[Question #6158] Hiv test

17 months ago
Dear dr,

I am a bisexual male living in India . Most of my sexual encounters have however recently been with men.

15 days after my exposure I started getting pain on the sides of both sides of mchest whenever I stretch and during gymming . It also hurts sometimes when I press in that area . I could feel something rough on both sides . The same issue behind my legs . I don’t know if they are swollen lymph nodes . 
However I got a test ( combo test) at 21 days and at 30 days post exposure . Both were non reactive . The second test was from a different lab just for me to be sure about the accuracy ( 0.16 was the cut off value)
I am super worried about hiv . Also I was on a strict diet a while back but now I am not gaining any weight at all even after eating properly . 
1. Could this be due to hiv ? Would hiv show weight loss and swollen nodes with 15 to 20 days ?
2. How accurate are my tests ? I’m confused because somewhere it says 4 weeks and somewhere 6 weeks .
3. Do I need to retest ? 
4. Have you seen anyone turn positive at 6 weeks after r negative at four weeks ? 

I am very worried doc . Request your advise .
Edward W. Hook M.D.
Edward W. Hook M.D.
17 months ago

Welcome to our Forum. thanks for your confidence in our service.  I'll do my best to help.  You raise a number of questions. 

1.  What you describe does not sound like lymph nodes.  further, even when you can feel lymph nodes, on some occasions they are normal.  The diagnosis of enlarged lymph nodes is best accomplished by a trained health care provider.

2.  A 4th generation, combination test is more than 99% conclusive at 4 weeks (28 days).  I have never seen a negative 4th generation test become positive after 4 weeks in a person who has not taken anti-HIV therapy.

3. Could this be due to hiv ? Would hiv show weight loss and swollen nodes with 15 to 20 days ?

HIV would not cause weight loss this quickly.  Your symptoms are not likely to be due to HIV.  I recommend you see a clinician to evaluate these symptoms but I would not worry about HIV.

2. How accurate are my tests ? I’m confused because somewhere it says 4 weeks and somewhere 6 weeks .
See my comment above

3. Do I need to retest ? 
Officially yes but, in my opinion it is probably not necessary.  You haven't said much about your partners or exposures so I cannot be more precise.

4. Have you seen anyone turn positive at 6 weeks after r negative at four weeks ?
No

I hope these response are helpful. EWH
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17 months ago
Dear dr hook ,

Thanks for your response .

Regarding the lymph nodes . I had one in my groin a few weeks back which was confirmed by my physician . 
Now I can feel a small one on the side of my neck too .
Besides my elbow crease and outer chest also hurt when I stretch or press in that area and I feel a feeling of fullness in the area after I gym .

Regarding the exposure , it invilved getting fingered and rimmed by a 
make of unknown status.

Also it’s been more than a month since the exposure and I’m just not gaining weight and losing a bit at times . Hiv wouldn’t cause weight loss just after a month of exposure ?
I also feel dizzy when I get up and sit down .

He also rubbed his penis on my anus but I’m quite sure he did not penetrate . I was diagnosed with a fungal infection a few m on the back and my worry is that his precum rubbed against my broken skin around the upper butt crack . Since the area was sore I’m not sure if there was any minor bleeding as well due to the friction .

Edward W. Hook M.D.
Edward W. Hook M.D.
17 months ago

Even if you have swollen lymph nodes. it would be unwise to assume that they represent HIV, particularly with a negative test.  If your lymph nodes were swollen due to HIV, your test would be positive. 

The exposure you describe is a virtually no risk event.  Neither receipt of masturbation (i.e. being fingered) not receipt of rimming is associated with HIV risk. 

I would look for other reasons for your weight loss.  Dizziness on standing could represent dehydration or be part of your weight loss.  It is not suggestive of HIV.

Like masturbation, having someone rub your anus without penetration should not put you at risk for HIV.

My advice is to believe your test results, not worry further about HIV, and work with your doctor to look for other reasons for your weight loss and dizziness.  EWH

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17 months ago
Dear dr hook,

Thanks for your detailed responses . My last two clarifications :

1. I have read that hiv 2 can take more than 4 weeks to show in a test , upto 3 months . If this is true does it mean a combo test should be repeated at three months ?

2. Also regarding the exposure since he pushed his penis is the upper part k my butt crack that was already sore , what if there was some trauma or minor bleeding and his precum came in contact with it ? Wouldn’t that be exchange of body fluids or precum in contact with broken skin that can cause hiv ?

3. I am also worried that what if my blood samples at the lab got exchanged and my test wasn’t accurate . I guess I am overthinking .
But I have also tested from a different lab at 3 weeks that was also non reactive .

4 . For the future , how do I ensure I am safe ? If I choose to have anal sex are condoms effective for anal sex?
Also I have never had oral sex with a man without a condom. Do I need to use a condom for oral sex everytime as well ? I am unable to enjoy sex because of all these thoughts and apprehensions .


Sorry to bother you with so many questions. Thanks for all your help doctor .
Edward W. Hook M.D.
Edward W. Hook M.D.
17 months ago

Let me start this final reply by stating that the activities you describe are NOT activities that warrant concern about acquisition of HIV (1 or 2) so your questions regarding testing are misdirected.  As for your specific questions:

1.  There is a small amount of HIV-2 seen in India but not much.  This, given your no risk exposures and the rarity of HIV this is not a concern. IN THEORY, if you had been exposed meaningfully to HIV-2, development of antibodies might take longer but the problem is so rare that the data are imprecise.  Certainly well over 90% of HIV-2 infections would be detectable at 4 weeks.

2.  As I said earlier, no penetration, no risk.  This is a "what if" question regarding surface contact without penetration.  It would not put you are risk.  Surface contamination of the sort you describe is typically not a meaningful concern.

3.  You are being paranoid and overthinking this. No have a no risk event and two different tests that are negative.  Believe your test results.

4.  You can reduce your risk for HIV in a number of ways. You can start by asking your partners of their HIV status and when they were last tested- most people tell the truth.  If you are exposed, the most effective means is to take PrEP every day.  Condoms are also highly effective when used throughout he penetrative sexual activity but break about 1% of the time with breakage being higher with new partners and with rectal sex.  Regarding oral sex, there are no proven cases of HIV which have been acquired from receipt of oral sex from an infected person.  Persons performing oral sex 9fellatio) on an infected man are at slight risk for infection.  The U.S. CDC estimates the risk for infection as being about 1 infection for every 10,000 exposure.   

I hope that this information has been helpful.  As per Forum guidelines, this thread will now be closed.  Take care. EWH

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