal.

My questions are -

1. Is it possible for ARS symptoms to start that early like 2-3 days after exposure and then keep coming and going? Do the symptoms are severe for entire duration or keep changing. e.g  I had mild sore thorat for about 2 days , then it got severe for a day and then again back to normal.

2. Is absence of fever an indication that it is probably not ARS?

3. I had 3 CBC in last 12 days after expsoure and my WBC count was 9.2 on 4th day,went upto 10.4 on 8th day and came down to 10 today. What can be the reason of this high WBC count? Is it stress?

4. Out of anxiety due to all these symptoms, I went for Qualitative PCR RNA test at around 5 days after exposure and it was negative. I have read in many places,that this test is highly accurate even 48-72 hrs post exposure. Even my doctor said the same. How reliable is the test and what is the correct time to take this test?

5. Is anxiety ,lack of sleep and problem in concentrating symptoms of ARS? I think I am going crazy about this. I feel like crying every 5 mins.

Please help me doctor. I feel like I am going to die soon

[Edward W Hook, MD]

All such lab values have numerical values.  Values below a threshold level are negative as is yours.  Don't worry.  EWH

[Edward W Hook, MD]

Welcome to our Forum.  I suspect you are over reacting.  There is little risk of HIV from your exposure.  Remember, most commercial sex workers do not have HIV and among those who do, your risk of getting HIV form a single encounter is less than 1 infection in 1000 sex acts, on average.  In your case, given how brief your exposure is, it would not surprise me if your risk was actually lower than that, again IF she had HIV which is unlikely.  From here I will go directly to your questions:

1.  Two days is too soon for your symptoms to be the ARS.  The ARS occurs, in part due to the presence of developing antibodies to HIV.  this typically occurs at between two and four weeks after infection.  This is also the time when the ARS typically occurs.

2.  Yes. The ARS is a syndrome which has multiple components, including fever.  BTW, your gastrointestinal problems are likely to be due to the side effects of the antibiotics you took,.

3.  This WBC is not high enough to be noteworthy.  Most doctors would ignore it unless there were other clear reasons to worry.  The WBC may not be elevated in persons with early HIV.

4.  There are no good data on when PCR tests come positive.  That is part of the reason why we do not routinely recommend it.  We typically find that it is a waste of money to use PCR testing for HIV.

No, anxiety is just that- anxiety.,  It is NOT a sign of ARS.  

You need to get a grip on yourself.  Your concerns are far, far overstated.  EWH

[sunny83]

Hi Dr. Edward,

I would really appreciate if you answer my one last question.

I went for HIV DUO Test( Antibody + p24 Antigen)  on 27th day of exposure and the result says negative with value 0.305.

Now, I am not able to understand if I am negative then why this value 0.305 coming in the report. What is the meaning of 0.305 on DUO test result?

Thanks again Sir. You are doing great work.

[Edward W Hook, MD]

There are not enough data to tell you that a 12 day PCR is definitive but it IS strong evidence that you were not infected, validating the advice that I gave you earlier.  A DUO test at 28 days would be definitive.  Similarly, a standard HIV antibody test (without the p24 antigen test which is the other aprt of the DUO test), would also be definitve at 8 weeks.  Take care.  EWH

[sunny83]

Hi Doctor,

Thank you for your wonderful response which eased a lot of stress of me . I am happy to inform you that my 12 day Qualitative PCR RNA Test also came negative! The doctor at lab advised me not to go for any further testing and take this result as conclusive.

I am feeling relieved but still would like to know whether you would suggest me any further testing. I have read at many places that HIV Duo test at 28 days is considered conclusive while some people still believe that 3 month antibody test is concusive.

Which test should I take which i can consider conclusive? I am a bit tensed about this situation because I am going to get married very soon. Hence, before marriage I want to close this chapter and move ahead in life.

Thanks a ton again for your help !

[Edward W Hook, MD]

The decison to test is a personal one. From a sceintific and medical perspective, I suspect there is little reason to seek testing.  If you feel the need, please use antibody tests which are the recommende tests.  REsults at 8 weeks following this very, very low risk exposure will be definitive.  EWH

[newusers123]

Based on what you have given. I should re test it again?

[Edward W Hook, MD]

In general we do not recommend HIV PCR tests for HIV diagnosis.  The problems with these tests are: that they have a higher false positive rate than antibody tests, that the time course by which they become positive in infected persons, while certainly sooner than the antibody tests, is not well characterized; and that they tend to be expensive.  They are becoming more widely used but at the present time are not sufficient for a definitive diagnosis of HIV and while a negative test is somewhat helpful information in many situations, it is not sufficiently well characterized to be definitive.   EWH

[newusers123]

Hi Dr. Edward
your answers seems to contradicting with the answer with Dr.Sean in HIV international forum.  i posted a question about PCR and Dr. Sean reply if I had a NEG antibodies and NEG PCR DNA at 32 days then im NEG.

http://www.medhelp.org/posts/HIV---International/High-Risk--RT-PCR-DNA-/show/1471439?personal_page_id=2005912#post_6693249

However, your answer said its waste of money which you made it sounds like an inaccurate test. can you please explain a little bit ? thanks