[Question #3476] HIV 4th Gen AG/AB Accuracy and my symptoms. Please Help

35 months ago
January 15th was my "potential exposure".
March 3rd I took a 4th gen AG/AB test. Blood was drawn from vein. Also tested for Syphilis, chlamydia and ghonorea.  (All negative)
March 9th I've developed swollen lymph nodes on the right side of my neck and I feel a bump under my left arm pit.  Some back pain mainly on my right shoulder blade area.
March 12th I went to a county clinic where they only test for STD's.  4th gen AG/AB blood drawn from vein. Received results on March 19th (All negative). 
CBC was done on March 12th. 
My WBC is at 8.6%. Normal range is 4-11%. 
My Neuts came in at 74%. Normal range is 36-68. My Lymphs came in at 19%. Normal range is 22-47%. Everything else on my CBC came in normal.
I've had two days of night sweats. Some fatigue and about 9 pounds of weight loss. Eating regularly but first week of March I felt like the my stomach was full sometimes.. before eating and sometimes after eating very little.
Have I waited long enough rule out HIV is causing my symptoms from the testing I've done so far?
Please note that I indeed tested positive for genital herpes. (Not sure if that helps) 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Welcome to the forum. Thanks for your question.

You needn't worry at all about HIV:  for sure you were not infectged. You also have none of the other STDs for which you were tested with negative results. (More about genital herpes below.)

The AgAb (4th generation) HIV test is absolutely conclusive any time 6 weeks or more after the last possible exposure, and the results always overrule symptoms (no matter how typical of an acute HIV infection) and exposure history (no matter how high the risk at the time). Your symptoms are not typical for HIV or any STD, and apparently you had a low risk exposure, since you call it "potential". But these things don't matter any way: the HIV test results prove you don't have it. Your blood counts are normal; 19% vs 22% lymphocytes is meaningless.

If you would like to say more about your positive test result for "genital herpes", I'll be happy to advise you about it. There is no test for genital herpes, but I suppose this means you had a positive result for HSV type 2. However, many apparently positive results are false -- so let me know the exact numbers for both HSV1 and HSV2 antibody and we'll take it from there. (But you can rest assured your symptoms are not due to HSV.)

In summary, I am confident you have no STD or any other infection from the sexual exposure in January. (I can also comment further if you'd like to provide some details of the exposure.) You should see a doctor if your symptoms continue or you otherwise remain concerned, but you can put HIV and other STDs out of mind.

I hope this information is helpful. Let me know if anything isn't clear or if you'd like to get into more detail about the exposure and your HSV test results.

HHH, MD

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35 months ago
Good afternoon Dr. Handsfields

I appreciate your fast response and I apologize that I forgot to add the important detail of my potential exposure. It was unprotected with a sex worker (I know...I'm a big dummy) I am not circumcised  . Intercourse was under 10 minutes. Jumped in the shower immediately (Not that showering immediately would change anything) but just wanted to add that. My HSV 2 range was at .92  according to the lab results I received it said that testing in 2 weeks would be better and that anything over 1.10 would be considered definitely positive. Screening was done by Arup laboratories.  I quess my main concern is the fact that I have never had swollen lymph nodes whatsoever. Or have weight loss that didn't include exercising. At this moment I am eating regularly and some junk food but someone still manage to drop about half a pound a day. I haven't gotten a sore throat or felt like I have the flu. No coughing either.  It doesn't hurt when I eat or drink liquids neither. At this moment I am bit more calm, sleeping a little better. But when I went in to test on March 12th...I was a nervous wreck, filled with anxiety. Being anxious and fell into depression from just thinking about this whole fiasco. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Thanks for the clarifications.

Although your exposure was relatively high risk for HIV, the test result still rules and shows for sure you weren't infected. So this information doesn't change my analysis of your HIV situation.

It is unlikely you have HSV2. Although it can take 3-4 months for positive results, most newly infected people have positive results by 6 weeks. The clinic doctor is correct that your slightly elevated result of 0.92 could become positive in a few weeks, probably it will not.

I agree it makes sense to continue medical evaluation to assure nothing serious is going on. If your weight loss and other symptoms are related to the sexual exposure, it's conceivable you have sexually acquired infectious mononucleosis (Epstein Barr virus, EBV) or cytomegalovirus (CMV). Or it could be nothing more than anxiety affecting your appetite. In any case, keep working with your doctor, secure in the knowledge you don't have HIV or syphilis, and probably not HSV2.

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35 months ago
Should I still test at 90 days for HIV and syphilis?  Even though I tested with a 4th gen AG/AB  for those two at 56 days from the potential exposure.  I have never tested for Mono or CMV. I will be seeing my physician tomorrow afternoon to see if testing for those two would be into consideration based on my current symptoms. I'm just curious and concerned because those two were never brought up to me. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
I would not recommend any further testing for HIV or syphilis. Tests for both are conclusive any time 6 weeks or more after exposure.

I'm speculating rather wildly in mentioning EBV and CMV. But they are often sexually transmitted and can cause nonspecific symptoms and lymph node inflammation and enlargement. OTOH, most healthy peoplle have been infected, usually by age 20 -- so if you're older, they are quite unlikely to be the cause of these symptoms. It's just something to discuss with your doctor, but I would trust her judgment about whether it is worth the bother to test for them. If present, they'll clear up on their own; there is no treatment.

That completes the two follow-up comments and questions included with each question. I hope the discussion has been helpful.

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