[Question #5478] ARS Concerns - Body Rash

22 months ago
Hi, 

9 weeks ago I had an oral exposure to someone who turned out to have recently acquired, untreated HIV infection. I received fellatio and rimmed the person in question. I have had several duos (Weeks 4 and 6 negative, and awaiting a week 8 result) and a negative Alere Rapid 4th Gen test at 60.5 days. 

However on day 56, I developed a rash on my stomach, back, and arms. It is non raised, not itchy, but tingles. It is red but the redness varies throughout the day and is at times barely noticeable. 

What are the characteristics of the ARS rash? Does it look more like chicken pox? Is 56 days entirely too  late for ARS to begin? The only other symptom I have had has been loose stools for the last 3 days. 

Thanks for your incoming response 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Welcome to the forum. Thanks for your confidence in our services.

Your concern is understandable -- this obviously has been an anxious time for you. However, your worries are over:  you do not have (and cannot have) HIV. Here's why:

First, oral sex and rimming carry little if any risk for HIV, even with known infected partners and even with exposure to early HIV infection with a likely high viral load. There have been no proved transmissions by such exposures. Second, your test results overrule anything else:  you could have had the highest imaginable risk or very typical symptoms -- it wouldn't matter. The HIV blood tests are among the most accurate diagnostic tests ever developed, for any medical condition, and are absolutely conclusive if sufficient time has passed since the last possible exposure:  and 60 days is plenty with the AgAb (4th generation) HIV tests. Third, it is impossible to have HIV symptoms with negative antibody test results. Fourth, acute HIV symptoms cannot start a couple of months after exposure -- onset always within 2-3 weeks. Fourth, skin rash alone never is an HIV symptom -- ARS rash always occurs in conbination with other symptoms like fever, sore throat, lymph node enlargements, etc. (Never look at HIV symptoms and conclude that just because you have one or two, you might have HIV. It doesn't work that way. It's never a single symptom, but only the pattern, combination, and timing of symptoms that can sometimes help raise suspicion. By itself, every symptom listed is far more common with other conditions than with ARS.) (And loose stools also do not suggest HIV. Neither does your description of your rash.)

There are too many possible causes of rashes like yours for me to guess the cause, except to be certain it isn't HIV. If it continues, you'll need to see a doctor to sort out the possibilities. In any case, you don't need the additional test you apparently are planning at 8 weeks:  6+ weeks is plenty.

So all is well. I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
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22 months ago
Thanks Doctor for your highly reassuring reply. 

Just a few add on questions if I may 

1) There is no possible way this rash is related to HIV/ARS? 

2) I forgot to mention a negative RNA PCR at around the two week post exposure mark, does this further concrete my negative status? 

3) I am just curious as to what the ARS rash looks like, could you quickly highlight the chief characteristics? 

4) Is it at all possible, a later test pertaining to this exposure could turn positive? 

Thank you again for your time and the great service you offer through this forum. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Try not to focus on the various "yes but" or "could I be the exception" sort of questions that might come to mind. You will not be a previously unheard-of exception!

1) Nope, no possibility that I know of.

2) That test alone was virtually 100% proof you weren't infected.

3) Typicallly red bumps, non itchy, sometimes with a hemorrhagic component (meaning bleeding into the lesions), typically widespread but most prominent on the trunk. Buit 99% of suich rashes are NOT due to HIV -- it's a nonspecific appearance, i.e. the details of what it looks like don't help very much in knowing the cause.

4) Nope, no possibility.

Thanks for the thanks. I hope these comments also are helpful. As I said at the outset, I know this has been stressful. But that stress should now be over. You're home free. Do your best to move on without further worry.
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21 months ago
Hi Doctor, 

My rash persists, and perhaps wrongly my HIV concerns. 

Owing to the rash, I had a PCR RNA and 4th Generation test at day 70 post exposure, somewhere between 12 and 14 days after the appearence of said rash. This was followed by an Insti test at 73 days.  

If the rash was a result of HIV, I am assuming the above two tests would have 100% been positive? 

And that I can be absolutely certain I did not require HIV from the exposure just over 10 weeks ago? 

21 months ago
Forgot too mention that the above tests were obviously negative. 

The rash remains non itchy, but quite painful. Has not blistered and isn't raised. Concentrated on stomach and lower back. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
Please trust the science, and the reasoned, science based reassurance I have tried to give. Your test results PROVE you do not have HIV and that something else explains your symptoms. And anyway, HIV infection never causes rash as the only symptom.

As I said at the outset, I really do understand why this situation is frightening. But the science is the science. You really can move on without concern about HIV. See a doctor if the rash persists or you otherwise remain concerned. 

That concludes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion, and especially this last exchange, has been helpful and reassuring.
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