[Question #11665] Follow up on HIV risk, Oraquick accuracy, and persistent dry mouth

Avatar photo
13 months ago
This is a follow up to the question I submitted a few weeks ago, number 11526.

I understand and appreciate Dr. Hook's response that I should trust my Oraquick test result 2 years after possible exposure. Three recent developments have brought me back for additional insight.

1. I spoke to the woman with whom I had unprotected sex. She said she tests regularly and is clean, though I did not specifically ask about HIV. She also said she was in the swinger lifestyle years ago. That raises the risk profile, though she did say they used protection.
2. I saw in Dr. Handsfield's comments on oraquick, that he said the test will not detect 2-5% of infections, regardless of when the test is taken (meaning outside the window period). Is that accurate? 
3. My doctor said the thrush has cleared up, but the persistent dry mouth and lips have continued. I also sweat excessively, am tired, and have a very stiff neck, and my eyes occasionally burn. I did a full autoimmune panel, which came back negative. I have tested for syphilis, which was also negative. Should I get a blood test for HIV to be certain, or should I still trust the Oraquick result?
Avatar photo
H. Hunter Handsfield, MD
13 months ago
Welcome back. I reviewed your recent discussion with Dr. Hook and agree with all he said. Directly to your questions.

1. No comment, except that "swinging" isn't necessarily very high risk and that it is extremely unlikely your partner has HIV.

2. Some data suggest the oral fluids test misses a small number of infections, because there is a lot less HIV antibody in crevicular fluid (tissue juice around teeth and gums) than in blood. However, other studies disagree. Given the near zero risk of the exposure itself, even a test that detects "only" 95-98% of infections should be considered conclusive, which undoubtedly was Dr. Hook's interpretation of your situation. You should not look at test results as inherently more reliable than analysis of the risk of being infected. However, if you would feel more reassured by having a test that by itself is 100% conclusive, feel free to have an AgAb (4th generation) HIV blood test.

3. Your sympotms do not fit with HIV, not even a hint. Or syphilis for that matter. And by the way, even though Oraquick isn't quite 100% conclusive about having HIV, it IS 100% proof that any symptoms are not due to HIV. Do your best to move on with 100% confidence you do not have HIV, with or without an additional AgAb blood test.

I hope these comments settle your fears. Let me know if anything isn't clear.

HHH, MD
---
---
Avatar photo
12 months ago
Dr. Hansfield, thank you for the response. Can you clarify what you mean by "it IS 100% proof that any symptoms are not due to HIV"? Do the symptoms I described not fit with someone who is in the latent stage of HIV?

I have not been clear about my range of symptoms in my prior posts. Here they are: chronic dry mouth, recurring oral yeast infection, excess sweating, semi loose stool for several months (not diarrhea but rarely solid), my testosterone levels are low: 287 total ng/dl, 54.2 testosterone, free (I am 40, and those numbers apparently are low), erectile dysfunction, irritated eyes, plus an ever increasing sign of hair thinning. Whenever I look online, I can find articles and scholarly studies showing those symptoms do appear with HIV positive individuals. That is the cause of my concern, despite the negative Oraquick test result. Are you saying those symptoms are not consistent with HIV from your research? Dr. Hook did say there is a lot of misinformation online about it, so I would appreciate your guidance.
Avatar photo
H. Hunter Handsfield, MD
12 months ago
Wrong:  these symptoms still don't fit well with HIV. You entirely misunderstand what you're finding on line. Yes, such symptoms are common in people with HIV. But every one of them occurs with many other health conditions that are far more common than HIV; 99% of people with them don't have it and they do not point in particular to HIV in any way. And test results always overrule symptoms and exposure history. No matter how typical symptoms may be, negative test results prove that HIV isn't the cause. You could have told me you mainlined HIV+ blood and that you have truly typical symptoms widespread lymph node enlargements, sore throat, fever, and a body wide skin rash -- and with your negative Oraquick test, I would still advise you that you don't have HIV.

In the 20 years of this and our preceding forum at MedHelp, with thousands of questions from persons concerned about having HIV, none has yet turned to be infected. You will not be the first. If and when it finally happens, surely it will be from a truly high risk exposure, unlike yours (think unprotected anal between two men); symptoms if present will be typical; and test results will not be falsely negative.

My advice remains the same as I stated above:  "if you would feel more reassured by having a test that by itself is 100% conclusive, feel free to have an AgAb (4th generation) HIV blood test." I'll be happy to comment one last time if you decide to do that and would like to let me know the result. Beyond that, there is nothing more you can say that has any chance of changing my evaluation and advice.
---
---
Avatar photo
11 months ago
I just got a full STD panel bloodwork back, which included a 4th gen HIV test. NEGATIVE. Thank you both for your calm and reassuring advice during what was an extremely stressful time. I appreciate it more than you know. 
Avatar photo
H. Hunter Handsfield, MD
11 months ago
Of course I'm not surprised by your negative test result, but glad to hear it. Thanks for the thanks; I'm pleased to have helped. Best wishes and stay safe.---