[Question #5252] Please help make sense.

22 months ago

Dear Drs,

Middle East, unprotected receptive fellatio – protected vaginal intercourse with CSW from India (higher risk for hiv 2?) 9 months ago.

3 months: fungal/yeast infection on penis, cleared with cream.

3 months: keratosis pilaris, today, 9 months after exposure, it is wide spread.

7 months: mild, consistent headache for 5 weeks. Gone for a month, then back again, this time on and off for a month.

7 months onward: constant ringing in ears. Lately experiencing a feeling of fullness / pressure in ears along with instant bursts of pressure every once in a while, during which the ringing gets really loud and in a few seconds gradually diminishes with the pressure. However, the low pitch ringing is always there.

8 months onward: developed a whiteish / transparent patch on lateral border of tongue. Doctor says doesn’t look like leukoplakia. Looks like kerotasis also.

All these problems experienced first time ever, after the above mentioned sexual encounter.

8 weeks: negative with AB/AG.

1. Could hiv cause these problems during chronic infection stage?

2. If #1 is yes, does the timeline seem consistent with chronic infection symptoms or too early? (I heard with the so called seronegative people, disease progression is much faster)

3. Are there well documented cases of people who never produce detectable antibodies?

4. If #3 is yes, how could a seronegative person be diagnosed with hiv 2 seeing AG component only detects hiv 1, and hiv 2 rna testing is nonexistent in many countries (at least where I live). Theoretically one could keep testing negative indefinitely. Is this a possible scenario?

5. do you have any advice for me? Can’t get another test for 2 more months.

22 months ago
In my previous message, I wanted to get all the info in one message, while respecting the word / character limit. Therefore, I apologize for the lack of courtesies. I think you are doing a great service here and your help is much appreciated. Thank you.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Welcome. Thank you for your question and your confidence in our services. And thank you for summarizing your concerns and adhering to the limits on length of questions.

Quick summary:  You had a very low risk exposure and no symptoms that suggest any STD or other infection as a result. Your test results prove you did not catch HIV.

You are making the very human mistake of associating various symptoms with a particular event and your anxieties and apparent regret about it. But the fact that event B follows event A does not usually indicate that the first caused the second. And every one of your symptoms is much more typical for emotional reaction and exaggerated symptoms because of anxiety than of any infection. But perhaps most important, it is impossible to have HIV with a negative AgAb test 8 weeks after catching the virus. It's simplly impossible. To your specific question:

1,2) "Chronic" means infection several months along. Anyway, everyone with HIV more than 6 weeks has a positive AgAb test. There are no exceptions.

3) This question suggests you do not undertand the AgAb tests. Yes, rare persons may not produce antibodies. But the test detects both antibodies (the Ab part) and antigen (Ag), i.e. the virus itself. If antibodies do not develop, the Ag part of the test is even more strongly positive, A negative result shows that neither the virus nor antibodies are present. Therefore, no HIV infection.

4) The test detects HIV1 antigen, but not HIV2. Howver, the antibody part is 100% reliable all by itself. Anyway, HIV2 is rare outside parts of west Africa.

5) My only advice is to stop worrying. You do not need any further tests; for sure you do not have HIV.

I hope these comments settle your fears. Ignore your symptoms -- or if they continue, see a doctor. They are not typical of HIV and the test proves something else is causing them.

22 months ago
Thank you for the response Doctor Handsfield.

When I used the term chronic infection symptoms (and perhaps wrongly), what I meant was the health problems that people experience once the infection is settled - as opposed to the symptoms that can occur during seroconversion - and whether or not the symptoms and the time frames I listed were consistent with it. Because I read that once a person seroconverts, they do not have any symptoms for several years and I was in a way hoping that 3 to 8 months post exposure is too early to have these problems due to hiv. I saw a few doctors regarding the skin, headache and ear problems. While the dermatologist said the reason for kerotasis pilaris is not really known, the ent and the neurology specialists failed to find the cause of the problems, which further fueled my fears.

I understand that the ab/ag tests can detect infections due to the ag component even when antibody is not in detectable levels. However, what I am worried about is - although very rare - if one was infected with hiv 2, which the ag component cannot detect, and at the same time happened to be one of those very few people who never produce detectable antibodies,  they would continuously test negative regardless of how much time has passed after the exposure.

I also understand the chances of this happening -while I suppose theoretically possible- is extremely unlikely: partner being infected with hiv + that being hiv 2 + a one time receptive fellatio leading to infection + the person infected not producing antibodies.

You are the expert, and doubtlessly a very good one at that, and if you say an 8 week negative ab/ag test is enough to let this go I will do my best to let it go.

Thank you very much for your help and have a great weekend.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
I think you may have forgotten or didn't fully understand one of the main things I said in my initial reply:  "it is impossible to have HIV with a negative AgAb test 8 weeks after catching the virus. It's simplly impossible."

The HIV blood tests are among the most accurate diagnostic tests ever developed, for any medical condition. They are far more accurate than sympotms or exposure history in determining if someone has HIV. You had a low risk exposure, and your symptoms are not typical of HIV, either acute or chronic. But these don't matter:  no matter how high the risk of HIV might have been at the time of exposure, and no matter how typical the symptoms for an HIV infection (acute or chronic), the test results always overrule.

It's time to move on without worry about HIV. If your symptoms continue or you otherwise remain cocnerned, see a doctor. But for sure you do not have HIV. Please do not be tempted to start a new thread about this exposure, symptoms, and your test results, as many anxious persons do. There is no information you can provide, or new symptoms you may develop, that would change our opinion or advice.

That concludes this thread. I hope the discussion does what I intended, stop all your worry about HIV or other medical consequences of the sexual exposure described. Best wishes and stay safe.