[Question #6382] Oral and esophageal thrush but HIV tests positive

14 months ago
I had unprotected vaginal sex with a woman who says that she's afraid of get tested. A couple of weeks later, I got symptoms that are in the book: low-grade fever, headaches, enlarged lymphs, sweats, diarrhea, oral and esophageal thrush (these last two freaked me out).

At the 6 weeks mark I got tested NEG (Ag/Ab), then two more Ag/Ab repeatedly NEG at 9 and 12 weeks mark. After that, I decided to go move on my life, but the initial symptoms never subsided since they appeared and it seems they will not, especially the lymphs nodes, sweats and the recurring oral thrush and at this point I've gained about 22 pounds, in addition, after the first negative result, I decided to continue having unprotected sex with my girlfriend but a few weeks later she got SHINGLES!! she's 21

After 4 mo, I got tested NEG again. Two days later I got esophageal thrush again! I know thrush itself isn't a good HIV indicator, but I'm still having the initial symptoms I've mentioned and esophageal one is seen only in HIV+ people and it went twice. I feel like randomly pain and burning sensation in my upper chest and my back, very unpleasant taste in my mouth, dryness in mouth and throat, very white tonge, white plaques inner my cheeks and tonsils, also burning sensation in my mouth, tongue and tonsils and feeling like something stuck in my throat but I don't have pain while swallowing anything. This is indeed thrush.

Why am I not positive yet?

Please Docs, don't dismiss my severe symptoms
Thank you.
14 months ago
Sorry I made a mistake writing the title. Correction:

Oral and esophageal thrush but HIV tests negative

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Welcome to the forum. Thanks for your confidence in our services. Even before seeing your correction, I knew you meant negative in the title, not positive.

It is a common misconception that yeast infections (thrush) -- whether oral, esophageal, or wherever -- only occur in immunodeficient persons, and that therefore they often indicate HIV infection. This is wrong. Such infections sometimes occur in entirely healthy people. As for the other symptoms, they are nonspecific:  that's the medical term meanting that they occur in many medical conditions and therefore rarely point to any particular cause. (Which you seem to understand in regard to the yeast infection, but it also applies to all the symptoms you describe.)

Perhaps most important, the current HIV blood tests-- in particular the antigen-antibody (AgAb, 4th generation) tests -- are among the most accurate diagnostic tests ever developed, for any medical condition. The result overrule all other consierations:  no matter how high the risk of HIV at the time of exposure, and no matter how typical the symptoms, the test result rules, assuming the test is done long enough after the last possible exposure, which is 6 weeks for the AgAb tests.

So the answer to "Why am I not positive yet" is that you do not have HIV. The test result proves it. There are no exceptions:  nobody has ever reported false negaive AgAb tests beyond 6 weeks of acquiring HIV.

All this assumes your yeast infection(s) were professionally diagnosed by providers experienced with this condition. I would also wonder whether you have had other events that can predispose to such infecions, such as broad sprectrum antibiotic treatment.

The bottom line is that I am confident you do not have HIV. You should continue to work with your doctors to figure out the cause(s) of your symptoms and next steps in diagnosis and treatment. But the evidence is solid that it isn't HIV.

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

14 months ago
Also, rewieving another threads and as you told me above , I have seen that tests rule over any kind of symptoms but for me it's difficult to believe in my , If I got thrush accompanied with another systemic symptoms after few weeks after an exposition and after 4+ months still not subssided, it must've an explanation and HIV makes the most sense (I have not been taking antibiotics) .

Reading on internet some cases (scientific reports, not random users) which people have symptoms as thrush come out repeatedly negative with screening tests but finally they come out POS with PCR. I know those cases are very rare, but I have reasons to believe that I am one... the recurring yeast infections make me assume that my body is having a poor humoral response...

According to you answered me:

1) Can I keep continue unprotected sex with my girlfriend without any worry about hiv? As I said, she got shingles.

2) Is there need for further testing? Should I go for a PCR?

3) I've gained some weight (about 22 pounds) this whole time, is it an important fact against HIV?

4)  Persistently sweats, headaches and something like a low-grade fever for more than 4 mo could be a concern for HIV?

Thank you Dear Dr. HHH.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
I'm sorry you find it "difficult to believe" that you don't have HIV. But the scientific evidence is clear. It is true that there are reports of false negative HIV tests, but these were with earlier HIV antibody-only tests, and as you point out, such persons had positive results with PCR. The antigen portion of the AgAb tests does the same as PCR, i.e. it is a direct test for the virus. In other words, negative AgAb is the same as having both negative PCR and antibody.

That said, it would be reasonable for you to ask your doctor to do a PCR for HIV. For the reasons discussed, I'm confident it would be negative.

1) Yes, you can safely have sex without fear of transmitting HIV.

2) Yes, having a PCR for reassurance make sense. If you do so, it will be negative.

3) The weight gain doesn't say anything one way or the other about HIV.

4) Your test results prove your symptoms are not due to HIV.

I'm going to leave this thread open in case you decide to have an HIV PCR and would like to post the result. I will have no other advice or comments of any kind unless and until you do that. (Threads are closed after 28 days, so if you're going to have the PCR test, do it before then.)

Thanks for the thanks. I'm glad to have helped so far.
14 months ago
I tried but unfortunately I will not be able to order a PCR test (at least within 28 days) because in my area (Colombia) that type of test is very expensive.

I just want you to tell me something and I will leave here very calm or concerned as appropriate, but I just want the truth... Did you recommend me to do a PCR just for my mental reassurance or do you think there's a real or a minimal chance (based on my symptoms) to be a persistently seronegative or a delayed seroconversion case and the AgAb tests may have missed the infection?

I would have really liked to do a PCR and publish my results here.

Thanks for your help Dr, I really appreciate it.

Without another particular and as per the forum guidelines, you can close this thread.

Happy holidays and happy new year, Dr.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
I recommended PCR only for reassurance. Do your best not to worry about it.

Thanks for the thanks. I appreciate it. Happy holidays to you as well.