[Question #1747] Worried about HIV exposure. Please help Dr Handsfield.

44 months ago
Hi Dr Handsfield or Dr Cook. I have been following you closely for years on Medhelp back when you guys were active on there. I admire your work and your help. My issue stems back to October 10,2014 I had unprotected vaginal/anal sex with a friend. He is a straight white male but I have a feeling he might be very promiscuous and sleep with men as well. Around November 21st 2014 6 weeks from my exposure I began experiencing frightening symptoms. I had a debilitating headache for 4 days followed by lack of saliva production/ dry eyes and nose and mouth every thing dried out. I was also having chills and night sweats along with tingling/neuropathy feeling in my legs for weeks along with diarrhea and sometimes even constipation. I also had hives that were coming and going along with burning eyes and lost some sense of taste and smell still till this day it has never been the same. For 2 weeks straight I was sleeping for about 12 hours a day. After 2 weeks of this nightmare I finally decided to take a rapid test oral at 8 weeks which was negative. I did not trust the rapid test so I went to the doctor and ordered an HIV Elisa blood test at 10 weeks which was also NON reactive to HIV. But my cbc neutrophil count was elevated and so was my liver alt counts slightly. My doctor claims it was juat a cold but this was no cold like I have ever had before. These mysterious symptoms continued to ruin my life for an additional 4 weeks then I told myself to wait till 14 weeks to get another blood test becausr it would be considred "Conclusive" at that point. On January 23rd at a little over 14 weeks my HIV elisa test was NON reactive was again and my blood tests cbc"s were back to normal. But my symptoms continued on for an additional 2 months. I never got any explanation as to what these symptoms were caused by and I never had enough courage to go back for a 6 month test after all that stress I went through I couldnt bare another test and anxiety. Could I have seroconverted later th
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Welcome to the forum. Thanks for your question. I think I can help and am pleased to do so. The bottom line is that for sure you do not have HIV, assuming no more recent exposure that you haven't mentioned.

The modern HIV blood tests are among the most accurate diagnostic tests ever developed, for any medical condition. The results are 100% reliable if done sufficiently long after the last possible exposure, which varies from 4 weeks to 3 months, depending on the particular test or combination of tests. For the p24 antigen-antibody (4th generation) test, that time is 4 weeks; if you had standalone antibody tests, they were conclusive any time 6-8 weeks after exposure (or 1-2 weeks after onset of symptoms). Because the tests are so good, the results override all other consdierations:  no matter how high the risk at the time of exposure (e.g. if one your partner were known to have HIV), regardless of how typical the symptoms mgith have been for an HIV infection; and no matter the results of any other lab tests, your test results prove for sure you didn't acqurire HIV during that exposure in 2014 and that HIV wasn't the cause of your llness a few weeks later.

Although the illness you describe has some features consistent with the acute retroviral syndrome (ARS, i.e. acute HIV infection), it was not typical for it. Among other things, it started too late (onset almost always 1-2 weeks after exposure. It also lasted too long; ARS symptoms rarely last more than 3-4 weeks. You'll probably never know the cause,but  most likely it had nothing to do with the sexual exposure 6 weeks earlier. 

As implied above, it is never necessary to wait 6 months for a conclusive HIV test. But since you have been worried enough to come to the forum, I recommend you have one more HIV test now. Anxious persons usually are more reassured by negative testing than by even the most expert opinion, and you definitely can expect a negative result (assuming no new exposure in the past few weeks).  You know (intellectually if not emotionally) that it's nonsense to delay testing for fear of the result. It isn't the test that gives someone HIV, and if somehow you actually were infected, you have a responsibility to know it. For all testing for potentially life threatening conditions -- not just HIV testing, but things like mammography, pap smears, colonoscopy to detect colon cancer, etc -- anxiety almost always declines when testing is finally done, even if the result is positive. The stress of not knowing always is worse than having the answer.

I hope this has helped. I look forward to hearing the result of a repeat HIV test. Let me know if anything isn't clear.

Best wishes and stay safe--  HHH, MD

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44 months ago
Hi Dr Handsfield Im so elated that you replied to me so quickly. I had a test at 14 weeks which was also HIV non reactive which is reassuring. I just never went back to a final 6 month test because I was afraid it would come out positive. I have not had any exposures since that time. So you really think there is no chance I could have seroconverted to HIV positive after 14 weeks? I would also like to know which symptoms of mine were consistent with ARS and if my bloodwork results (neutrophils being elevated and alt count) sounds like something that is common or that happens during ARS? I will go back for a final test eventually I just wanted an experts opinion first which I greatly appreciate!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Thanks for the thanks. I'm glad to have helped. For sure I am confident there is no chance you could have seroconverted after 14 weeks.

Weakness, headache, fatigue, and skin rash all could go along with ARS. But they also fit with a hundred or more other conditions. Most people with ARS have more or less simultaneous onset of sore throat, fever, enlarged lymph nodes (neck, under arms, groin), and often a non itchy skin rash. This pattern of simultaneous symptoms is much more important than the particular symptoms or others. In any case, altered bowel function (diarrhea, constipation), altered taste, etc are not typical of ARS. And as noted above, the timing (onset, duration, etc) was wrong for HIV from the exposure described.

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44 months ago
Thank you Dr Handsfield for your imput it is very reassuring and I greatly appreciate it. Its just that I never got an explanation as to what it could have been which always leaves me to wonder. I know that you have stated you have never seen a 3 month negative become a 6 month positive in all these years you have been in this field. But sometimes people cant help but think (including myself) that we can be one of the outliers. My last and final question is if you thought my neutrophils and alt counts being elevated was odd during all of this phenomonon? I appreciate your answers and taking the time out to read and give your expert opinion on my case. Have a blessed day and take care!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
You had some sort of inflammatory illness, probably an infection. Unexplained infectious illnesses are common. Perhaps if an intensive effort had been made, i.e. testing various possible sources and a number of blood tests, a specific diagnosis could have been made. But this usually isn't done for nonspecific symptoms (nonspecific meaning several possibilities, with nothing obvious based on symptoms) unless more severe or more long lasting than yours. The fact that the cause wasn't known does not elevate the chance it was HIV -- and as discussed above, your test results were conclusive.

That concludes the two follow-up comments and replies included with each question and so ends this thread. Thanks again for the thanks. I'm glad to have helped -- that's why we're here!

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