I had an unprotected rough anal sex (insertive) with someone I don’t know the hiv status of. After 7-8 days post exposure I came up with a high fever 103 degrees Fahrenheit, chills, fatigue nausea/vomiting which lasted for about 6 days. So i got scared and took the hiv foruth generation at 12 days, and then the hiv rna pcr test at 14 days and then the hiv foruth generation test at 49 days and they were done at labs and blood was taken from my vein and they all were negative. However, I’m still anxious and scared because I’m not sure if my results are conclusive or not because I read online that it’s conclusive after only 3 months? What should I do? And is there still a chance i have hiv and these tests missed it?

You can be 100% confident you do not have HIV; something else was responsible for your fever etc. I won't speculate about other causes, and it is conceivable you acquired a gastrointestinal virus from your sex partner; but it's equally or more likely from some other source entirely.

Why am I so confident? First, many or most sources about HIV test window period only cite time to proved infection, without discussing symptoms. The symptoms of acute retroviral syndrome (ARS, acute HIV infection) are caused by the immune response to the virus, and immune response is reflected in the antibody tests. Therefore, it is not possible to have ARS without positive antibody testing. In addition, if your symptoms were caused by HIV, your RNA PCR test would have to be positive, and so would the antigen component of your AgAb (antigen-antibody, 4th generation) tests. In other words, your initial tests -- AgAb at 12 days and RNA at 14 days -- were conclusive proof your symptoms were not ARS. It still was wise to have another AgAb test more than 45 days after exposure, to make sure you didn't acquire HIV without symptoms. But that negative results puts icing on the cake, proving for sure you do not have HIV.

Unfortunately, many online and other resources continue to cite a 3 months period for all HIV tests, even though the data are solid that the AgAb tests are conclusive after 45 days (which actually can be rounded off to 6 weeks, i.e. 42 days). In addition, PCR is nearly conclusive all by itself at 12-14 days. Some sources have unthinkingly continued the same advice as better testing evolved, and others just take a hyper-conservative stance because of legal CYA attitudes. In the future, you can be entirely confident in 6 weeks (or 45 days) for the AgAb tests.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

1) Is a fourth-generation HIV test at 49 days conclusive?

2) I forgot to mention that when I was having these symptoms I went to the hospital and thy diagnosed me with a viral illness. However the next day I woke up and my entire forearm was red and kept increasing and was hot and swollen. So I went again to the hospital and was diagnosed with cellulitis. And I had to take many antibiotics, could that have impacted my hiv results

3) I also tested positive for herpes 1 and now I woke up with a cold sore on my lip, which makes it 2 months post that exposure? So could have the fever and chills I had 8 days post exposure could have been because k herpes or cellulitis? Could have this 1 sore on my lip be related to hiv from this exposure?

4) Can I skip the 3-month test if my fourth-generation test at 49 days is conclusive?

2) Thanks for clarifying the cause of your illness (cellulitis). There are no health problems, illnesses, or medications that have any effect on HIV test timing or reliability -- none, including all antibiotics.

3) Half of all Americans test positive for HSV1, usually due to oral infection. Oral herpes often is entirely without symptoms until something triggers an outbreak, like an illness with fever -- which is why oral herpes was called "fever blister" and "cold sore" decades before the cause (HSV1) was known. This has nothing to do with HIV or the sexual exposure you described -- it's a consequence of your cellulitis.

4) Yes. There is no need for further HIV testing at 3 months or any other time.

Really, you can stop worrying entirely. For sure you do not have HIV.

2) Even after I mentioned this above can I be 100% sure I don’t have hiv?

3) I’m so scared I might have hiv because it’s 2 months but I can’t let go of the stress and I feel anxious and low energetic and my life is not the same since??

4) what should. I do to let go of this feeling and convince myself that I don’t have hiv and that the fever, chills, fatigue and nausea I had after 8 days of that exposure is not hiv related???? Are you 100% sure I don’t have hiv?

That completes the two follow-up questions and replies included with each original question. If you cannot shake your fears despite the reasoned, science based advice you have had -- perhaps from your own doctors as well as my replies -- you might consider professional counseling. It really isn't normal to remain so concerned once the facts of the matter are clear. I raise the possibility of counseling from compassion, not criticism.

I do hope these comments help you understand and believe you aren't infected and you are able to move on. Best wishes to you.

2) Do I have to retake another test at 3 months? And if I do what can I expect?

3) is the herpes or cold sore on my lip related to hiv?

4) the antibiotics and my sickness of cellulitis during that period could not affect the result of tests since my immune system was weakened I guess?

5) is the rags that was diagnosed as cellulitis (redness, swollen and blisters) hiv asr related?

6)what makes u so sure I don’t have hiv and that I don’t need a retest at 3 moths?? Thank u

Threads are closed after two follow-up exchanges and this is the third. Do your best to move along without worry. Thank you and good luck.