[Question #5682] Scared of HIV after negative result at 25 days

21 months ago
I have a friend since February and we had sex on the weekend of May 10th unprotected (said she had just been tested). Next at 2am on June 15th, we again had unprotected sex and my foreskin ripped with a bleeding large cut which I didn't notice until I finished 2 minutes later. 

8 days later I was incredibly anxious about HIV and started getting a mild headache whenever I thought about it, felt very hot all the time, a scratchy throat. Questioned if these could be caused by anxiety but then when I was moving some boxes felt tired and hot within 30 minutes (regularly rock climb, 15 mile day hikes) and stopped. Minor joint pain, and started getting frequent stomachaches. Then I went to India for a week (from the US) and every time I ate my stomach hurt, and I started getting hunger pangs more and more often. I got bad diahrrea and constipation which has improved but is still happening. India was 100 degrees daily which made me feel even hotter and I ended up taking huge naps every day.  Never had nausea or cold sores (which I get sometimes). 

She has been sick a lot recently with coughing/low fever/sore throat and complains about being tired often (also works 50 hour weeks in healthcare). Last week she had a peritonsillar abscess for a few days (found a study online linking it with early indicator of HIV). Also she has not had periods for 2 years due to her IUD, but had one randomly in late May and complained her lymph nodes hurt. She insists she doesn't have HIV and says she tested 4th gen in the first week of June and that I've been her only partner since March. I don't think she has ever lied to me. She's angry i don't trust her. 

This Tuesday, I took a duo at 25 days which came back negative, so I definitely didn't give her HIV. But my lipids also came back and my HDL is low at 39 and my triglyc high at 190 which google says is common in HIV. I smoke maybe 2-3 cigarettes a week and don't have a great diet but am skinny and athletic.

should I still be worried.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
Greetings. Thanks for your question.

The important information in your question is that your antigen-antibody (AgAb, "duo") test is negative 25 days after the exposure. That result proves your symptoms are not due to HIV; it is not possible to have HIV symptoms with a negative test. If you caught HIV -- which almost certainly you did not -- it is asymptomatic so far; something else explains your symptoms. As you suggest yourself, they sound like the physical manifestations of anxiety. With 100% certainty, HIV is not the cause.

In addition, from all you say, there is no realistic chance your partner has HIV. It sounds like you have been accusatory toward her, which is not justified. I understand why she might be angry and agree with her about it. 

Your blood lipid results are irrlevant. Just because something is common in people with HIV does not make it suspicious you have the virus.
Your smoking history and physical conditioning also don't matter one way or the other.

For a conclusive test result, have another HIV AgAb test 6 weeks after your last exposure. In the meantime, stay mellow -- there is no realistic chance you have HIV. And please apolotize to your partner. You owe her a very nice dinner with flowers and fine wine.

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

HHH, MD
---
---
21 months ago
"it is not possible to have HIV symptoms with a negative test. If you caught HIV -- which almost certainly you did not -- it is asymptomatic so far; something else explains your symptoms."

Can you explain what you mean by this? Is it impossible to have a negative test after you have had symptoms - for example if you had symptoms from day 8 to day 16 and then took a test on day 17 and it came back negative it would be 100% correct? Or do you mean if you have symptoms WHILE you are taking the test and it comes back negative it's 100% correct? Because I lost many of my feeling hot, feeling tired and fatigued, scratchy throat symptoms already...it's just my stomach that's still upsetting me slightly. Although many of them went away as I felt less anxious I don't want to rule out that they may be ARS?

Would being sick and having an irregular menstrual event and getting her bacterial abscess not count toward possible symptoms of ARS and immune system failure?

The reason I mentioned the lipids is because I usually consider myself pretty healthy and spend a lot of time outdoors so I was surprised by the high cholesterol...so I thought maybe HIV would explain it and got scared. But have some factors like occasional smoking and bad diet that could also maybe explain those borderline numbers.

I know I am most likely fine but it seems like a high risk scenario with open wound and unprotected although we are both low risk.

I feel bad to put her in this situation where I'm most likely fine but keep asking her, but the fear is really great and making me be really inconsiderate. I don't like the way I've not trusted her but am still scared and trying not to be. Will definitely treat her to a nice dinner if I am okay.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
Sorry if my comments about testing and symptoms were not clear. The symptoms of a new HIV infection, typically some combination of sore throat, fever, muscle aches, swollen lymph nodes in several areas of the body, and skin rash  -- called acute retroviral syndrome or ARS -- are not caused by HIV itself. The symptoms result from the body's immune system reacting to the virus. Antibody is produced when that happens. Therefore, the antibody test almost always is positive when symptoms appear, or certainly within a few days of onset of symptoms. HIV antigen usually is present as well, during the early stages.

Therefore, in people iwth symptoms caused by a new HIV infection, the AgAb test (or a 3rd generation antibody test) always is positive. Some of your symptoms could occur in ARS, but the overall pattern is not typical. And if your symptoms were caused by HIV, for the reason just desdcribed, you would have a positive blood test. Therefore, you negative result proves something other than HIV was causing those symptoms. 

This was definitely a low risk scenario, not a high risk one. That you and your partner both have had a low risk sexual lifestyle is the importatn determiant of risk, not the details of the sexual event itself.

The whole idea of all my comments is to explain why it is not rational for you to still be scared of HIV. There simply is no realistic chance you have it. In addition to a low risk exposure and symptoms that do NOT suggest HIV (including your slightly elevated triglyceride level), your negative test at 25 days is 90-95% conclusive.

Threads remain open for two follow-up comments after the initial reply, so you have one more coming. I suggest you not ask anything more until you have had a conclusive or nearly conclusive test (another AgAb test at 4-6 weeks after the event. There is no point in any further discussion of the exposure or your symptoms until a conclusive test has been done.
---
20 months ago
I understand that if symptoms are currently present the AgAb is always positive. But what if symptoms had been present and passed?

In addition - please answer this - I had taken a TDAP vaccine immediately prior to my first AgAb test at 25 days. Would that have the ability to cause a false negative at all?

In any case, twenty minutes ago I took another AgAb test (at 52 days). I understand if this comes back negative I am 100% all clear. I am hoping for the best. Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
Within a few days of symptoms onset, the antibody test wil be positive; and once positive, remains positive for life regardless of what symptoms do or do not occur. 

No medications of any kind, including vaccines, have any effect on HIV antigen or antibody in the blood or on HIV test reliability.

You definitely can expect your latest test to remain negative. You don't have HIV. If you remain unconvinced, please carefully re-read all of the disucssion above. All my comments are realistic and science based, and intended to be reassuring. Please interpret them that way.

That completes two follow-up comments/questions and replies and so concludes this thread. I hope the discussion has been helpful.
---
---