[Question #3181] HIV tests and worry

39 months ago
Dear Doctor,
I am a bisexual male who occasionally has receptive anal sex (Always with Condoms) I last took an HIV 4 gen Test in July and was negative.  Since then I have had two male partners who both used condoms.  One on 9/21/17 and the other was on 12/8/17. 
In the last week everyone I’m my family has been sick.  My kids had some viral infection my wife has been sick as well. My doctor treated me for bronchitis and a sinus infection. He used Azithromycin 500mg for three days and then levoflxcin.  I am allergic to pennacillin. 

I took one 500mg  pill of the levifloxin and had some terrible nerve pain in my hands and nightmares and diarrhea. I went back to my doctor today and he ran a full blood work up on me and I asked for another 4th generation test as well as RA and other things. I should get results next week.  I have never had any feaver or sore throat symptoms in the last few monthes and no rash to speak of.  

I realize that this is 32 days after my last event and not the full 42 days that you currently recommend on this forum. Will that make it less conclusive? Should I retest at 42 days? 

My wife has Pleurisy and is being treated with prednisone and an abuterol inhaler, she has been tired and has had night sweats. This terrifies me that I possibly got infected and then infected her with HIV despite using condoms with my other partners I realize that this may also be guilt from some stupid sexual decisions that I regret and my wife may just have the same viral bug that my kids had.  My anxiety is through the roof.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Welcome back to the forum.

Your symptoms are not from acute retroviral syndrome (ARS, i.e. symtpoms of a new HIV infection). First, they started too late:  ARS onset generally is 1-2 weeks after exposure and it sound like your symptoms started at least 3 weeks after your sast exposure. Second, that exposure was low risk (condom protected). Third, your symptoms aren't right:  ARS does not cause cough, bronchitis, or sinus symptoms (stuffy or runny nose, etc), and generally does not cause diarrhea, nighmares, or pain in the hands (whether or not that discomfort is "nerve pain"). Fourth, both the timing of your symptoms and consistency with the others in your family point to the obvious cause, a shared viral infection. 

So you definitely can expect a negative HIV test result. The AgAb ("4th gen) HIV blood tests are almost 100% conclusive at 28+ days after exposure, so your negative result will settle it for sure. You could have yet another test at 6 weeks if it will further reassure you, but it really isn't likely to be necessary unless your doctor advises it. (I hope he is aware of your sexual lifestyle and risks.)

It is much too soon for your wife to have caught HIV from you and have symptoms from it. And pleurisy and her other symptoms don't suggest ARS.

All things considered, no worries at all about any of this. When you get the negative result of the current HIV blood test, discuss with your doctor whether or not to have another one at 6+ weeks.

I hope these comment are helpful. Let me know if anything isn't clear.

HHH, MD

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39 months ago
Doctor Handsfield,
Thank you for the reasurance. My doctor is aware of my lifestyle and past choices although I did not tell him of the last two risks. In response to not haveing enough time for me to have infected my wife and for her show signs, I understand that there prob wouldn’t be enough time since my risk on 12/8, but I was more concerned of the event on 9/21/17, as I thought that was enough time for me to have possibly been infected and then infect my wife since then. Although I used condoms for that as well. 
 Her night sweats and complaint of back pain (which her doctor said was Pleurisy after taking X-rays) have me wracked with guilt. 
Of course it is perhaps silly as condoms  were used and I saw that they did not break. Am I being totally irrational?  
Her illness didn’t present the nasal symptoms of the rest of us only the night sweats and whatever the doctor saw in her lungs. Can the same virus as my kids had, present differently in her? 
I read that perifial  neuropathy is common in HIV but the Levofloxin I took yesterday is also known to cause that. My doctor took me off that medication today. Is that more common in advanced infection and not early on? 
Of course, I realize that tests overrule any symptoms that either my wife or I have currently. She has not complained of a rash or sore throat, but the night sweats and muscle pain seem bad.  Perhaps some of the muscle pain is from her tensing up from the Pleurisy ? She hasn’t been taking the muscle relaxant they gave her very much. 

So I understand correctly that I can rely on this test at 32 days? I know you used to recommend 28 days but that the CDC has changed it to 42, I’m guessing to be medically and legally conservative.  I won’t get results until sometime next week I’m guessing, although 1/19/18 would be 42 days so anything after that would be 100% if I got another test. Or would that be a waste of time if this comes back negative from today? 
However, is it still true that no one has tested postive  at 6 weeks, who was negative at 4 weeks? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
I suppose your wife could have ARS if you had acquired HIV in September, but that's unlikely to have happened and her symptoms still are not suggestive of ARS. Don't overthink it:  the obvious and logical explanations are, well, obvious and logical.

Neuropathy is an issue primarily in longstanding HIV, i.e. overt AIDS, but not ARS.

The difference between 28 (or 32) and 42 days is 1-2% tops, i.e. from 98-99% of infections detected to 100%. That implies that there must have been a few persons who tested negative at 4 weeks and positive at 6, but I certainly have never had that occur in my clinical experience.

Whether or not an additional test would be a "waste of time" is addressed above when I said "You could have yet another test at 6 weeks if it will further reassure you". If you are comfortable with the virtual certainty you should get from the pending test result, that's great. But many anxious persons are more reassured by negative testing than expert advice. So it's up to you whether or not to have another test at 6+ weeks.

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