[Question #357] Struggling because of rash

35 months ago
Dear Doctors. I am reluctantly returning to this forum (please don't be angry) because I have nowhere else to turn, and there is such conflicting information available online. I am now almost 18 weeks post-exposure, and have had no less than 8 negative HIV tests, including a PCR at 21 days, a 4th generation at 13 weeks and a 3rd generation at 17 weeks. At 12 weeks I developed a sore throat (no fever) which developed into bronchitis and took 3 weeks to clear. I consulted with you and it was clear that this was not HIV. However at 16 weeks, I developed a horrible rash on my lower legs, right knee, all over my back, back of my elbows and both sides of my stomach. The rash is generally itchy (most of the lesions are itchy), and consists of red, raised lesions of varying sizes (average around 1cm). I have never had this type of rash before, which is why I am concerned. My doctor tried to treat it with anti-histamines and anti-inflammatory cream, but it did not respond. The original lesions (about 40-50 in total) are still there after almost 2 weeks, and I continue to develop new lesions every few days, in addition to the original one. I saw a dermatologist a few days ago, and he said that it is likely urticaria, although urticaria lesions usually last a few days (mine have been there for almost 2 weeks). He has now prescribed new medication, but no response yet, and I still develop new lesions. I would like your overall thoughts on this, as well as your specific views on:
1. Have you ever seen ARS develop after 16 weeks?
2. Can rash be the only ARS symptoms (I have a mildly sore throat that comes and goes)? Dr Tan's site/blog cites cases where rash has been the only symptoms, although seems from your experience that this cannot be. Pls clarify. 
3. Can ARS rash be itchy? Some "experts" say yes, some say maybe, some say no. 
Thanks in advance for your help. I really would have moved on by now if it wasn't for this rash. 
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago

Steven.  I will not get angry with you but I am worried.  I have reviewed some of your past interactions on the forum and see that you have been reassured that you do not have HIV yet you are having trouble believing the advice you have- this is apparently true despite both professional reassurances from us as well as multiple negative tests.  Further, despite having been advised not to seek answers through searching the internet, you continue to do so.  This is compulsive, anxiety driven behavior which I suspect you may need professional help to overcome.  Clearly you have not been successful in doing this yet.  If you cannot do this, I fear that every time you get the sort of minor, community acquired rash that most people get from time to time, you will suffer from these anxieties in recurring fashion and that is not healthy. Brief (and repetitive) answers to your questions are below:

1. Have you ever seen ARS develop after 16 weeks?
No, absolutely not.

2. Can rash be the only ARS symptoms (I have a mildly sore throat that comes and goes)? Dr Tan's site/blog cites cases where rash has been the only symptoms, although seems from your experience that this cannot be. Pls clarify.
The ARS can be manifest in a wide variety of ways including only as a rash.  Further, some people who get HIV, become infected without experiencing the ARS at all.  Having said that however, your tests ARE CONCLUSIVE and should be believed.  Current HIV tests are among the most reliable tests available in all of medicine and your multiple negative tests, obtained with different types of testing methods, make it clear that you do not have HIV. 

3. Can ARS rash be itchy? Some "experts" say yes, some say maybe, some say no.
As I noted above, the manifestations of the rash of the ARS can be highly variable.  For that reason, testing of persons who are at risk is recommended- a negative test means that the rash is not due to HIV.

You really need to figure out how to address your unwarranted concerns.  Rather than searching the internet which is notoriously unreliable, or wasting your money on further testing, I urge you to seek help from a mental health professional to help you work through your anxieties.  I say this out of concern for you.  EWH 
---
35 months ago
Thanks very much Doctor. I appreciate your concern and advice. My problem throughout (why I have been unable to accept the negative results) has been that I have not been able to logically put the pieces of the puzzle together (specifically how I can develop such a rash when I never usually get rashes, etc.). I know that I am over-analyzing things, and have been for a couple of months, as there have just been too many coincidences. But all logic should point to the outcome that I don't have HIV - I have done 8 tests, I have consulted many doctors, etc. I will consider your advice to seek professional help. 

If I may pick your brain on a separate topic, I have also (to add to my woes) developed 2 small skin-colored warts (1 each on 2 different fingers of the same hand). Is it correct that common warts are caused by different type of HPV to those that cause genital warts? So I should not worry about genital warts developing from this? 
35 months ago
So sorry to ask this but seems that the growths on my 2 fingers are likely molluscum contagiosum (sent a picture to my dermatologist). I understand that this a common sign of HIV infection, and I am now starting to get worried again. Sorry....
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago

You are attributing normal variation and coincidences to a disease you don't have.  This is illogical.  As you point out, you ARE over analyzing things.

Again, with all due respect, you are putting 2 and 2 together and coming up with 104.  The HPV that causes warts on the hands are rarely the same sorts of HPV that cause genital infections.  Further, if you have molluscum (you really do not know what these lesions are, do you- I suggest the place to start is with a dermatologist who can tell you what the bumps you have noted are), the fact is that the vast majority of molluscum occurs in persons who do not have HIV. Molluscum is by no means a common sign of HIV. 

I hope you will follow the course of action you have indicated that you plan to follow and seek the input of a counselor or other mental health professional.  You may wish to print out this exchange to help bring them up to speed on your concerns.  EWH

---
35 months ago
Thanks Doctor. I agree. As I won't be able to consult a psychologist for at least the next week, I am going to keep telling myself the following:
1. The risk of exposure was questionable in the first instance. 
2. I have had 8 negative tests of varying types in different countries. 
3. It is normal to get infections and rashes from time to time. In any event, ARS rashes generally don't itch. The stress that I have been putting myself under has surely aggravated the situation. 
4. It is literally impossible to get ARS illness after 4 months. 
5. All evidence makes it clear that regardless of my rash or how I feel, I do not have HIV. 
In fact, I would even say that if I were to develop every symptom in the book tomorrow, there is absolutely no way it could be HIV. 
I will keep telling myself this, and I thank you once again for your assistance in helping me to close this chapter. 
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Good plan.  Take care.  I'm pleased to hear that you will be seeing a psychologist.  EWH
---