[Question #11860] Risk, testing and ARS

11 months ago

Hello -
Thank you for your service.

At day 0 I had a brief insertive UAI encounter with someone in a high risk group. Although they said they are negative and on prep I have no idea if this is true or the ability to validate. Again it was brief (about 10 seconds) before I realized that it was stupid and stopped.

At day 22 I started to develop a low grade (99-100) intermittent fever. There were no other noticeable symptoms except some headache and fatigue and sweatiness as fever comes and goes.
At day 27 (4 weeks) I had a negative (non-reactive) 4th gen test via a lab (in the US). (I also had a neg test for all STIs at 4 days as a baseline.

It is now day 30 and the fever remains low and on and off. There has not been development of other symptoms besides some intermittent headaches.
A doctor I saw suspects tick borne illness. On doxy for 4 days so far. CBC showed low WBC. Lyme test hasn't been received yet.

Primary question is whether I should suspect HIV ARS given the above info or focus on other potential diagnosis. Looking to get intimate again with my current partner. Thank you!

Edward W. Hook M.D.

11 months ago

Welcome to the Forum. Thanks for your questions. I'll be glad to comment. I would be inclined to believe your partner when he said he was negative and on PrEP. Most people tell the truth. Even if he did have untreated HIV however there is a less than 1% chance that unprotected UAI would lead to infection.

Your symptoms are not suggestive of the ARS and you have proven that the symptoms you have experienced are not due to HIV. The ARS is described to be a combination of high fever, severe sore throat and widespread muscle and joint aches, sometimes accompanied by a widespread rash or diarrhea. The symptoms of the ARS all start at about the same time and because the ARS is due to the interaction of antibodies to HIV with the virus, tests for HIV are always positive almost immediately after the symptoms begin. Your day 27 test proves that your symptoms are not due to HIV and, at 27 days, well over 95% of recent HIV infections would yield a positive test.

You can be confident that you do not have HIV. I would look for other causes of your symptoms which sound like they are improving.

I hope these comments are helpful. EWH

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11 months ago

Hi Dr. Hook. Thank you for the quick response. Yes this is very helpful and alleviates my concern. One bit that was very insightful was that if the symptoms were due to ARS, a test taken after symptoms being would be positive. That seemingly obvious reality isn't clearly stated in the literature I reviewed. I'm still dealing with this low grade fever unfortunately but it is a little better each day. I highly suspect a tick borne illness given recent outdoor activities and the area of the country I am in but we'll see what the lab says. With all these pathogens out there (adding EEE and west nile to the mix as of late) it's a rough landscape for the worrisome type. :)

Edward W. Hook M.D.

11 months ago

You are correct that the relationship of the ARS to positive tests is not well characterized but if one works through reports characterizing the ARS, one finds that indeed, tests are positive and associated with very high circulating virus levels. EWH---

11 months ago

Got it. Thank you again. Regardless if your assessment is that I don't have to worry about HIV based on the information I provided then that's good enough for me!

Edward W. Hook M.D.

11 months ago

Great. Glad I could help. Time for us both to move forward. Take care. EWH---