[Question #11978] HIV risk and tests reliability

11 months ago

Hi. I've been lurking this site for a while and finally decided to submit a question for some peace of mind. So, on July 15th I (M) had sex with another M. I was the insertive partner and used a condom all throughout the act. I also sucked him very briefly and engaged in cunnilingus. All of this took place in a hotel room. This was around 10AM. By July 17th at night I noticed a bump on the right side of my neck. It's a posterior cervical lymph node near the base of my neck. I checked for other symptoms but I didn't notice anything else at the time. A few days later I started experiencing hoarse voice and overall malaise, accompanied by anxiety and depression. Back then I could barely eat. The first physician I visited prescribed me some antibiotics, azythromycine for 6 days, as well as Vitamin C, benzydamine spray (commercial brand is Benzirin) and naproxen. The hoarseness eventually faded but the lymph node remained and still does to this day. I've had 2 blood tests checking white blood cells and other parameters. I've also been tested for hepatitis b & c, toxoplasmosis and HIV. I've had 3 HIV tests so far, which is my main concern. I had one 18 days post exposure, then at 25 and 37 days. Thank God they all came back negative. I'm not sure if they were 4th gen tests, they came with an index value and the papers indicated they tested for both the antigen and antibodies against HIV1/2, but the health personnel weren't able to give me reassurance about this. These were my results:August 2nd: 0.32 (cutoff of 1.00). NON REACTIVEAugust 9th: 0.22 (cutoff of 1.00). NON REACTIVEAugust 21st: 0.35 (cutoff of 1.00). NON REACTIVEI was feeling really anxious given as the doctors didn't give me reassurance about my tests so I went and took my partner to get tested 46 days after our encounter, he came back negative with a result of 0.11.At this point, I didn't feel the urge to get tested

11 months ago

After I took him, that helped because I didn't feel the urge to get tested every 2 weeks. So right now I'm waiting to get tested at 3 months in October, hoping and praying my results won't change. At the moment I still have a swollen lymph node. X rays detected a couple more but they are not visible or easily palpable. So my question is, do you think I'm safe and what else could be causing my swollen lymph node? I feel persistent though subtle mucus at the back of my throat and some minor discomfort in the upper chest/throat. I think those are my main symptoms. My stool is not liquid, but it's narrow, it used to have more consistency if that makes any sense.

11 months ago

I forgot to mention the HIV tests were with blood drawn from the vein. Also, I had another exposure but that was back on June 14th and also used a condom. My last test was taken 2 months after that.

H. Hunter Handsfield, MD

11 months ago

Welcome, and thanks for perusing the forum (whether or not you call it “lurking”).

There’s a lot of information here and I’m not going to try to comment on every detail. However, it is clear you have no STD. But let’s start with the confusion of terminology. “Cunnilingus” is oral-vaginal contact — I’m guessing you meant analingus (oral-anal).

No STI can cause lymph node enlargement (if that’s the lump in your neck) within 2 days of exposure; starting 7/17 it could not have been from a sexual exposure 7/15. It’s hard for me to know whether it had anything to do with the throat symptoms that began soon afterward, but apparently that was your doctor’s belief; and the prescribed treatment is not one recommended for any STD, so presumably he thought he was treating an upper respiratory bacterial infection, perhaps complicating a common cold. (From what I can tell from this long range perspective, I probably would not have prescribed the azithromycin.) And anyway you describe a very low risk exposure for all STIs, including HIV.

But probably to your main concern, it is 100% certain you do not have HIV. When HIV testing is done sufficiently long after the last possible exposure, results overrule all other considerations: no matter what the symptoms and no matter how high the risk of exposure at the time, your tests prove you do not have HIV. And in any case, none of the symptoms you have had — with the possible exception of the initial sore throat or hoarseness — fits with HIV, and even those symptoms were not typical.

Variable cut-off values of negative HIV tests are meaningless, as long as the cut-off is below the positive level (usually 0.9 to 1.1). Pay no attention to the variable numbers on your tests. (The very same specimen tested 10 times would give 10 different numbers.)

You don’t need any further testing at 3 months or any other time. The modern HIV antibody tests always are positive in newly infected people within 8 weeks or so. And if any of your tests were antigen-antibody tests (AgAb, “4th generation”, “combo”), they were conclusive after 6 weeks and nearly so at 4 weeks.

So all is well at this point. Whatever you had is entirely unrelated to the sexual exposure you have described — as well as the one about a month earlier.

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

HHH, MD

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11 months ago

Thank you, doctor. It's very calming to read your reassurance and sorry for going overboard with the amount of words and details, I actually had to edit my post because the page said it was too long lol. I meant analingus, yes. Does analingus or sucking pose any risk for contracting HIV?

About the swollen lymph node, it was indeed very sudden. It's movable, painless and not overly big and very persistent, it hasn't fully shrunk after 2 months which keeps me up at night. It's terrifying. My first doctor thought my tonsils were swollen and I showed her some pictures I took of the inside of my mouth on July 20th where I could see 2 white-ish spots resembling small pimples on the right side (here's a pic in case you would like to check: https://i.postimg.cc/wTJC4Pth/IMG-8918-1.jpg

and here's a pic of the lymph node as of recently: https://i.postimg.cc/MpmhqQmH/IMG-1154.jpg

). I have no clue if these have anything to do with the lymph node or the hoarse voice that came afterwards; I didn't take pics earlier because that was the time I started experiencing hoarse voice. My throat didn't hurt and I never presented with fever, but whenever I talked, I could feel my voice coming out a little hoarsey. On July 27th I had a blood test and neutrophils came out a little high, I got 6714 neutrophils per mm3. Lymphocytes stood at 2397.

Could this slightly high neutrophil count have anything to do with HIV or any other STD? Could it be that the azithromycin had prompted them to rise temporarily (I was 3 days into the treatment)? Just for the record, I had a second hemogram on 9.13 and neutrophils have since gone down to 4599 per mm3 and lymphocytes measured 2110.

Now, onto the testing part... I'd like to make a few questions, to gain some extra reassurance. Please bear with me.

11 months ago

So, getting a negative result 35 days after the onset of symptoms, e.g. swollen lymph nodes, this means the swelling is unrelated to HIV?

Is my result at 37 days post exposure and my partner's at 46 days a strong indicator of my status? It's hard for me to tell whether or not they were 4th gen tests. I think they are, they appear to have been carried out with the Aptio robotic system by Siemens and they are from a private laboratory. The only reason that makes me doubt is because of the way the test is labeled, the results say just Antibodies but in the guidelines, it says it detects both the antigen and antibodies. The one I had at 25 days was processed in my state health provider's laboratory. This one is a lot more straightforward in making clear that it detects both, so I'm thinking this one was a 4th gen test for sure. Whichever the case it may be, is my test at 37 days a good sign? I already set an appointment for a test prior to my consultation with you, it should be on October 10th and I'll be glad to share my results. One of the doctors that examined me said I should get tested at 6 months. There was me thinking the test at 3 months was enough. I understand doctors want to be cautious, but 6 months seem like a lot to me. Do you agree with him?

Thank you in advance for your help with these!! Best wishes,

H. Hunter Handsfield, MD

11 months ago

Answering the first sentence of the second comment more or less answers all the others on your mind: "So, getting a negative result 35 days after the onset of symptoms, e.g. swollen lymph nodes, this means the swelling is unrelated to HIV?" Correct. People with HIV symptoms always test positive on any and all types of HIV blood tests. There are no exceptions.

All the rest is looking at much greater detail than necessary to know you do not have HIV. Your negative result at 37 days indeed is "a good sign". We don't get into evaluating health issues other than HIV and other STIs, and you have none -- so I have no comment on your blood counts except to say they all are normal; and variation of numbers within the normal range is generally meaningless.

We do not look at clinical photos: it comes too close to practicing medicine from a distance, which we cannot do.

I do not agree with your doctor about additional HIV testing beyond 3 months from exposure, and usually 6 weeks is sufficient -- certainly not at 6 months.

There is no point in sharing any future negative HIV test results. All we would do is agree it's negative and you don't have HIV. I am already convinced 100% about it.

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10 months ago

Hi, doctor. I just wanted to share the good news with you and anyone reading. They conducted a test yesterday, translated into English, it reads: Comprehensive HIV Elisa verification. Solid phase immunochromatography. Qualitative detection of HIV-1 and HIV-2 antibodies and p24 antigen. I'm in Colombia so this was the test they ran for confirmation. Result was NON-REACTIVE. This was conducted with blood drawn from the vein and it was done 86 day after potential exposure.

I don't even know what kind of test this is, but I feel good. Can I finally put my fears aside and carry on with my life?

Should I worry about late seroconversion and all that?

Any other input you may have would be highly appreciated.

Thank you a lot for your guidance. I appreciate you.

10 months ago

Actually, 87 days*.

H. Hunter Handsfield, MD

10 months ago

Congratulations on your negative test result, but as we discussed above, it was already 100% certain you did not have HIV and your latest test was unnecessary. Then possibility of "late seroconversion" was only for the first HIV antibody tests, not used for many years. There is no such thing as "late seroconversion" for the tests you had.

That concludes this thread. Best wishes and stay safe.

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