[Question #3937] Follow up to #3303

33 months ago
Hello,

A couple of months ago I typed here that I was worried after involving in receptive/insertive oral sex with another man without ejaculation from both parts. I was just starting to acknowledge and move on but after about 2 months I developed and itchy flaky rash on my face which I think is seborrheic dermatitis which is always associated with hiv! At first my face was so itchy that it used to wake me up from itching but now itching is gone and only flaking on nose, eyebrows and beard remains. My self confidence is destroyed and I feel depressed and sad all the time. I dont have typical redness or severe dandruff but my T zone is still affected. I've been preparing for a major medical exam at the end of summer so I cant go get tested now but these were my previous tests:
1, 3, 5, 6, 7 months ELISA
11 months VIDAS hiv duo ultra
13 months RNA PCR undetected (<40 copies, artus qiagen)
14 months ELISA (bioelisa hiv 1/2, microelisa)

With all those 8 tests and I get this, I cant understand?! I always had a bit flaking but not this much, do you think I should move on again or what should I do?
And I found out this thing called silent HIV infection in some medical articles from early 90s where viral load and antibodies were not present and they diagnosed with DNA PCR and viral culture. DNA test is not available in my country. I'm very lost and cant concentrate on my studies.

Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
Welcome back to our Forum.  On this occasion I'll be answering your question but I have reviewed your earlier interaction with Dr. Handsfield and I agree with all that he said.  The interaction you described was virtually no risk and I am sorry you continue to worry about it.  I am guessing that your continuing anxiety over the event has caused you to seek information over the Internet, something that we urge clients not to do as there is so very much there that is incorrect, taken out of context, or is out of date.  This appears to be the case for you.  Seborreic dermatitis, while common in persons with HIV, does not occur only in persons with HIV and in fact, most seborrhea occurs in persons who do not have HIV.  This is the case for you, your prior testing for HIV is conclusive and proves that you were not infected by your encounter of concern.  Unequivocally, you did not get HIV and there is no need for further testing.  "Silent" HIV is a myth.

I hope that my assurances will be helpful to you and perhaps they will help bit I suspect you would also benefit from working through this with a trained counselor.  As I said above, there is no need for further testing.  EWH
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33 months ago
Thank you Dr Hook,

You are right, I'm obsessing over this but it was so coincidental to have this disease after an hiv scare. And tonight I have a prom but I got down again when my barber said you have dandruff in your hair even though I had washed it. Do you think my extreme stress over this and my upcoming exam could be a contributing factor to seb derm? I went to a dermatologist before but she gave me a very unusual cream called la roche cisaplast baume b5 which only contains zinc, magnesium,copper whereas on textbooks and people online say they are given antifungal shampoos, and mine didnt work. So maybe I should try a different doctor?
1)By the way I get frequent groin pain which could be  heat rash or jock itch, especially when I walk for a long time. Could it be due to fact that I gained about 10 kg weight when studying for my exam(and a bit due to depression), is it worrisome concering my immune system?
2) Do you think DNA PCR has more sensitivity than RNA PCR and combo test? I'm kind of hung up on  it since I couldnt take it.
3)Silent infection as I understand claims that viremia happens much later than actual infection, I belive latent infection like Herpes viruses. But that's not the case for hiv, I think, otherwise they wıuld never accept blood donation from people that had a risk?

I'll try my best to get over this, maybe see a therapist after summer.It's been hard because every textbook other than anatomy repeatedly mentions it, so forgetting is hard.
Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
 I do not know where their stress and anxiety make seborrheic dermatitis worse or not. Regarding treatment I would not counter with the dermatologists recommendations although I am not familiar with that medication.  Regarding your other questions: 

1.   Weight gain is not a symptom of immune dysfunction. Growing pain is a nonspecific finding but it is not a typical finding of either HIV or immuno deficiency. 
2.   From a practical perspective a DNAPCR is equivalent to an RNA PCR. From a theoretical perspective, if anything the RNA test should be more sensitive. Believe your results. 
3.   Within a few weeks of acquiring HIV virtually all infected persons have asymptomatic viremia.  In untreated persons viremia occurs throughout the course of disease and is never undetectable unless a person is taking effective therapy for their HIV infection. HIV viremia occurs before the onset of the other symptoms which are typical of advanced HIV infection and  if this is what you mean by "silent" infection you have already proven that you do not have it.   I believe you are either misinterpreting something you have read on the Internet or being misled by an incorrect statement. 

EWH
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