[Question #11988] HIV 2 & Symptoms

11 months ago

Hello hope all is well and thank you in advance

I ave a couple questions around a recent exposure i had. Details of the exposure

My questions are;

1. What is the accurate window period of HIV-2? All literature is biased towards HIV-1 and also the 4th duo test is biased towards HIV-1 in the detection of P24 and the antibodies.I have read that antibodies for HIV-2 develop significantly later.

2. What other STI/STD bacteria or viruses should I also be testing for? I did a PCR for HCV/HBV and also Syphilis IGG/IGM which came back negative. 8 weeks.

3. What is the possibility of condoim failure? I have heard cases of people contracting HIV even when using a condom that is fully intact.

11 months ago

Details of exposure;

Oral, Vaginal sex, Finger in anus with two CSW workers. ALL protected and condom didnt seem to break or tear however it was their condoms.

1 week after exposure, I developed a painful shingles like rash on arm, and a lot of other symptoms consistent with ARS. Nausea, loss of appetite, joint/muscle pain, headache, chills, night sweats, mild fever etc. Symptoms subsided after a week and a half and now I have swollen lymph nodes in my neck and armpit and also lingering muscle pain, headache.

I tested initially for HIV-1

PCR HIV 1 , 11 days, 15 days, 4 and 6 weeks / HIV 4th Gen 15 days, 4 weeks, 6 weeks, 9 weeks / Hiv 1/2 PCR 8 weeks

all results not detected or negative

11 months ago

However I didn't initially suspect HIV-2 until later as the CSW workers were previously in spain and I know there are more cases there than the UK. HIV-2 also can be undetectable apparently and still cause symptoms. I may have done the HIV-2 PCR test too late at 8 weeks which may have meant I have missed picking it up all together.

what other test are there that I can take to rule out HIV-2? Proviral DNA or specific HIV-2 PCR?

Do I need to retest at 90 days? 4th Gen

Very concerned due to the rash/shingles like and also current swollen lymp nodes. also noticing hair loss from beard as well

11 months ago

The reason I did not take PEP was because I was sure the condom, didn't break or tear. However after reading online there are various views that condoms arent fully effective against preventing HIV even when used without breaks or tears. Unsure the durability of the condoms they used.

H. Hunter Handsfield, MD

11 months ago

Greetings. You didn't need to start a new thread; the one you started yesterday was still open. I'll delete the other one and ask Admin to reimburse your card.

Even though only the opening lines were visibie, my reply there still is valid and covers most if not all your questions. Responding only to the title of your question, I wrote this:

Welcome to the forum, but your question is incomplete. I'll be happy to respond if you can complete the necessary information. At this point all I can say is that if you have symptoms and have tested negative with any of the standard HIV blood tests, that result shows that HIV (either HIV1 or HIV2) is not a possible cause of the symptoms. It is not possible to have symptoms due to HIV in presence of a negative test for HIV antibodies or virus -- and all standard antibody or 4th generation HIV tests detect HIV2 antibody.

Window periods do not apply when it comes to symptoms. If HIV testing is negative, any symptoms at that time -- or up to then -- cannot be due to HIV. And the standard antibody tests cover HIV2 as well as HIV. Given condom protection, I don't see a need to test for anything else. But if you would like the security of negative results, feel free to have a urine test for gonorrhea/chlamydia and a blood test for syphilis. I definitely do not recommend any others: the chance is too low and the tests for some infection not accurate enough to rely on.

As for HIV2, in a sense of symptoms, the standard antibody and antigen-antibody (AgAb, 4th generation) tests are conclusive after 2 months. There is no need to retest at 90 days, and no need for RNA/DNA testing. In addition, your PCR for HIV 1 and 2 also is valid. In addition, HIV2 is too rare to worry about anyway.

I'm glad you didn't seek PEP: it wasn't necessary or recommended after such a low risk exposure.

Condom failure should be viewed in two ways. First is "biological effectiveness". Since your condom didn't break, you were 100% protected against HIV and other infections transmitted primarily by genital fluids (like gonorrhea and chlamydia), and ~90% against those transmitted skin-to-skin (herpes, HPV, syphilis). "Use effectiveness" is different and refers to efficacy over time and many exposure, taking into account human error, breakage, etc. This is about 90%. Since your condoms remained intact, you should consider yourself completely protected. That your partners provided the condoms doesn't mean anything: there is no such thing as microscopic leaks or defects that have any effect; it's an urban myth. If the condom doesn't break wide open, protection is complete,

I think those comments cover all your questions. You're home free! Let me know if anything isn't clear.

HHH, MD

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11 months ago

Thanks for the explanation and this is clear. A coupe more things

1. so the fact that I didn't do the HIV-2 PCR test within the first 4 weeks is fine as window periods do not apply when there are symptoms? The later test at 8 weeks would cover that. Just wanted to understand that

2. Is it possible to acquire other viral/bacterial infections from CSW that are non STI based? Have you seen any cases like mine before?

3. Should I speak with a healthcare provider about other symptoms? I also noticed kidney pain during the flu like period and also this lingered after till now? But I assumed it was part of the HIV symptoms.

Last thing out of interest based on the research, I have done.

Do you see there being improvements in the drugs provided to aid people living with HIV-2? More options, injectables etc It seems all developments are primarily focused on HIV-1 which is understandable. However there is still a few million of people that could be better catered for that are living with HIV-2. What are your thoughts on this?

H. Hunter Handsfield, MD

11 months ago

1. Yes, this is fine. You have had several tests that prove you do not have either HIV1 or HIV2, and all those results are conclusive.

2. Any close contact of course can transmit colds, flu, covid, tuberculosis, staph, strep, and many other infections other than STIs.

3. Your symptoms do not seem to require seeing a health professional.

I'm not sure what statistics show "several million" people with HIV2. Maybe in parts of Africa where that virus is prevalent, but there are no more than a few hundred in the US or Western Europe. And current treatment usually is just as effective as for HIV1.

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11 months ago

Thanks for this! Really clear and concise

I think the main thing here for me is the symptoms now! I think naturally with anxiety it can be very difficult to look past the symptoms and find a clearer explanation as the timeline and list of symptoms seems to match more closely to ARS than anything else based on the exposure

How often do you see symptoms like this actually result in a positive test?

and once again do you feel like this is sufficient enough for me to move on?

Appreciate the work you are doing on here! Thank you

H. Hunter Handsfield, MD

11 months ago

It's a natural human tendency to link sequential events causally -- that is the first event must be the cause of the second, especially when the first is unusual or special in some way, e.g. producing anxiety. But I can assure you with 100% certainty that your symptoms are not caused by any infection of any kind from the sexual event you have reported.

"How often do you see symptoms like this actually result in a positive [HIV] test?" This could happen, of course, if someone really caught HIV. However, your symptoms are NOT typical of a new HIV infection, regardless of what you think you found online, probably from non professional websites. But in the 20 years of this and our preceding forum, with thousands of questions from people worried about HIV -- and probably hundreds with symptoms much like yours -- nobody has yet turned out to be infected with HIV. You will not be the first. If and when it happens, it will be a) from a true high risk event, which you did not have and b) with more typical symptoms, and/or c) without initially false blood test results.

Yes I definitely "feel like this is sufficient enough for [you] to move on". Your definitely do not have HIV. Believe it and move on without giving this a minute's more concern.

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

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