[Question #5813] Symptoms Questions?

18 months ago
I had some general questions around HIV/ARS symptoms related to some things i have read on here I believe from Dr Handsfield.

I know I have read that ARS symptoms if they happen would be in the 1-3 week post exposure range.  I also think I read that it's a misconception that people get sick more often when they unknown/untreated HIV, is this true?  what about  getting sick and it lasting longer than normal?  

I also read that the average length for real immune system issues related to HIV take 5-10 years but can sometimes be 1 year. If the one year is possible, would you say that a flu that came on 5-6 weeks after exposure with the symptoms mostly going away after a week but some lingering still at the 10-11 week post exposure could be a HIV symptom/ARS?  Symptoms being slight throat soreness and neck lymph nodes swell, slight cough,slight upset stomach, slight joint soreness. All just slightly hanging around.. Anything to worry about there? I guess basically would lingering normal cold/flu symptoms in the 2.5-3 month range post exposure be a sign of possible infection?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
Welcome to the forum. Thanks for your confidence in our services and for reviewing other questions similar to your own.

I don't understand the first question about a "misconception". You'll have to explain more clearly. How sick someone is with ARS is unrelated exposure to treated vs untreated HIV.

The duration of ARS is quite variable. It can last from only a few days to several weeks.

The question starting "I also read" seems to confuse symptoms caused by initial HIV infection itself (ARS) with illnesses that result from immune system damage due to HIV, i.e. overt AIDS. It is true that serious immune system deterioration usually takes 5+ years, but it can be as short as 1 year or as long as 20 years; 5-10 years is typical. A lucky few (about 5% of people with HIV) are "elite controllers" who get no important immune system failure even after 20 years or more.

ARS rarely if ever starts as long as 5-6 weeks after exposure, and rarely would cause lingering symptoms for another 4-6 weeks. This also is too soon for symptoms due to an infection resulting from a failing immune system. And in any case, your symptoms are not typical for either ARS or for an infection due to immune system damage.

But the real question is this:  Why are you asking instead of just getting tested? If you were potentially exposed more than 6 weeks ago, then you can have a conclusive blood test. That test results will be much more reliable than trying to guess based on the rather vague and atypical symptoms you describe. Since you have said nothing about your potential exposure, I can't judge the amount of risk. But based on what you have said, I think it very unlikely you have HIV and predict a blood test for HIV will be negative.

I hope this response is helpful. Feel free to clarify the first question. I also urge you to be tested for HIV, and then feel free to let me know the result.

HHH, MD
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18 months ago
Thank you for that information Doctor I think you answered my question on these symptoms.

The reason I ask about the symptoms and not just  go get tested is partly I guess so i gain some proper education on what symptoms I should be looking for related to each STI as the internet as you know can be a pool of bad information. Also so that I'm not living fearful and jumping to get tested after every sexual encounter.  

I am also aware from reading your past answers to others on here that a one time sex encounter with an infected women carries less than 1% chance of infection and then the chance a heterosexual women having HIV is less than 1% so I'm assuming overall that must be a reallysmall percentage. 

As for my encounter it was a drunken one night that really only involved oral both ways and hand/foreplay. The small problem being that due to alcohol and memory being blurred I can't be 100% sure an attempt or slight penetration didn't occur. I am of course assuming I would remember any prolonged actual sex. So I think I'm right in that I put this into a low risk event? Guess maybe just some doubt crept into the mind with the symptoms. Anyway, maybe I will go get a test. Thank you again 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
Sorry for the delayed reply to this follow-up question!

Knowing symptoms to look for is good, but less useful for HIV than for other STDs like gonorrhea, chlamydia, syphilis, herpes, or HPV. For HIV, symptoms often don't occur and when they do, they are pretty much identical to symptoms of several much more common medical conditions.

Your statistical analysis is a good way to analyze risk, but you're using an unrealistically high percentage for HIV transmission risk. The best estimate for a single episode of unprotected vaginal sex, if the woman has HIV, is 1 in 2,500, far lower than 1%. For oral sex, it's far lower still. There has never been a scientifically proved case of HIV transmission mouth to penis or by cunnilingus (oral-vaginal).

So this event was not just low risk -- it was zero risk for all practical purposes. That said, I still encourage HIV testing if you remain concerned. It's human nature to trust negative tests more than expert opinion based on probability and statistics. This doesn't mean that I believe there is any realistic chance you have HIV -- if you test, it's strictly for the reassurance you may feel from the negative result. 
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18 months ago
Thanks Doctor,

I definitely agree that reading the symptoms people suggest online related to HIV are all over the place.

I did have a question related to joint pain and a persistent cough/itchy throat as I see them get brought up in symptom questions alot. I do know that ARS which happens generally a couple weeks after exposure can present joint pain.. But would joint pain or a itchy throat cough presenting a few months after exposure represent a symptom?

Thanks again,
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
Joint pain may occur from time to time with ARS, although the main pain is muscle aching -- which can be confused with joint pain. However, this combination of symptoms really isn't at all suspicious. The important thing in ARS is not the individual symptoms (all of which can occur with hundreds of conditions) but the pattern and timing of symptoms. Half of all new HIV infections cause no symptoms at all, but when they do, almost always there is a combination of sore throat (not just "scratchy"), enlarged lymph nodes in several areas, fever, and skin rash. Other symptoms can occur as well, but rarely if ever by themselves.

As I said above, it is a mistake to rely on symptoms at all. You had a virtually zero risk exposure, so on that basis, no testing is needed. But if you feel you need to know for certain you don't have HIV, testing is the only way it can be done. Period, full stop, no exceptions. If or when you get tested, you definitely can expect a negative result -- which probably would be a lot more reasuring than anything else I could say.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. Please don't post any more questions about this exposure, symptoms, etc. Just get tested -- and don't waste a new posting fee to tell us the negative result! All we'll do is say "Yup, negative. All is well." (or something similar).
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