Hello dear doctors,

Since then, I have been tested for HIV at different intervals:

28-day rapid 4th gen test: Negative

36-day HIV 1 and 2 PCR test: Negative

4th gen Lab test CMIA at 60 days: Negative

4th gen Lab test CMIA at 94 days: Negative

4th gen rapid test at 180 days: Negative

4th gen rapid test at 365 days: Negative

I was also tested for Hepatitis B and C and Syphilis at 94 days, all of which were negative.

The standard HIV tests, including all the ones you have had, are among the most sensitive diagnostic tests ever developed, for any medical condition. Negative results on tests collected long enough after exposure -- intervals much shorter than yours -- are 100% reliable. The results overrule all other considerations. No matter how high the risk of exposure at the time, and no matter what symptoms or non-HIV lab results, the test results rule.

In addition, you describe a nearly zero risk exposure for HIV:  even before you were tested, you can assume the odds a partner like yours had HIV to be around one in a thousand; and the transmission risk to an uninfected female partner, from a single episode of unprotected sex, also is around one chance in a thousand. Combining those two probabilities, even before you were tested the chance you had acquired HIV were no higher than one chance in a million. And the symptoms  you report are not nearly as typical of HIV as you seem to think. Even though your illness 2 weeks after the sexual exposure have some elements that could go along with ARS, they were not typical. Among other things, ARS does not include cough or sputum production; and of course garden variety colds and other respiratory infections are hundreds of time more common than ARS.

Those comments pretty well cover your specific questions, but to be explicit:

1) No, it is not possible you have HIV.

2) HIV infections never cause just a single lymph node to be enlarged or inflamed -- and it isn't possible to have HIV symptoms and test negative.

3) Blood counts:  Mononucleosis is far from the most common cause of a modesty elevated monocyte count. I suppose you could have had mono, but can't say more. For sure it had nothing to do with HIV.

4) Despite misleading information to be found online, there are no known variants of HIV that would not be detected by the tests you had.

5) In theory, PCR could miss an infection at that time, e.g. in the group of infected persons called elite controllers. But you also had several negative antigen-antibody (AgAb, 4th generation) blood tests.

6) There is absolutely nothing the health issues you have described that suggests any reason not have unprotected sex with your partner.

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

HHH, MD

Dear Doctor HHH,

Thank you for your insightful responses; they have significantly alleviated my concerns regarding HIV. I appreciate having the opportunity to consult with someone as knowledgeable as yourself on this matter.

I have a few follow-up questions:

1 - Based on your responses, would it be accurate to assume that I may have been excessively tested? While I mentioned specific tests, I actually underwent a few more (mostly rapid 3rd/2nd gen tests I performed at home), totaling over 20 tests within a year due to my anxiety. All results were negative, with no instances of indeterminate or positive results. Is it unreasonable to believe that all 20 tests could be false negatives?

2- There's some discussion about strains or subtypes of HIV that might evade detection by standard tests, which has added to my anxiety, especially considering the timeline of my symptoms. In your professional opinion, is this concern valid, or is it more of a myth?

3- Could the lump or swollen lymph node I mentioned be attributed to a potential Mono infection, and if so, is it possible for it to remain permanently swollen? I've come across information suggesting this could occur in some cases.

4- What would be your recommended next steps regarding this lump or lymph node? My doctor suggested ignoring it since I don't have any other symptoms, but I'm still concerned.

5- I've encountered conflicting information online regarding testing guidelines, with some sources suggesting 45 days, others 90 days, and some even mentioning 6 months. Additionally, there are discussions about differences between HIV 1 and 2, with claims that HIV 2 may take years to be detected. Should I stop testing since it's 100% certain I don't have HIV or would you recommend any further steps or tests?

Once again, thank you for your assistance.

2. Don't believe everything you find online. There have been theoretical considerations about the potential for new strains to evolve that would be missed by the Curren tests, but they do not exist -- or are so rare, and limited to Africa (with none at all in Europe or North America) that the possibility is nil. It absolutely is nothing to be worried about.

3. Like ARS, mono also is unlikely to cause a single lymph node to be enlarged. However, once any lymph node is inflamed and enlarged, it may remain swollen (mildly) forever.

4. We don't advise on health issues other than HIV and other STIs. A single long term persistent node or other lump you can feel usually is entirely harmless. But show it to a doctor if you remain concerned about it. For sure it's not HIV or any other STI.

5. The science is clear. For the AgAb blood tests, negative results are conclusive by 45 days (and 98% of the time by 28 days). Longer times typically refer to older tests no longer in use, failure of the advisor to have kept up with newer tests, and sometimes political or religious conservatism partly try to frighten people into behavioral change. It takes only a bit longer for reliable HIV2 results, but probably about 60 days is conclusive for the AgAb tests. It used to be that the PCR tests didn't detect HIV2, but now they do.

Definitely stop testing! 

Dr. HHH, thank you for your responses.

I underwent approximately 20 tests within a year, though I can't provide an exact count. My fear was overwhelming, and I now realize it was irrational to entertain the notion that I might have HIV for such an extended period. Unfortunately, my country still advises a 3-month window period regardless of the type of test, and some doctors even suggest waiting 6 months to a year. You can probably understand my concerns regarding this conflicting information. Discovering your forum earlier might have spared me from a year of such distress. I attempted to rationalize my symptoms through the lens of HIV, as you might understand.

I am committed to follow your advice. If you assure me that I am 100% free of HIV, regardless of any past or current symptoms, and that there is absolutely no chance of discovering I am positive related to this exposure, I will place my trust in your expertise.

I won't burden you with further repetitive questions. Instead, I simply want to express my profound gratitude to you and the other professionals who manage this forum. Thank you immensely for assisting individuals like me. Wishing you all the best.

My guess is that your country does not have a national policy about time to conclusive testing -- even if many or most doctors and clinics give such outdated advice. My guess is that it is a politically, socially or religiously conservative place. But that doesn't mean science should be ignored. Trust me on this: with the tests you had, nobody in the world ever has required more than a few weeks for conclusively negative test results (with the exception of those who take anti-HIV drugs to prevent HIV (post exposure prophylaxis).

Thanks for the thanks. I'm glad to have helped. Best wishes and stay safe.