[Question #3468] General questions re: symptoms/testing

35 months ago
Hi there, 

I’ve been on this forum before, but I had to create another account (I was having trouble signing in with my existing account). 

This is for Dr. H or Dr. H :) 
I wanted to keep these questions rather general so they might be able to help others who read the forum. Thanks for taking the time to answer these. 

1) What percentage of people who acquire HIV experience ARS?  How many days or weeks does ARS typically last? Does it vary? 

2) When Lymph Nodes swell during ARS, are they either body wide OR in one specific area such as the neck? It seems as if there are conflicting answers on this on credible STI websites. 

3) If someone unknowlingly acquires HIV and 
is not on treatment meds, are these people more susceptible to colds, flu, allergies, bronchitis? Can they catch it “easier” if they have HIV? 

4) Can untreated HIV cause eyes to “yellow” in the corners or white part of the eyes? Is this a potential symptom or indication? Have you seen this in any of your experiences with HIV patients? 

5)  If a person doesn’t know they have HIV and are not on treatment, at what point would they typically start to experience signs and indicators of untreated infection? 
Is fatigue a factor? 

6) Are local ER labs a sufficient place to get HIV results? Most seem to have their own lab and run tests “in house”.  Do you think they have the same testing capabilities and/or regulations such as a place like LABCORP or QUEST? 

7) When you advise that testing is no longer needed after a negative 6 week result, do you also account for technician error or lab mistake that could affect test outcome? What’s your opinion on the probability of this happening? 

Thank you both for providing this online service! Very appreciative. 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Welcome back to the forum. Directly to your questions.

1. ARS symptoms are recognized in roughly half of all new HIV infections, but often are mild -- some reports say as high 80-90% if very subtle symptoms are included. Onset is almost always 1-2 weeks after infection and duration averages 1-3 weeks. 

2. Lymph node inflammation is generally body wide, rarely if ever localized to only one area like one side of the neck, one armpit, etc. Typically they are painless; pain in lymph node bearing areas is not evidence of ARS.

3. No, this is a common mispercptioin. People with untreated HIV, who have not progressed to overt AIDS, have no increased risk of common illnesses (colds, etc) than anyone else. The immune suppressive of HIV is manifested primarily by increased severity and danger from various infections, but not increased frequency until they are already quite ill with AIDS.

4. Such changes in the eyes are not likely to be due to HIV and certainly would never occur in the absense of many other symptoms of advancing HIV infection.

5. Progression to overt AIDS occasionally occurs within a year but can take 20 years or more. Most people progress to overt illness between 5 and 10 years.

6. All lab-based HIV blood tests uses the same highly automated equipment, which is more or less foolproof. The equipment used, and hence reliability of testing, is essentially the same in the least elaborate small hospital, or in a clinic that has its own lab, as in a sophisticated medical center, or a large national lab like LabCorp or Quest.

7. With a modern HIV antigen-antibody (Ag-Ab, "4th generation") blood test, there is never a need to test beyond 6 weeks, no matter what lab does the test and regardless of the nature of the exposure to HIV and the symptoms a patient may have.

I hope these comments are helpful. I have the feeling you have asked them all previously, perhaps several times. It's time to stop:  accept that you do not have HIV and move on with your life. Best wishes.


35 months ago
Thank you Dr. Handsfield for the quick response and answering my questions in detail. I do have a few follow up questions. 

Regarding Question 4, are you able to share with me if you have seen this in HIV patients? Have you personally treated a patient with HIV who had a yellow discoloration in their eye(white area)? 

You mentioned that advancing HIV has many associated symptoms. Can you share some of those symptoms? In your patients with advanced HIV, what signs or symptoms are relatively common? Can you define the approx time period at which advancing HIV begins? 

Last, referring to Question 3, that only someone with overt AIDS could catch illnesses quicker.....Does this occur with someone who has had AIDS for quite some time OR does this take place once HIV progressed to AIDS? 

Thank you again , Doctor. This will conclude the rest of my questions to you. 

Appreciate it very much. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
It seems clear you're asking these questions because you have had such symptoms and remain obsessed with HIV as a possible explanation despite your negative test results. It's a pointless exercise:  the HIV blood tests are among the most accurate diagnostic tests ever developed, for any medical condition. If enough time has passed (e.g. 6 weeks for the AgAb tests), the result overrules all other considerations. No matter how typical the symptom for HIV, or no matter now high risk the exposure, the test result rules. It is therefore pointless to ask about particular symptoms if indeed you have been tested and negative. Hence, very succinct replies.

Yes, some people with HIV are jaundiced, with yellow eyes, if they also have serious liver disease. I don't recall any HIV patients who had such a problem, but it might have happened.

Google "symptoms of ___" (AIDS, HIV, ARS, etc). Too many to spend time here when the information is so readily available. I already gave you the usual time frames above.

Assuming you indeed have been tested with conclusive results, I'm going to ask that this be your last question (under any username) about HIV symptoms, timing, and HIV test interpretation. Thank you.

35 months ago
Thanks for reply. I had a 5 week negative result from unprotected vaginal (one exposure).  Would you personally test again if you somehow found yourself in this situation?

I understand the 1/1500 per exposure  and 98% test accuracy at 5 weeks. At the same time, its also pretty tough to have symptoms that are similar to that of HIV. Having to live with the “what if” is very real to me and many of us on here. 

The reason I asked about Advanced HIV, is because most sites I’ve explored said that there is a long period of asymptomatic stage where there are no indicators that HIV could be present. That’s why I was seeking clarification on what you meant when you spoke of “advanced HIV symptoms”.  Just wanted you to briefly describe some symptoms that you’ve seen in your professional career from HIV patients after 1-2 years of having it. 

I understand that you probably don’t want to mention any because you don’t want to alarm other thread readers. I do feel, however it’s a valid question. 
 Most of the time, web sites and threads talk about ARS symptoms. This is not an ARS question. 

I am aware this is my last reply. Thank you for your time

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
I would strongly recommend that rather than wringing your hands over possibilities about as remote as being struck by a meteorite, you just wait a few days and have another AgAb (4th generation) HIV blood test. No, I would not personally test again if somehow it were me. But I might not have been tested the first time either; or would have waited to have a single test at 6 weeks, if the exposure were sufficiently high risk. But I'm not you, and some anxious persons are more reassured by negative testing than by professional opinion, no matter how expert. Another negative test migth (I hope) get you to a point of genuine belief you aren't infected and rsolution of your worry about it.

From what you have said in this thread, it seems you have not had much in the way of symptoms "similar to that of HIV". If you did not have a combination of simultaneous sore throat, fever, body-wide skin rash, and painless lumps in several locations, then you did not have typical ARS symptoms; and the context (being concerned about a recent exposure) indeed made your question much more relevant to ARS symptoms than those of overt AIDS. Of course it is nonsense that we would not mention severe symptoms out of fear of alarming forum users. But since you ask:  by "advanced HIV symptoms" I mean someone looks and feels very ill, with combinations of such problems as fever, poor appetite, marked weight loss, chronic cough, shortness of breath, unremitting diarrhea, and more. Although such advanced disease could occur as soon as 1-2 years, usually it wouldn't be until 5 or more years after acquiring HIV.

In any case, the reason we speak on this forum primarily of ARS symptoms, and not overt AIDS, is that we have had almost no questions from people with known HIV infection; in fact, they are discouraged from asking questions here as we emphasize prevention and early diagnosis. 

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful and that you can now move on without worry -- if not quite yet, then after you have your 6 week test result in a few days.