[Question #10604] F/u 10547 ARS

21 months ago

Fit 44yr HCW. No diagnosis. Longer than simple illness.

Oct20,21 until today: MINOR definite nasal stuffiness SINCE ONSET. No runnynose/PND/sorethroat/cough/allergy. Tired, muscle pain in 1st week. Muscle pain (less) but occurs different times of day. Still Having SUDDEN daily surges of tiredness lasting mins and sudden HOT feelings lasting mins. MaxT37.8 when checked. Intermittent nausea in 1st week. Eased but WORSE last 4days. 3x/hour getting severe nausea/epigastric/abdo_discomfort. Settles in mins. No D&V. Oct23, mild tender left submental_LN area. No swelling. Settled. Last 4days, MODERATELY tender left buccinator_LN. Minimal swelling. Night sweats Nov2,3.

FBC/LFT normal. Multiplex PCR NORMAL respiratory viruses. NO DIAGNOSIS.

Last 24 hours: local left parasternal MODERATE stabbing pains for seconds, 3x/hour. No tenderness/SOB. ? Infective oesophagitis

All day, FREQUENTY feel tired, nausea, epigastric/abdo_discomfort, hot, aching but symptoms settle within MINS. Not 100% inbetween episodes.

Worried HIV. Symptoms 6-9days after encounters. Symptoms evolving? ARS? Other viral illness overlap with ARS?

I worry. When withdrawing from CSW's vagina, condom had CERVICAL/vaginal discharge on it. She instantaneously massaged condom, removed it, used same hand on penis HEAD for seconds, put on another condom, for sex.

H. Hunter Handsfield, MD

21 months ago

Welcome back, but I'm sorry you found it necessary. It happens that this question came to me, but I reviewed your recent discussion with Dr. Hook. I agree with all he said, in every detail.

It seems clear your emotions are getting way ahead of your objective thinking and, apparently, your training as a health care professional. Did you not understand or just not believe Dr. Hook's analysis and advice? To repeat some of those take-home messages, you were at no measurable risk of HIV, and almost as low risk for other STIs. Second, your symptoms are NOT at all typical or even suggestive of a recently acquired HIV infection. Third, as he also said, you can be tested now to prove your symptoms are not due to HIV. Dr. Hook pointed out that it is not possible to have HIV/ARS symptoms with negative blood tests!

And as I look at these additional questions now, I have nothing to add to Dr. Hook''s assesement. These are not symptoms of ARS. But it seems clear that our reasoned, science-based professional evaluation and advice are not going to resolve your fears. Have an HIV blood test now. Even if a bit early to prove you weren't infected, negative results will prove that ARS is not the cause of your symptoms. And I will reemphasize that they don't suggest HIV/ARS anyway.

Here is a fact that all health care professionals understand -- or at least should know: symptoms almost never are useful indicators of possible new HIV infedtion. If you are not aware of that, you need further training or to do some additional investigation. The fact is that ALL symptoms of ARS are more common in other conditions, even in those at high risk of infection (and you decidedly were NOT at high risk anyway); and further that half of all new HIV infections cause no symptoms at all. Blood tests are the ONLY valid way to judge whether or not someone has HIV; and the results always overrule both exposure history (no matter how high the risk at the time) and symptoms (no matter how typical for ARS they may be).

Trust me on this: all you say argues against you having HIV or ARS. I will be happy to comment further if you would go forward and get tested, and post your test result. I am confident it will be negative.

HHH, MD

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21 months ago

Thank you for your reply.

I am in Middle East so I planning to do my test in UK. I will be there mid November.

Bettertoknow offer the Abbot HIV/P24 fingerprick test. They say it is more than 99% accurate after 26 days. (I believe it must be the Determine Early test). Is this a suitable test to take at around day 30 of my 'non exposure'.

The problem with the 4th generation duo is I'm told by the clinic that the results will take up to 5 days and I don't really want to wait, or is the duo test what you would recommend?

Finally can you comment on the OraQuick home HIV antibody only test. Window period is stated as 3 months. How soon would this be positive after acute HIV symptoms begin.

Thanks for your time.

H. Hunter Handsfield, MD

21 months ago

I agree the test you had is around 99% reliable at 26 days -- or maybe 95%. That is, very good and is strong evidence you were not infected, especially since you had a low risk exposure and your symptoms do not suggest HIV.

It seems peculiar to not wait 5 days for a test result, and instead wait a few weeks until you can be tested in the UK. That makes little sense.

The oral fluids HIV tests miss 2-5% of HIV infections no matter when they are done. However, a negative result would still prove your symptoms are not caused by HIV.

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21 months ago

Dr Hansfield. I haven't actually done my test yet!! I didn't want to use my last message until I had my test incase it was out of the ordinary but it appears you have misread my last message (which seems straight forward to me as I re read it), and I've ended up getting really stressed out.

To clarify,

I am going to have the test on Nov 15. I will travel to the UK to do it. I can have the Abbot finger prick test or the Duo test. But the Duo test results will take 5 days and I don't feel I can wait that long so I will choose the finger prick test. Maybe I will do both.

I will try not to think about HIV now despite my symptoms. You don't need to reply to this message unless you have anything new to add because I want to be able to message you after my results. I just had to write this given your reply. Thanks

H. Hunter Handsfield, MD

21 months ago

I still see no reason to not be tested where you are. I hope you're not traveling to the UK just for testing! To spend the travel money when there is virtually no chance of a positive result is frankly irrational. And you're willing to take all that time and energy to travel but then not wait a few more days for the result?? In any case, I see no reason for you to inform me of your negative test result, which is what it will be. I would simply agree it's negative, congratulate you, and advise you once again to stop worrying. But I'll make a deal with you: if your test should be positive -- whether you do it where you are or in UK -- and if you would like to discuss it on the forum, we'll reimburse your posting fee. But what the heck, I'll leave it open for another 2 weeks, max.---

21 months ago

Dear Dr, Today I took - Rapid Determine HIV Early Detect on day 30. "Bettertoknow", a well known provider in the UK states it is 99.8% accurate at 26 days.

My test was negative. However the nurse said I should repeat it at 3 months & 6 months.

So I went to another clinic and I did a 4th generation HIV Duo test. The result was negative.

Given the activities I have mentioned, do I need to retest?

I note the new UK guidelines state tests are conclusive at 6 weeks. You have also stated 6 weeks although in the past you & Dr Hook used to say 28 days was conclusive.

I read about Delayed seroconversion - it said it can occur after 6months, or even after years? For example if the viral load was low at time .of exposure. That caused me some stress as I was exposed to potentially low viral load.

Should I retest at 6 weeks or 3 months or 6 months or accept my results and move on. I accept your case that my symptoms cannot be ARS as the tests were negative despite feeling unwell for 2-3 weeks.

Thank you for your help

H. Hunter Handsfield, MD

21 months ago

Glad to hear of your further negative results, but of course not surprised. You can move on with complete certainty you do not have HIV. I see no need for further tests. I would always advise reliance on national guidelines like those of CDC (in the US) or those promulgated by UK, the European Union, etc. Such guidelines always are based on the most comprehensive data reviews and the expertise of those nations' top experts. Obviously such guidelines are the ones you should apply to your own situation.

As for "delayed seroconversion", that goes back to older standalone antibody tests, no longer used. There is no such thing with the AgAb (4th generation) tests or the modern (third generation) antibody tests.

The change of our advice about AgAb test timing on this forum from 28 days to 6 weeks (or 45 days) 4-5 years ago wasn't arbitrary. New data became available. Of course professional advice should evolve as needed to be consistent with science.

Don't forget you had no significant risk of HIV from the exposures described anyway and didn't even need testing! Your continuing doubt about test reliability was unfounded and I hope you can now move on without further concern.

Please note the forum policy against repeated questions on the same topic. This being your second, it will have to be your last on HIV test performance after potential exposures. Thanks for your understanding. Best wishes and stay safe.

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