[Question #3306] Follow up and worried

39 months ago
Dear Doctor
Please read my earlier conversation/question if you have time. After having no risk (as told earlier) exposure, i tested negative at 16, 26, 43, 57, 69, 90, 105, and 123 (4 months) days using 4th gen ag/ab laboratory based test, I was relieved and trying to move on with life. I was little worried about blood draw happened at 90 days as i didnt see the nurse taking out the needle. However i convinced myself that transmission can not happen that way during testing. At 4.5 months, i went for some dental work as i had a serious cavity from last few years. After two days from dental work, I got fever around 100-101 F that remained for one and half days, one sided (same of dental work) severe sore throat, same side swollen painful lymph nodes and one sided swollen tonsils. I took antibiotic, it went with in 24 hours and i felt fine. I went to went to dentist next day, he said not due to dental work, may be some viral or bacterial infection which made me worried, he did some work again. After finishing antibiotic for 3 days, sore throat came again, i immediately started antibiotic again, again i felt fine with in one day and completed the course for 3 days. 

As i was worried, after 10-11 days from the first onset of symptoms, I went for ag/ab HIV lab based test in a in Tokyo, It came negative. I was relaxed. Then I again went for dental work, and again after 2 days from dental, mild symptoms of sore throat came, I went to a different doctor and took antibiotic for seven days. Now everything is gone and nothing came back. In last six months, no sex, only thing which i had were many tests, all tests were taken in Japan except 90 day test in India.

My questions are

1. If symptoms were due to HIV, ag/ab tests would have been positive. This is worrying me as I am not sure whether antigen would have been in detection limit or not, I read that HIV RNA tests are always positive during ARS but not ag/ab tests. 

2. Do i need another expensive tests like RNA

Regards
Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
I'm disappointed that you continue to needlessly worry about your misstep more than five months ago.  I looked at our earlier interchange.  did you?  If you did, I am sure you saw my earlier statement "The ARS typically occurs within a few weeks (less than 30 days) of acquisition of infection and is unheard of more than 3 months following exposure."    Further, despite your dentists statement to the contrary, logic would suggest that oral symptoms following a dental procedure would be due to the dental procedure.  You need to believe your multiple earlier test results and stop your worrying that you could have caught HIV from your exposure so long ago.

In addition, your question about limits of detection suggest to me that you have been on the internet looking for information.  This is a bad idea as much of the information there is either taken out of context or incorrect. Thus, in answer to your specific questions:
1.  Correct, if your symptoms were due to the ARS, your test would have been positive.
2.  You do not need an RNA test or, for that matter, any other sort of test for HIV related to your exposure months ago.

EWH
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38 months ago
Dear Doctor

Thank you very much for your reply and i am sorry for making you disappointed. Actually i was relaxed after your assurance and  my negative tests. Then all those symptoms after my dental work came which made me really worried. Few things which made me survived during that tough time were the facts that symptoms were only on one side and they were responding to antibiotic. The test which i took was antigen/antibody test and blood was taken from arm and it was taken at 11 days from onset of symptoms. I am little confused, infact worried, about the testing during or shortly after symptoms

You may think I am sounding stupid, but i am really worried about blood draw at 90 days in India. Recently more than 30 people get infected by HIV when a fake doctor used a common syringe on people. This is really making me worried. So last test was exactly at 2 months (5 months from original exposure) from blood draw (at 90 days) and 11 days from onset of symptoms.

Now do you think 11 days after on set of symptoms is enough time to detect antigen or antibody or both on the duo test. I have gone through many of yours and Dr. HHH answers. In most of them, it was said that combination tests are always positive during symptoms, but in few of them, it is mentioned that just after 3-4 days, they became positive. Recently Dr. HHH mentioned that antibody tests becomes positive after around 7 days from onset of symptoms. I will be highly thankful to you if you can explain this in little detail. May i completely eliminate attributing symptoms to HIV if antigen/antibody tests came negative after 11 days?

Regards

Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
You are adding 2 and 2 and coming up with 8 as your answer. 

The spread of HIV and other infections is well described in situations in which persons have repeatedly used the same syringe for injection.  Your situation is different- you were having your blood taken, not receiving an injection.  If vacuum tubes were used, this too is indicative of the fact that you are not at risk because vacuum tubes for obtaining blood are designed for a single use.

Similarly, you are over reading Dr. Handsfield' s statements.  Antibodies are always detectable about a week after the onset of ARS symptoms but the antigen is detectable sooner.  Thus combination antigen-antibody tests taken just 2-3 days after the onset of symptoms are typically positive because the antigen is detected.  They symptoms of the ARS are due to the mixing of antigens and antibodies, thus it is logical that the tests are positive very soon after the onset of symptoms.  EWH
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38 months ago
Dear Doctor

Thank you very much for your reply. Please dont disappoint and upset for my queries. Last time, you said that  "The spread of HIV and other infections is well described in situations in which persons have repeatedly used the same syringe for injection", Actually I was first relaxed and then got worried as my symptoms (one night fever, one side sore throat and lymph nodes) started 10 days after first dental work visit (2 days after second dental work visit). My dentist used an injection to numb the tooth. I understand that chances of getting infection via injection is dental work is extremely unlikely, but for an anxious person like me, it fueled my anxiety..

I am a researcher (not in medical science), I know rare things happen. As told you last time, i took Ag/Ab test after 20 days from first dental work (9-10 days from onset of symptoms), it came back negative. Your last response kept me relaxed for some time. Then i started worrying again and want to put a final end to it as it is destroying my professional career badly.  

My last tests (taken from two different clinics) after 50 days from first dental work where injection was used:
1.  Private clinic: HIV-1 RNA, Taqman, detection limit 20 copies/ml: Negative
      Private clinic: HIV Ag/Ab, Hep B surface antigen, Hep C antibody: Negative

2. Govt testing center: Hiv Ag/Ab : Negative,    Syphilis, RR and TPR : Negative

So In total, I had 11 antigen/antibody test, lasts tests HIV ag/ab and  HIV-1 RNA test at 181 days from original exposure (at 50 days from first dental work, injection used by dentist). I really want to move now.

Do i need to worry about HIV-2 or any strain not detected by those test. Are HIV-1 RNA and ag/ab 50 days after dental work conclusive? Is there anything else i can do? 

There were no exposure in between, only original exposure six months back and dental work 50 days back. Are HepB, C and syphilis conclusive..

I apologize in advance if i upset you again...Please advice...I know you will close the thread after your reply as it is second follow up question...

Regards
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
The test results you report are absolutely reliable in relationship to the injections that you received in the dentist office.  They would have detected HIV-1 or -2, as well as syphilis. hepatitis B and C.  You do not have these infections.  You need to forget about this and move on without concern.  While rare things (likefailure of a test to detect 'do occur, this is exceedingly rare and does not occur repeatedly.  Believe your tests, they are conclusive.

As you point out, since this is your 3rd question as part of this post, this thread will be closed shortly.  In addition, I must warn you that further anxiety-driven questions of the sort you are now asking will be deleted without comment and without refund of your posting fee. 

Take care.  EWH
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