[Question #4483] 4th Generation Negative Query

81 months ago

Exposure in Thailand with high end csw

-Kissing, mutual masturbation and protected sex.

Day 26 i had fever/chills/sore muscles.

After 5 days felt normal except pain in spleen when jogging the next week.

Had tests blood test from vein at lab south africa

Day27 ag/ab negative.

Day 43 ag/ab negative.

Docter, i was diagnosed at day 50 with high level antibody of cmv, but no current or recent infection. Also diagnosed with ebv antibody, with the docter saying its positive for either a reactivation or recovery from an acute primary infection. He told me that south africa has a 6 week window for combo tests and i tested outside the window. What i want to know is am i reliably negative, or could the infectious mono have altered the hiv test?

H. Hunter Handsfield, MD

81 months ago

Welcome to the forum. Thanks for your question.

First, HIV is now quite uncommon in Thai female commercial sex workers; the success of Thailand's public health programs in reducing the previously high HIV frequency in female CSWs has been applauded world wide. And probably particularly low risk in a "high end" CSW.

Second, congratulations for having entirely safe sex. HIV is almost never transmitted by oral sex, and never by fingering or other hand-genital contact; and condoms are highly effective in preventing transmission during vaginal sex.

Finally, your negative HIV AbAg test result at 27 days was nearly conclusive and definitely was conclusive at 43 days. In other words, I agree with the advice you received South Africa.For sure you don't have HIV.

Almost every healthy person over age 20-25 has positive CMV and EBV antibody test, mostly the result of having been infected during childhood or the teen years. Having "high level" may raise the chance of a recent infeciton, but if you haven't had a mono-like illness, there's nothing to worry about. There are no medical conditions, including acute CMV or EBV infection, that have any effect on reliability of HIV AgAb testing.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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81 months ago

Hi Dr

Thank you so much for your prompt reply.

I did have a mono like illness after the exposure, at 26 days. Fever, muscle ache, nausia, painful spleen, palate petechia, and the doctor said the results indicate mono from ebv, likely because of the kissing involved in thailand. Do u agree with my doctor that

1) if the symptoms at day 26 was ars, the duo at day 43 would def be positive.

2) my cmv high antibody does not matter as lab testing shows no recent infection, only historic antibody and i havent had any exposure other than the one mentioned 43 days ago.

3) acute mono from ebv have no impact on testing and i am conclusively negative according to national south african testing guidelines from my 43 day negative lab duo test.

Should u agree with 1+2+3 u may close the thread, and once again, i dont know how to thank you so much for your expertise and quick reply.

H. Hunter Handsfield, MD

81 months ago

Thanks for the additional information. I agree this seems to be a mono-like illness. Not to be too picky, but recent research has partly debunked the notion that most cases are acquired by exposure to saliva. Saliva indeed can transmit EBV, but it is also transmitted via genital fluids, and in teens and young adults, most cases are acquired sexually. Since you used a condom, it could well be you acquired it by kissing. But this doesn't apply to most cases. The same is true for CMV.

1) ARS symptoms almost always begin <2 weeks after exposure. Onset at nearly 4 weeks doesn't fit well with ARS, but is typical for EBV or CMV. And yes, the duo tests always are positive in persons with ARS symptoms.

2) I agree.

3) Already answered above: there is no known effect of ANY medical condition, including acute infections like mono, on HIV test reliability, especially with the AgAb tests.

Also note that I base my confidence you don't have HIV on more than the test result; see my risk analysis above.

Thanks for the thanks. I'm glad to have been of help. Each question comes with up to two follow-up comments/questions, so the thread will stay open a while longer in case anything else about this exposure etc comes to mind.

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81 months ago

U mention high levels cmv may indicate recent infection. Do u mean cmv or hiv.

So i can conclusively say im negative after the 43 day duo and put everything behind me? Thank you doc.

H. Hunter Handsfield, MD

81 months ago

I meant CMV. However, it is more than antibody "level" that may indicate acute or recent infection. There are 2-3 types of CMV antibody tests. The combination of specific tests is a better indication of old vs new infection than antibody level is. But this really is nothing to worry about. Almost certainly you had mononucleosis due to EBV. The CMV test means nothing in terms of your health now or in the future.

"Can I conclusively say...?" I haven't changed my mind in the last hour and see no need to repeat myself. Read above.

That concludes this thread. I hope the discussion has been helpful.

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