[Question #2028] Please Help Diagnose My Problems

46 months ago

Hello Dr HHH / Dr Hook

I will try and keep this short and to the point. I am in India.

Sexual Encounters:

Encounter 1 - Dubai

With 3 High End Escorts – Condom Protected with No Condom Break in December 2016

HIV DUO test done at 4 weeks – NEGATIVE

HIV DUO test done at 8 weeks – NEGATIVE

HIV DUO test done at 12 weeks – NEGATIVE

Encounter 2 - Dubai

Nipple Sucking and Hand job with a High-End Escort

HIV DUO test done at 4 weeks – NEGATIVE

HIV DUO test done at 8 weeks – NEGATIVE

I got my full body profile blood work done after this.

Vitamin D Levels are low at 34

Vit B12 levels are low at 244.

Fatty Liver with ALD – 9% and NAFLD – 5%

ALT – 120

AST - 48

CRP levels are at 20.18

CBC – Lymphocyte count was 45% (when I had low grade fever)

Triglycerides - 221

Current Symptoms are Fatigue, Back Pain, Leg Pain, Body Pain, Low Grade Fever (got only once), Swollen Gums with Bleeding.

My Questions:

1.       Do the above symptoms sound like an autoimmune disease and the HIV test results could have been affected by it?

2.       Are my HIV tests conclusive with nothing to worry about with respect to my current symptoms?

3.       Is the elevated lymphocyte count alarming although the CBC test was done just after a low-grade fever?

4.       Are the CRP levels high due to Liver fibrosis or swollen gum Periodontitis?

My Doc has started – Metadoxine for 6 weeks, Vitamin D3 for 3 months, Vit b12 for 3 months and Rosuva Statin for 3 months as cardiac problems run in the family.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Welcome to the forum. Thank you for your confidence in our services. But a minor point before I address your questions, at least partly semantic:  We do not provide medical services and cannot diagnose anything. We can provide probabilities and a certain amount of speculation, but nothing more, especially outside STDs and HIV.

You had very low risk exposures. Indeed, my first response is to congratulate you for the wise decision to have only safe sex during the exposures described. I would have recommended against testing for HIV. However, those test results are conclusive:  the 4th generation HIV blood tests (antigen-antibody, or duo tests) are conclusive any time 4 weeks or more after the last possible exposure, so the tests done 6, 8, or 12 weeks after each exposure were unnecessary. There are no medical conditions or treatments that have any known influence on the 4th generation tests, so the results always overrule exposure history, symptoms, and any other lab test results. In other words, there is no chance you have HIV, assuming no possible reexposures that you haven't mentioned.

To your specific questions:

1,2) See comments above. There are no autoimmune or other conditions that alter the reliability of the kind of HIV tests you had. Neither the symptoms mentioned nor any others would alter the conclusion that you don't have HIV.

3) Any number of medical conditions other than HIV could cause modestly elevated lymphocyte counts in this range. Presence or absence of fever is not likely to have made any difference in those numbers.

4) There are innumerable causes of elevated CRP. You don't mention alcohol, but fatty liver with the liver function test abnormalities you report, your lymphocyte count, and the elevated CRP all are consistent with alcoholic hepatitis, and although I am not personally experienced with metadoxine, my understanding is that it is primarily used in the treatment of alcohol addiction, so I would guess this is similar to your doctor's analysis. I would be surprised if periodontitis would elevate CRP to this extent, but might do so if the gum disease is quite severe. You should also ask your doctor about viral hepatitis -- you don't mention it, but my guess is tests were done, in view of the abnormal liver function tests. However, there is a long list of conditions that could explain all this -- so this is a problem to be addressed with your doctor. However, no STDs likely to be responsible, and even apart from HIV, I doubt any of this has any relationship at all to the sexual exposures you have described. 

I hope this information has been useful. Best wishes and stay safe--  HHH, MD

46 months ago
Hello Dr HHH

Thank you for calming my nerves. Sorry for the wrong title, obviously diagnoses cannot be done over a virtual message board. 

No i have not had any exposures since and dont plan to have any such in the future as the anxiety that comes with it is unbearable. 

I am not suffering from alcoholic addiction. The doctor told me he prescribed metadoxine for 6 weeks - 3 times a day 500mg to clear out all residual alcohol driven issues from the liver. I was a sporadic alcohol drinker something like once in 2 months which he said was also bad and sudden spikes liver cannot handle. All abnormal liver enzyme levels came up accidently when i did the full body blood work, i had no symptoms. 

Last few questions:

1. Can my current symptoms of fatigue, muscle pain, gum pain, back pain be due to low vitamin d and vit b12 levels as all other blood parameters in cbc were in normal range and i want to be certain abt what is causing this? 

2. Since i have been a very very sporadic alcohol drinker should i take a second opinion on the metadoxine dosage or continue with it? 

3. I read scarry stuff online abt HIV being a risk factor for liver disease and periodontitis that scared me and OCD started spiralling with disbelief in my HIV Tests - Hope i can be rest assured these conditions are not connected and my safe sex with HIV tests are to be believed in? 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Thanks for the clarifications.

1,2) We strictly limit advice on this forum to HIV and STD issues. In any case, I have no knowledge about these symptoms as a manifestation of vitamin deficiency, but to my knowledge these deficiencies cannot account for your hepatic and oral health problems. And I have little occasion to manage alcohol addiction and related problems, and I have never once prescribed metadoxine. You'll have to ask your doctor about these things.

3) As noted above, your HIV test results prove you don't have HIV -- and of course that means that HIV cannot have anything to do with your liver problem or periodontal disease. You indeed can "rest assured these conditions are not connected".

46 months ago
Thank you doctor for your help. 

One last question and i would be done. 

I have been a smoker and i quit 1 month back, i have always had bleeding gums from time to time. They say smoking masks the gum diseases and it comes out when you quit. 

But my question is: 

At what stage of the disease does an HIV patient develop a gum disease? 

Thank you for your time and invaluable help. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Gum disease would never be the main or only symptom of HIV; it occurs late in HIV, i.e. advanced infection with overt AIDS, in people who are otherwise ill with many other symptoms. In any case, the test results always overrule any and all symptoms:  even if this were typical for HIV, your test result shows that HIV cannot be the cause.

I don't know who "they" might be, but they are wrong. Smoking does not "mask gum disease" in any way.

That concludes the two follow-up comments and replies included with each question and so ends this thread. You can move on without worry about HIV. Continue to work with your doctor about your liver and other health issues. Best wishes and stay safe.