[Question #3071] Hiv risk

40 months ago
I'm based in the UK and had unprotected sex with a woman in August this year. I have since been extremely anxious about hiv and have had several lab based antibody/antigen hiv tests both through the NHS and a private clinic, most recently at 14 weeks post risk. All have come back negative. I'm still very concerned though as I have had several palpable lymph nodes in the groin area for the last 3 months, a very stiff, painful neck with some small bumps and have had a white tongue for a few weeks which my gp and dentist have said is likely to be thrush. Could this still be hiv despite my negative test result beyond 3 months? I have no underlying health conditions that I'm aware of but am concerned that my very high anxiety levels may have affected my immune system and test results. 
Edward W. Hook M.D.
Edward W. Hook M.D.
40 months ago
Welcome to the Forum.  I'll be glad to comment.  One of the scary things about HIV is that some of the most common findings associated with HIV such as generalized lymphadenopathy, skin rashes, and even thrush are also VERY common in persons who do not have HIV. This leads many persons to then worry that their swollen lymph nodes, thrush or other findings may be due to HIV.  This is where tests come into play.  Currently available tests are amongst the most accurate microbiological tests ever developed and are powerful tools for distinguishing which swollen lymph nodes or other finding s are due to HIV and which are not. As it turns out the majority of swollen lymph nodes, flu-like illnesses following sexual contact, thrush, etc. occur in persons who do not have HIV.  I urge you to have confidence in your test results, particularly after testing several occasions.  Based on your history and that you have negative tests out 14 weeks after exposure you can be entirely confident that you did not acquire HIV. There is no reason for further concern and no reason for additional testing related to the contact that yo mention.

I hope these comments are helpful. If there are further questions, please don't hesitate to use your up to 2 follow-up questions for clarification.  EWH
---
40 months ago
Thank you, that's very reassuring. I'll try my best to stop worrying!
Edward W. Hook M.D.
Edward W. Hook M.D.
40 months ago
Great, glad my comments were helpful.  EWH
---
39 months ago
Sorry to come back again, but I'd be grateful for your views on whether extreme stress /anxiety could compromise the immune system to the extent that it could delay the production of antibodies. 

I don't want to undergo further testing if it's really unnecessary as it's incredibly stressful each time, but my concern is mostly with my white tongue, which comes and goes. If it is oral thrush, my understanding is that it is a sign of immunosuppression. 

If it helps, I've had 9 antigen/antibody tests to date at 3/4/7/8/10/11/12 & 14 (x2) weeks post risk. All negative

Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
Your question is one that we hear frequently.  There are no data to suggest that emotional stress or anxiety have a negative effect on the ability of the body to create antibodies. The idea that this occurs is an internet-perpetuated myth.  In addition, I would point out that your testing includes tests for not only antibodies put the p24 antigen of HIV which  is in no way influenced by stress.  Since the antigens reflect the presence (or, in your case, absence) of virus, this serves to doubly prove that you were not infected.  There is absolutely no reason for further testing- your tests thus far more than prove that you were no infected by HIV.

I hope this comment will allow you to move forward without additional, unwarranted concern.  EWH
---
39 months ago
Thank you. Once again that's very helpful and should set my mind to rest.  

If I may, I'd like to use my final question to ask whether you've ever seen someone who has had as many negative tests as I've had later turn positive? And does hiv2 have a longer window period? I believe p24 is specific to HIV1 so the duo test only detects HIV2 antibodies not antigens. 

I'm rapidly going off the Internet but there seem to be documented cases where people have taken up to 6 months to develop detectable antibodies, hence why the cdc maintained a 6 month window period until fairly recently.  The cdc appears to state that 97% of people with HIV develop detectable antibodies within 3 months of infection, although the UK bodies state a figure of 99.99% at this stage, so there's a lot of conflicting information.

Thanks again. 

Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
I'm afraid that your internet searches are misleading you, perhaps in part by providing you with older, out of date statements.  The CDC has not suggested that it takes 6 months for tests to become positive in many years.  I have never seen a person who had as many HIV tests as you have turn positive.  Even the earliest tests were completely reliable at 12 weeks following acquisition of infection and the newer tests have improved in many ways, providing higher sensitivity sooner after infection.  Further, the p24 antigen test is positive in persons with either HIV-1 or HIV-2 infections.

I am not trying to be unkind but you asked for my assessment.  I provided it using the most current and accurate information I have available.  If you prefer to believe what you've read on the internet, that is your prerogative but my answers and assessment are not going to change.  If you wish to rely on the internet however, you will certainly find lots of misleading and conflicting statements.  My advice remains to be entirely confident in your multiple test results and put this behind you.  If you are having trouble doing that, the answer is not more testing but addressing the basis for your continued concerns with a trained counselor.  Take care and best wishes.  EWH
---