Just a quick follow up question from the other day. 

After acquiring genital hsv 1 a month ago I was concerned with hiv as well. You basically said very low risk. Covered sex and uncovered oral etc which was very comforting. I have done some research and it seems so remote to catch hiv even if my partners were hiv positive. 

I have still been feeling tired, having sore muscles (especially my lower and middle back and swollen lymph nodes behind my jaw. So I got tested at 27 days after my last exposure hiv 1 and ag/ab. I know it was a little early and one day before 4 weeks but I had time to it and figured if it’s around 90 percent accurate that would do for piece of mind anyway. 

It came back negative as expected and I was very relieved. I did realise though that I had taken a 10 day course of valaciclovir 500mg twice a day during this time.

I just have two questions in regards to the testing

Could the valaciclovir push out the window period for testing and reduce antibodies for hiv testing as it’s an antiviral?

Also if for arguments sake we assume my symptoms are actually from acute hiv (I know it’s unlikely). Would an hiv 4th generation test show positive anyway? Regardless if it’s less than 6 weeks since potential infection? I figured if a person is showing symptoms they would test positive anyway. 

I’d appreciate your response Dr, and you were interested in the clinic that diagnosed my hsv. I’m in Australia and feel very lucky to have access to such a good service. 

Thanks again 

All these issues come down to a couple of simple facts about HIV testing that you actually have realized yourself:  I am happy to confirm that "if a person is showing symptoms [from HIV] they would test positive...." Exactly right! And this is regardless of the time since exposure to HIV. Almost all discussions of the HIV test "window period" -- the time to positive test results -- is for HIV infection without symptoms. If symptoms are due to new HIV infection, testing is ALWAYS positive, no matter how long after the exposure (even as early as a week or two).

Accordingly, your objective analysis (recognizing that anxiety and other emotional reactions are not always subject to objective thinking!) is right:  your negative test results prove with certainty that your fatigue, muscle aching, and possible lymph node inflammation are not due to HIV. In response to your ancillary question, there are no medical conditions or medications that alter or delay the reliability of HIV testing (except for anti HIV drugs themselves). That includes valacyclovir or your newly acquired HSV1 infection; they had no effect on your HIV test results.

A final comment is that such feelings as fatigue and muscle aching often are the result of worry, anxiety or other emotions magnifying minor symptoms or even normal body sensations that otherwise would be ignored or not even noticed. Lymph nodes -- maybe not -- but self-assessment of lymph node inflammation by medically untrained persons is notoriously unreliable. If these symptoms continue, consider checking back with the clinic or your personal physician -- but don't worry about HIV.

Last time I wondered if you might be in Australia. Your country's federally funded sexual health centres are, collectively, the world's very best network of STI/HIV clinics. And if you happen to be involved with the Melbourne or Sydney SHCs, you're at the best of the best. I'm friends with much of the SHC leadership in both cities. If you're still in touch, please convey my regards.

Happy holidays--   HHH, MD

I’m booked in to see a Dr tomorrow about my other symptoms.

I have thought that it could be anxiety causing these very real symptoms but normally I’m not an anxious person at all. But who knows, the mind is a powerful thing. I often have swelling in the lymph nodes anyway especially when dehydrated and have been working long hours so it will be good to discuss that anyway.

Yes I was unaware that sexual health clinics in Australia are funded by the federal government and offer free testing and access to a Dr (for everyone!). I was pleasantly surprised. 

Thanks again Dr. Enjoy the holiday period.