[Question #1308] HIV Concerns

83 months ago

Hi Dr's,I really appreciate your advice and knowledge. 


Struggling with what I thought could be HIV related symptoms. 13 weeks ago I performed unprotected cunnilingus on a female prostitute. It was dark. I must have been there for about 5 minutes, I was drunk. I was very stressed at work and have been pickling myself in stress hormones since!

2 days after a sore throat, mild fever, a coated tongue. Dr prescribed Erythromycin swabs came back clear, antibiotics did nothing, nor did an oral thrush medicine. Dr advised a viral infection. Following this my mouth and nasal passages dried up completely. Visited Oral Surgeon diagnosed a viral infection of the salivary gland (Submandibular). 13 weeks later my mouth is still dry, teeth are getting a bit of decay.  Weeks 2-9 nausea, lots of abdominal noises, and loose stools, lost about 4 kgs. Had a range of mouth sores - small ulcers, irritation / inflammation to the roof of my mouth. Tender lymph nodes all around the body get sore at different times to different areas, the base of my neck (behind collar bone) ached for most of the 13 weeks. In my groin nodes are tender. Suffered fatigue. 

Tests:POC's - 4th Gen Bioline SD HIV Ag/Ab Combo - 4.5 weeks and 81 days - negative.

Bloods - 4th Gen Abbott Architect HIV 1/2 Ab & p24 antigen  - 3 weeks, 8 weeks and 87 days - negative. 

My Dr and the local Aids Foundation just want me to ignore the symptoms and move on (from HIV scare).  Ongoing concern is 8 years ago I had rare skin condition, PLEVA. Theories suggest it could be caused by: A relatively benign form of T-Cell lymphoproliferative disorder, or an immune-complex-mediated hypersensitivity vasculitis.  I catch lots of common colds too. 

Questions: 1. Even though many symptoms have now cleared up could I have not seroconverted and not be detected in the tests?

2. Could my immune system be faulty and have not produced antibodies for the tests to pick up yet?Bottom of Form

H. Hunter Handsfield, MD
83 months ago
Welcome to the forum. Thanks for your question.

The answer is simple and straightforward. The HIV blood tests are among the most accurate diagnostic tests ever developed, for any medical condition. When testing is done sufficiently long after the last possible exposure, the results always overrule exposure history and symptoms. And all your tests were done well beyond their window periods. Your exposure was zero risk or close to it (HIV has never been documented to have been transmitted by cunnilingus), and your symptoms really aren't as typical for HIV as you seem to think. But even if you had the highest possible risk exposures, or the most classical symptoms of HIV, the test results prove without doubt that you don't have HIV. In other words, your doctor and the local AIDS foundation are exactly right.

I have no useful knowledge about your past skin condition, but I see no reason to worry about any sort of underlying immune deficiency. There is no immune deficiency that makes people more susceptible to upper respiratory infections.

Those comments pretty well answer your direct questions, but to be explicit:  No, there is no possibility you have not seroconverted. AMong other things, you were tested both for the virus itself and for antibody to the virus. The word "seroconversion" applies only to the antibody. If you hadn't seroconverted (developed positive antibody tests), then the virus tests (the antigen components of the tests) would be even more strongly positive than otherwise. In other words, there is simply no such thing as having HIV and having negative test results like yours.  

I hope this has helped. Let me know if anything isn't clear. Best wishes and stay safe--  HHH, MD

83 months ago
Hi Dr HHH,

Very much appreciate your prompt reply which answers my questions and also resolves my concerns. 
This service is excellent and thank you for your response.


83 months ago
once again thank you for your reply. 
Can I please check with you whether I should test again at 6 months to be sure? 

I suspect as you have outlined this may be unnecessary even if I had some sort of immune deficiency as you have outlined by 12 weeks if the antibodies hadn't shown up the antigen component would have. 

I understand that this is the reason why you conclude that a 4th gen test is conclusive at 6 weeks. Let alone the 12 I tested too. 

As you can appreciate I want to be sure I'm clear so as not to worry any more and also so no body else could become infected. 

Thanks again. 
H. Hunter Handsfield, MD
83 months ago
You correctly explain your understanding, including the reasons that no further testing is necessary. For sure you do not need another test at 6 months or any other time.