Seroconversion - Drugs - Emotional Stress - 8 weeks test

[daeumling]

Dear Dr.
I had a high risk possible exposure to HIV. I am aware of the definition high risk.
28 days after contact I started having ARS symptoms fever, soar throat, Lymphadenopathy, Myalgias, Joint pain, mouth ulcers (3), Weight loss, Nausea, loose motions, urticaria rash... Loose motions started 2 weeks after fever. The rash started with one object a day, itchy for the first 5 min and disappeared after ~2h (urticaria). Rash is the only remaining symptom now >4 weeks after onset of illness. It started very light but is now (after 3 weeks rash) very intense with many objects diffused over body at the same time on and off. My entire body itches.

Since onset of ARS I was under HIGHLY emotional stress with several mental break downs. I received clonazepam 0.5mg from my GP against anxiety (5 tablets).

I had 3rd Gen. anitbody test after 8 weeks 1 day (neg.). It uses recombinant derived antigens (Seimens Healthcare) and is a CMEIA (chemiluminescent microparticle enzyme immunoassay).

I know the statistics for testing times.

1. Do you have knowledge whether "your" testing time statistics also correspond to the 3d generation assay as mentioned? Is this a standard/typical assay used in USA today? I am in New Zealand and don't trust the health care system about their updates to western country standards.
2. Could the drugs for my anxiety delay seroconversion for a positive antibody test?
3. I know that severe stress produces hormones such as cortisol and epinephrine. Those hormonal fight or flight response are responsible for selective depletion of CD4 helper T-cells and T-cells in general (have references). Could that also lead to reduction of antibody production?
4. Is it typical that a rash at primary HIV infection starts light and reaches a peak after 3 weeks? Could stress increase the duration of ARS?
5. Is the T cell count (CD4) related to antibody production? Positive test can be at a time when ARS are still present?

THANK YOU.

[daeumling]

I am sorry. It seems I ended up in the wrong forum. I would appreciate if you still consider my questions appropriately.

Thank you.

[Edward W Hook, MD]

As you know, you have posted on the wrong site.   Questions about HIV belong on the HIV prevention site.  I will do my best to answer your questions with this reply but, if you have additional questions or follow-up they must be on the HIV Prevention site.  Sorry

You state you "know" much about what I am going to see but you seem to have missed our repeated statements that the symptoms of the ARS are TOTALLY non-specific and when people experience "ARS symptoms" they are much more likely to have something else, usually some other, more typical virus infection.  When this has been studied in the US, less than 1% of persons seeking medical care for "ARS symptoms" are found to have HIV, the remainder having symptoms due to other processes. In contrast, over a given year, there is almost no one who has not had a viral illness, night sweats or both (sometimes on multiple occasions).  In your case your symptoms were late for the ARS, the rash has lasted unusually long for ARS and your test at 8 weeks (4 weeks following the onset of your symptoms) rules out that your symptoms were due to ARS.   Your symptoms were NOT ARS.  Now, in answer to your specific questions:

1.  Yes, the statistics we quote are descriptive of the performance of the Siemens’s test you mention.

2.  No, anxiety drugs have NO effect on seroconversion.  

3.  No, stress related changes in hormone production do not produce enough steroids to effect antibody development.

4.  No, the rash of ARS typically lasts less than 2 weeks an in most cases less than a week.

5.  No it is not related to antibody production.  

Hope these answers are helpful to you.  Given your test results it is very, very unlikely that you have HIV and the symptoms you describe  are certainly not due to HIV.  Take care.  EWH


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