[Question #10084] ARS symptoms and HIV risk

26 months ago

On May 1, I (f) got ARS symptoms like swollen lymph nodes, sore throat, fever, hoarse voice, phlegm, cough, and a rash (looks like bug bites) that still persists until now while other symptoms are gone. I don't think I was high risk tho since I always use protection for penetration. I took duo test from vein on May 15 and another one on June 15 (6 wks after first symptoms) and was negative.

Doctor diagnosed me with chickenpox at first (negative for flu & covid) but rash persists. He said it might be because of an unknown allergic reaction due to my weak immune system from the viral infection (still not sure what).

1) Is the test conclusive at 6 wks? Some clinics say 3 mths. since some people develop antibody late.

2) The rash on my butt and thighs sometimes look like pimples with small white heads. What are the chances I get HIV if FRESH HIV semen was on the toilet seat that I sat on (given the rash might pop and cause an open wound for virus to enter the bloodstream)? Is it still infectious since the fluid is wet?

Edward W. Hook M.D.

26 months ago

Welcome to our Forum. Thanks for your questions. I agree that your risk for HIV is likely to be low- congratulations on your regular condom use. In addition, I can assure you that the symptoms you describe are NOT due to HIV. When persons experience the symptoms of the ARS tests for HIV are always positive and remain positive going forward. Thus your negative tests on both May 15 and June 15 prove that you were not infected. FYI, the symptoms are the ARS (sore throat, fever, muscle or joint aches, swollen lymph nodes) are non-specific and can be caused by many other more common viral illnesses, some of which (COVID and influenza) you were tested for. In studies when at risk persons sought evaluation for the sort of flu-like illness you describe, less than 1% have HIV- the remainder having other more common community acquired viral illnesses. Also FYI, a productive cough of the sort you describe is not typical of the ARS. While I do not know what has caused your rash, I can assure you that it is not HIV. In response to your specific questions:

1) Is the test conclusive at 6 wks? Some clinics say 3 mths. since some people develop antibody late.

Tests for HIV are entirely conclusive 6 weeks following an exposure. Further, as I mentioned, when persons have symptoms due to recently acquired HIV their tests are always positive. You can be confident that your symptoms were not due to HIV.

No, contact with infected material in the manner you describe is not a risk for HIV. HIV is transmitted only through direct, penetrative sexual contact or injection of infected material deep into tissue. It is not transmitted by the sort of contact with infectious material which may be on inanimate objects in the way you describe- even if the contact is with a rash, abrasion or open cut or sore.

I hope this information is helpful, Pease don't worry. EWH

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26 months ago

Thank you for your kind reply!

1) I've read your other replies that it usually takes 7-10 days for ARS symptoms to show up, and once they do antibodies will be detectable by the duo test, correct? However, isn't it quite early since the window period stated by CDC is 18-45 days?

2) This is purely my curiosity. I've done some research that says p24 antigen will appear first and then become undetectable after awhile. If ARS symptoms are present, then is p24 also present at the same time? Is there a scenario where p24 becomes undetectable before antibodies develop, hence leads to a false negative test?

3) CDC also says contact between infected fluid and open wound may lead to infection although the chance is low. What scenario would you think might be a risk if this kind of contact happened?

Edward W. Hook M.D.

26 months ago

Thanks for your follow-ups. Straight to your questions:

Admittedly 7 days may be a bit early but large quantiles of virus and an antibody response to the viruses (it is the interaction of the ntibodies and the virus that causes the ARS) certainly can begin to appear as soon as 10 days. Once present, antibodies would be detected in 4th generation, DUO tests. In the ARS either antibodies, p24 antigen or, most typically both are always present and detetable

With antibody production, the p24 antigen can sometimes become undetectable because it is tied up by the antibodies. But when that happens, there is lots of antibody present which would be detected with testing.

3) CDC also says contact between infected fluid and open wound may lead to infection although the chance is low. What scenario would you think might be a risk if this kind of contact happened?

CDC is in the business of "never being wrong" and makes general sorts of answers for this. Don't overread their statement that it "may" lead to infection. It is extraordinarily rare.

Hope this helps. EWH

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25 months ago

I’m so sorry I didn’t want to ask more questions but I think I have HIV OCD and am planning to seek help but I’m in Japan so that’s not possible yet. I was wearing an open-back top and a homeless man in Japan walked by and touched my back. I know this is irrational but I’m so scared he might’ve intentionally poked me with an HIV bore needle. I didn’t feel a prick but I’m scared I didn’t feel it since the needle might have been so thin (like insulin needle). Is it possible I couldn’t feel the prick?

1) What are the chances infection from this occurs as the needle penetrated skin and had access to the bloodstream?

2) I’ve read at IV drug users only had 0.63% chance of getting HIV even when they used the same needle with an HIV infected person. How is this possible if the infected blood is introduced directly to the vein/bloodstream?

Edward W. Hook M.D.

25 months ago

Thanks for acknowledging what appears to be OCD. I think you know intellectually that the scenario you are describing is not realistic.. I hope you'll get your OCD addressed. In response:

1. Zero chance. You would have felt the needle stick and it would have drawn visible blood.

2. There are no exposures in which a single exposure leads to infection 100% of the time. In fact, most exposures to infected persons do not result in infection. Think of how many times you've been around someone with cold and do not get it. More specifically for HIV, as you note, needle stick exposures lead to infection less than 1% of the time and most sexual exposures lead to infection even less commonly, depending on the type of exposure (for vaginal sex with an untreated HIV infected person, the infection is transmitted on average only once in every more than 1000 exposures (i.e. 99.9% of the time exposure does not lead to infection)

I hope this information is helpful. We provide up to three responses to each clients questions so this 3rd response completes this thread. The thread will be closed shortly without further replies. I hope that the information I have provided has been helpful. EWH

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