[Question #5533] 5487 follow up

22 months ago

Hi Dr - I read your answers over and over carefully as well as responses to other people.One item that got me very uneasy was your post about a month ago which you called a 'blog' like response where you mentioned symptoms 50% of people would have within 5 years. Now, again, my exposure was at the end of 2017. I had an RNA test 3 weeks after exposure that was undectable. Then a negative ab/ag test at 36 days, then a negative labcorp test at 88 days and then almost a year on the nose another negative ab/ag test.However, in the last few months I developed what seems to be sebbhorric dermatitis. i'm in my early 30s and this is new to me. my wife says ive always had some very mild dandruff in my eyebrows and there are pics that may prove it. However, what’s new is very dry peeling skin on both sides of nose, which seem to be tell tale for SD. I don't have dandruff in my hair to my knowledge. 

1. Can you give some insight to HIV SD...is it more severe than a mild case? Does it start as dandruff? You mentioned in the post 'especially when it extends to the face'. Does that mean literally connects from head dandruff down to the face? Mine is clearly off and on on the face. Granted I would have just moisturized and moved forward..it's not bad enough to go to a dr. otherwise. 

2. I also have had loose stool for a few months. Not diarreah, but loose. does it needs to be real, serious diarreah or does looser stool qualify.

3. these are 3 factors now that i'm one and a half years removed from the exposure. I have the very high immature platelet fracture number, the mild SD, and consistent loose stool. I researched Immature platelet fraction and it's an immune response that attacks healthy platelets. If you have low platelets this could be the cause. My platelet level right now is fine but i'm thinking this IPF could just be beginning and will do damage to my platelet count, and if that is low then I’ll have both low platelets and sebhorric which are two early markets for the virus?

22 months ago
oh - and i did a negative oraquick yesterday. I got freaked out when I googled my dry face and found that it was likely SD...and even if I've had mild SD before it's never been bad enough to cause flaky skin on face. I'm confident I conducted the oraquick correctly. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
I'm sorry you found it necessary to return. If you read and understood my replies in your previous thread, you would realize your current concerns are unjustified. As discussed last time, your tests prove unequivocally that you do not have HIV, assuming no new exposures since the one described at that time; and that HIV test results overrule every other consideration about HIV risk and symptoms. My statement that half of all HIV infected persons have symptoms within 5 years has absolutely nothing to do with that:  all those people also would have had positive blood tests within a few weeks of catching the virus.

1) Your seborrheic dermatitis is irrelevant. Indeed it is more common than in people without HIV. But that's like saying that fever is more common in people with pneumonia than those who don't have pneumonia. And of all people with SD, probably under 1 in 10,000 have HIV -- and all of them have positive HIV blood tests.

2) Same reply as for seborrheic dermatitis. Your test results prove that the nature and frequency of your bowel movement have nothing to do with HIV.

3) And really the same reply once again. Based on your symptoms, I'm inclined to believe you probably do not have any illness at all. But if these issues concern you, the answer is to see a doctor for careful professional evaluation. HIV is not the problem. Beyond that I have no advice:  as I said last time, on this forum we do not speculate on causes of symptoms other than HIV or STDs.

It's time for you to move on. Feel free to ask questions to clarify the above -- but I will not answer any questions that have already been answered, or whose answers should be obvious, from my comments above or on your previous thread. If you continue to remain so concerned, speak with your doctor about possible referral for professional counseling. It is not normal to remain so concerned after the reasoned, science based reassurance you have had -- for sure on this forum and perhaps from your own doctor(s). I suggest this from compassion, not criticism. Good luck.

HHH, MD
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22 months ago
Thanks Dr. Appreciate the swift reply. My wife and I separated for a short time after this incident, and while I thought there was no going back, I received oral last summer (june) and engaged in mutual mast with woman. I'm actually much calmer about that event. But still, even if I was wrong and there was risk, my test in December (one year after first incident, then 6 months after the june incident, would still cover it?)
Some follow-ups:
1. More into my original exposure. This woman was a bit more high risk. Married but by her own admission very open. There was no inter course, but I did do some 'manscaping' that day and had some signficant cuts in the area that bled a STRONG amount. We had mutual mast. and some frottage so I was nervous her fluids penetrated these cuts. The event was a few hours after the shaving. Would you have recommended testing off of that?
2. The reason the SD freaks me out is just because it seems like I never had it before. And literature seems to be pretty consistent that this doesn't just pop up out of nowhere. For peace of mind...would it be early in the process for this to present, if I was infected?
3. I did have a physical after we conversed (thats why they ran the blood test). My internist is a good man but he is NOT knowledgeable about HIV. He didnt even know what ARS was. He saw nothing to worry about about my one off level of IPF. He said he didnt know why they ran it and that they only look there if there is an issue. Still, I'm just worried this is a sign an issue is starting.
4. Lastly, not a question...he did refer me to therapy. he believes I have OCD. I don't have the stereotypical kind...im not hyper-neat (quite the opposite), but u said so too. Problem is I can't get in to therapist until late July. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
1,2)  Irrelevant. What exactly did you not understand about "HIV test results overrule every other consideration about HIV risk and symptoms"?? Your test results prove you don't have HIV, period. Any new symptom or medical problem has to start sometime, and the timing of your SD means nothing in regard to HIV. You cannot go through life attributing every new symptom, twinge or tingle to a zero risk sexual exposure you apparently regret.

3) Your doctor's HIV expertise, or lack of it, doesn't change anything.

4) I also believe you have OCD. I could use your two threads as a case to teach medical students about it. I'm glad you're lined up to see a therapist, and you might tell your doctor you consider it urgent and see if they can arrange to see you sooner than July; or refer to a different counselor with a more open schedule. But please stop asking anything more about these issues on this forum. 
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22 months ago
Thanks Dr. I've seen a counselor previously who had openings and I wasn't thrilled with the experience, so I'm hoping the Dr. who is very busy and very highly recommended is so for a reason. I've been up and down since the fall of 2017 thinking I hurt my family...I can likely push through for another month and a half. 

1. I'm not sure if you missed about my June exposure. No idea why i did it...I feel less guilty about it and thus I guess less nervous. But just wanted to confirm that the December 2018, single ab/ag test covers that as well.
2. I understand you don't want to get into the specifics of SD in HIV and realize there may not even be specifics to get into. But in terms of the actual risk with the relatively deep shaving cuts a few hours prior to the event. Generally speaking if I came to you before testing what would your opinion have been? Is that a fair question? To my knowledge I was not bleeding at the time of the event and a few hours had passed. I don't know for sure if her fluids entered but cautiiously i think it's reasonable to say some may have had contact with the cuts. 
3. And lastly, my apparent OCD has be questioning all of my ab/ag. The reasoning differs, but mostly because the report makes it look like 2 tests. It says on the title of test: HIV 1 & 2 antibodies. Then in says 'component results' and makes it look like 2 tests on 2 different lines. 1 is: HIV 1/2 AB screen nonreactive. 2 is: HIV 1 p24 antigen NONREACTIVE. Have you seen it written like this? 
4. The lab said they couldnt give information (manufacturer etc) but the lab tech did say its one test. Anyway - i have fear of how it was collected and how the sample both times sat over the weekend before they did the test. Irrational or not, would the quest QUANT RNA test to 20 copies undetectable at just over 3 weeks be enough by itself? 
Thank you and have a nice weekend. Sorry about your Warriors. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
*Sigh*

1. As discussed previously, the AgAb tests are 100% conclusive any time 6 weeks or more after the last possible exposure.

2. CDC and all public health experts recommend that all adults have at least one HIV blood test, including persons at no apparent risk. (Take a look at the authors of that advice from CDC: https://www.ncbi.nlm.nih.gov/pubmed/16988643.) If you had never been tested and presented with new seborrheic dermatitis -- or almost any other medical problem, or no problem at all -- I would recommend an HIV test. But in someone with seborrheic dermatitis alone -- or with that problem plus the others you have mentioned -- I would have told you to expect a negative test result, under one chance in many thousand (or one in a million?) of a positive result. SD alone almost never is the main symptoms of someone with HIV.

3.  The report you had is entirely normal, the same anyone with such testing would receive. It is automated:  negative result and the computer prints out such a report. And no, I have never had a patient with a false negative AgAb HIV test if done more than 4 weeks after the last exposure.

4. The antigen and antibodies detected by testing are extremely robust. Even in tropical climates when specimens are not properly refrigerated for a week or more, the test results remain 100% reliable. And yes, if you had HIV, the RNA test would have been positive.

That concludes this thread.  Please note the forum does not permit repeated questions on the same topic or exposure. This will have to be your last one; future new questions about this exposure, testing, HIV risk, and/or your symptoms will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.

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