Concerned about HIV exposure/ test results

[notsure3]

Hey Doc.

About 3 months ago I had unprotected sex with a girl and unprotected oral sex with another girl who I didn't know very well... (drunk decisions) Regardless, about 4 weeks later I developed enlarged lymph nodes, joint/ muscle pain,small raised forearm rash, and felt under the weather. Needless to say, I thought off the bat it was HIV. I then decided do go to the dr and get checked over,  My white count was a little high but my lymphocytes were low. I started a course of antibiotics because my dr thought it was bacterial. I also had an HIV test done, negative at 6 weeks. I felt the most better when I found out my results were negative, not antibiotics. Then about 5 days after finishing my meds I had a sudden high fever (103), sore throat, and chills. It happened very suddenly. Once again I thought this was a sign of HIV.  I went to the dr and they AGAIN thought it was bacterial. 20k with low lymph. I wasn't convinced. At 63 days I again went to get an HIV test which AGAIN came back negative. ELISA 1/2 blood test. I had a splenectomy when I was 4 and have had a weak immune system ever since. This has led me to believe that my body is just taking longer than everyone else to produce detectable antibodies. Now that I have vented my story my questions are as follows.....
1) Is there a difference in the blood work of someone who is infected with hiv (virus) or someone who is fighting a bacterial infection.  
2) With a splenectomy, should I trust these negative results? 6 and 8/9 weeks
3) How long after the exposure will acute hiv symptoms occur.

Thanks Doc!

[notsure3]

okay great.... just one last question.... because my lymphocytes were low during my illness, would this be evidence against my illness being viral (HIV). I know a test is the only concrete indication but would this be evidence against needing another HIV test because my doctors were quick to dismiss the possibility of HIV both from my blood test results AND negative antibody tests at 6 and 9 weeks (regardless of splenectomy) Sorry for all the questions... I promise this is the last haha.

-Thanks

[Edward W Hook, MD]

Because of your splenectomy, your white blood count, on average is a LITTLE higher than that of folks who do not have spleens.  

I suspect that when you doctor talked about white blood cells and viral vs. bacterial infections, she was actually referring to the balance between different types of white blood cells.  We each actually have several different types of white blood cells including ones called lymphocytes and ones called polymorphonuclear leukocytes.  The lymphocytes tend to be higher with viral infections and the lymphocytes tend to be higher in persons with viral infections, thus by looking at both the total numbers of white blood cells and how they are balanced, physicians can often get an idea as to whether their patients have a viral or bacterial infection.

I don't want to speak on behalf your doctor but I suspect this is what she is talking about.  Hope this helps.  EWH

[notsure3]

Hey Dr Hook

Thanks a lot for your response.... It really has just come down to anxiety and every little thing is getting to me. The issue with the splenectomy is, more likely than not, just a way in which I have mentally tricked myself into thinking I may still have hiv. But, as much as I know this, it doesn't help. Every little thing from a scratch on my neck to an enlarged lymph node is cause for concern. As far as I'm concerned, the two girls I had intimate relations with in college were not infected. PERIOD. BUT... who knows for sure ya know? I could sit here and discuss problems and concerns all day but in reality I guess its not doing much good. The only problem is that I don't want to keep going against my doctors because of my stupid anxiety.... I just want to believe that I am negative. Well... to get an HIV PCR is going to really put so much more anxiety on me BUT if I do have it, I would never want to pass it on. AHHHH!!! I guess my only other question is whether or not my high white count could really prove that its a bacterial rather than viral infection. I know that the HIV test is truly the only conclusive evidence but can these blood results hint at bacterial over viral? I really am in an unusual situation but I guess I just really do not want to keep putting all this anxiety on myself. It really is playing in to my every day life. I was having night sweats that I was sure were hiv BUT once I found out my negative results at 9 weeks they stopped. Turns out it was most likely just anxiety and stress. Again tho.... thank you very much! This website really is a great way for hypochondriacs like myself to vent our concerns to a professional. Sorry for the essay!

-Thanks a LOT!!  

[Edward W Hook, MD]

You've seen a physician who sounds to have approached your problem thoughtfully and carefully.  I agree with her- the results of HIV tests done at 9 weeks following exposure have about a 98% probability of detecting HIV if it had occurred.  

There are not good data on the impact of splenectomy on the timing of HIV seroconversion and I am sure that you could find someone who would tell you that because of your splenectomy developing a positive test might be delayed but, if it did, I doubt that it would be delayed much.  Given your unusual situation and the anxiety it appears to be causing, you may wish to discuss getting an HIV PCR (viral load assay) to put this behind you once and for all.  I predict it will be negative and once you have this result, I would take this as unequivocal evidence that you do not have HIV.  I hope this helps.   EWH

[notsure3]

Hey Doc

I also wanted to add that all of my test results for bacterial infection came back negative. I had a strep test, blood work, mono test, cat scan of my sinuses, and other stuff. My Dr. was baffled when she called me because she is still unsure as to what caused the high spiked fever. I actually just asked her how conclusive my HIV results were and she said as long as you wait 6 weeks then it is conclusive. I went as far as 9 and it was conclusive but I still forgot to ask her about a possible prolonged antibody count because of the splenectomy. Now I am seriously concerned because even my Dr. has no idea what is wrong. I also asked for clarification on blood work and she said that they can develop hints as to whether it was bacterial of viral from the different increases in different immune responses. But as silly and stupid as it sounds... I am STILLL not convinced. AH! Please get back to me and I apologize for the story I just wrote you. Just wanted to make sure your advice is given with full knowledge of my medical history.... or something haha.
-Thanks a bunch