[Question #5731] Follow Up #5648

19 months ago
Doctors:

I took a 4th generation test on the 17th day after exposure, which was returned negative on the 18th day.  On that very same day, however, I developed fever, slight body aches, nausea and GI upset.  My symptoms are continuing today (19th day).

My partner had a negative Oraquick result last week and tells me that it's been more than 6 months since she's had sex with anyone.  We have not had any further intimate contact since the initial exposure.

If my symptoms were due to ARS, wouldn't the antigen component of my recent test have been positive given that I developed symptoms the very next day?  I'm just very saddened and anxious by the timing of all this.  It makes me think my partner's Oraquick result was a false negative.  I'm considering testing again next week to rule out that my symptoms are caused by ARS.  I really thought I was in the clear given the two negative results for my partner and me, but just can't get over the timing of this illness.

Can you please offer further guidance or advice?  I really appreciate your help with all this.
Edward W. Hook M.D.
Edward W. Hook M.D.
19 months ago
Welcome back to our Forum.  I'm sorry to hear of your recent flu-like illness but I am confident that it is not due to HIV.  As we discussed earlier, your partner's recent negative OraQuick more than 6 months since sex with another person is an assurance that she was not infected.  Further, as you point out, 4th generation tests are typically positive for the p24 antigen at or just a day or two after the onset of ARS symptoms since the ARS is due to high levels of circulating virus which would be detected by the test. The timing of your recent illness is coincidental.  FYI, in studies of at risk persons experiencing flu-like symptoms, over 99% of their symptoms are due to something other than the ARS.  In your case, both your partners negative OraQuick and your own negative test provide evidence that your symptoms are not due to HIV.

If your anxiety is not helped by my assurances, you could seek an HIV RA PCR test.  These tests are expensive but in your situation would provide still more definitive information that you are not infected.  

I hope this information is helpful.  Please don't worry, I can assure you that give the information you have provided, you are not experiencing the ARS.  EWH
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19 months ago

Dr. Hook:

My anxiety got the better of me and I did end up taking an RNA test on the 19th day.  Results were returned negative today.  Do I need any further follow up testing in your opinion?  By the way, the illness I described in my earlier post resolved within 24 hours.  As you said, coincidental.  Thank you again for all your great work on this forum - especially your patience with all those seeking advice!

Edward W. Hook M.D.
Edward W. Hook M.D.
19 months ago
In the face of a negative HIV RNA test more than 11 days after an exposure, some experts suggest getting a 4th generation test at some point after six weeks.  My sense is that this recommendation is made out an abundance of caution and I have never seen o heard of a person with a negative RNA test go on to become positive at a later day.  Further as we discussed before, your exposure was a no risk event and your partner has a negative OraQuick test.  Given all of this, I am confident hat you do not have HIV from the events you describe.  I see  absolutely no scientific reason for additional testing.  I urge you to move forward without continuing concern.  EWH---
18 months ago
Good afternoon Doctor:

As you might have anticipated, I went ahead with another 4th generation test on day 30, which was returned negative.  So I've had a negative RNA test at day 19, and a negative 4th generation test at day 30.  I suspect I will probably go ahead and test again at day 42 *obligatory sigh*.

Like many people on this forum, I feel like my exposure was an indiscretion.  At the time, I had just broken things off with a long term partner but we are now dating once more.  What drives so much anxiety for myself (and I'm sure dozens of others here) is that nagging thought that I could somehow expose a loving partner to HIV infection.  It's why we continue to search for that elusive 100% certainty even in the face of astronomically low odds of having been infected.  I could probably speak for others, but my concern is often less about my own possibility of infection and more of the unbearable shame and guilt that would follow from potentially infecting someone else.  I realize this is a psychological burden but it is certainly what drives the repeated questions to you and Dr. HHH even in the face of sound medical advice.

So... redundancies aside, do I have anything to worry about with respect to resuming relations with my long term girlfriend (assuming she's had no other partners) and do I really need another test at 42 days?  Thank you again for all of the great work you do as a physician.
Edward W. Hook M.D.
Edward W. Hook M.D.
18 months ago
Thanks for your follow-up and your thoughtful self-analysis of your situations.  Your concerns and what I sense is guilt guilt are appreciated.  I remain entirely confident that you were not infected with HIV through your indiscretion and am likewise confident that, no matter how much you test, your results will be unchanged - you did not acquire HIV from the exposure you described.  I see no reason for you to worry that you might have acquired HIV which you could then transmit to your GF through resumed sexual activity and see no reason for further testing.  

One other suggestion.  Your concern appears to reflect more concern about your GF than yourself.  that being the case and since you had broken up at the time of your worrisome exposure, might it be possible to tell your GF about this and the worry that it has provided you.  My sense is that carrying this burden on yourself is only adding to your angst.

As you know we provide up to three responses to each client's questions.  This is my third response.  therefore this thread will be closed shortly without further responses.  I hope that my comments and the information I have shared has been helpful.  Take care.  EWH
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