[Question #6383] Can not rule out HIV possibility. Please help.

14 months ago
Dear Doctor,
I have suspicious sexual intercourse with a woman in Austria (she was from Spain and not CSW) more than 7 months ago. It was unprotected vaginal sex.
Approximately 1-1.5 months later I have noticed that my lymph nodes in my armpits are swollen FOR THE FIRST TIME IN MY LIFE. Besides I had night sweats for one or two weeks in my 2nd or 3rd month. 
I went to the doctor (around 4 month later after suspicious exposure) and yes they are both around 2.2 cm. And there are also some small lymph nodes around my neck. They were all reactive. After that HIV anxiety got me and I made several (7 or 8) tests. They were 4th generation combo tests and all returned as negative. I took HIV1 PCR on day 99 and it was also negative. My last test was in 220th days and it was also negative. 
My lymph nodes are still swollen. There is a slight pain, time to time. I can feel them and they remind me of HIV possibility. And I have constant tiredness for more than a month or maybe two. I am totally freaked out. My doctor told me it is not about lymphoma. But he could not explain the reason for my swollen lymph nodes. He told me it can be anything. So I also can not explain it to myself. As I said before, for the first time in my life my lymph nodes are swollen. That is why I can't stop thinking about it. I am asking what if questions all the time.
Meanwhile, unfortunately, I have read a lot of articles on the internet. I have seen some scientific articles about long-term seronegative cases. Some of them lasted 8 months, one year and even four years. This made me extremely uncomfortable. I started to ask myself what if the tests which I have taken could not catch the virus for HIV1. Or what if my immune system is weak and I have HIV2 and my body does not produce antibodies. Even if I know that HIV2 is only common in West Africa, I still can not overcome this possibility. And in my country, there is no PCR test for HIV2. In my country, PCR tests are only for HIV1. So, I really don't know what should I do. I have found your e-mail address and wanted to ask you. I know it seems a bit paranoiac. But I could not forget it.
I really need some advice from an expert. I am married. We have been thinking to have baby. But since I am afraid to have some kind of STD, I am hesitant to do that. I want to be sure dear doctor. I want to be %100 sure not %99.9999. I really do not know what to do. So I wanted to write and ask you.
1) What do you suggest? Do you think I should make more tests for HIV1? Do you think there's the slightest possibility? Do you think there's a risk even one in a million?
2) Should I try to get an HIV-2 PCR (which is extremely expensive here, in my country. I think they sent sample to U.S.A)  Or my results are conclusive? Should I forget about it? 
3) Have you ever heard about this kind of seronegative case? 
4) May I try to have children with complacency? Do you think there's any risk after 7 months?
What is the reason for those swollen lymphnodes? I want to rule out this scary possibility. Please help me, dear doctor. I am stuck.
P.S: I get tested for Hepatitis B and C, Syphilis, Gonorrhea and Chlamydia. Those were also negative. Only CMV and EBV igg were positive but my doctor told me I could have them at any time in my life. And he said the swelling in my lymph nodes isn't about them.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Welcome to the forum. Thanks for your confidence in our services.

There's a lot of detail in your question, but in regard to HIV, it really comes down to a simple analysis:  how much weight to give to symptoms versus your test results. And the answer is clear:  for sure you do not have HIV. The HIV blood tests colelctively -- and in particular the antigen-antibody (AgAb, "4th generation") and PCR testing -- are among the most accurate diagnostic tests ever developed, for any medical condition. If done sufficiently long after the last possible exposure, the results overrule everything else. No matter how high the risk of exposure at the time, and no matter how typical for HIV someone's symptoms might be, the test results are conclusive. Period, full stop, no exceptions. The business you have read about false negative tests in people who actually had HIV all date back to older tests, less accurate than those now in routine use. As for HIV2, the antibody portion of the AgAb test includes HIV2 and is conclusive at the timesy ou were tested. There is no such thing as immune weakness that does not allow antibodies to develop, except for rare conditions that always make people deathly ill and usually are fatal in childhood.

I will also add that you had a low risk exposure. HIV is uncommon in heterosexuals in Spain and it is very unlikely your partner was infected.

Those commentscover your specific questions, directly or indirectly, but to assure no misunderstanding:

1) "Do you think there is the slightest possibillity [I have HIV]?" Nope. "What do you suggest?" Nothing. you need no more testing to know for sure you do not have HIV. The only remaining thing is to work with your doctor(s) to find the true cause(s) of any symptoms that still concern you.

2) HIV2 PCR? No again; there is no need. HIV2 is vanishingly rare outside the parts of Africa where it evolved. I don't know about Spain or whichver country you live in, but in the US there have been very few HIV2 infections, almost all in people who acquired them in east Africa and were diagnosed after immigration; or in their regular sex partners (i.e. wives and husbands).

3) I have never heard of such a case. There has never been a reported case of someone with test results like yours who turned out to have HIV.

4) From an HIV standpoint, you can safely conceive and father children.  

5) What is the reason for those swollen lymphnodes? I can't say, and we don't speculate on non-STD, non-HIV issues. But many conditions other than HIV cause this problem. As already advised, keep working with your doctor(s).

6) I'm happy to hear of those other negative test results. Your doctor is correct about the CMV and EBV tests. However, these viruses can reactivate, and interpreting those test results is complex and often difficult (especially for EBV), especially for non-experts. You might ask your doctor about referral to an infectious diseases specialist.

The bottom line is that you definitely do not have HIV and can stop worrying about it.

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

14 months ago
Dear Doctor, thank you very much for your detailed answer. There some points which stick in my mind and bother me. Some of my questions may be repetitive. I apologize in advance.

In your answer you've said "The business you have read about false-negative tests in people who actually had HIV all date back to older tests, less accurate than those now in routine use." However, when I searched for seronegative hiv cases on google, I saw recent articles. One was even written in 2019. I am really confused. When I saw this, I thought your words might be just for consolation.
Mr. Doctor, I want to ask you frankly, your words are not just for comfort, are they?

After my suspicious exposure, my partner said she had an unprotected suspicious relationship 30 days before ours. The next day I asked her for a test and she got tested. It was 30 days after her suspicious relationship, but it was a 3rd generation test. The result was negative. But it's not a very reassuring result on day 30 for antibody-only tests, is it?

5 and 6 months after the suspicious relationship, I had a blood count test twice for another reason. I had a CBC. All my blood values ​​were normal. In addition, sedimentation, TSH and CRP were normal. If I had somehow acquired the virus, would there be any abnormality in these tests at 5 or 6 months?
In one of your previous articles on medhelp, you said that there was a chance of a one-in-a-million for seronegative case. Would you tell me that this possibility also applies to me, considering the tests I have done (many 4th generation tests and PCR)?

I know it will be a repetitive question, but would you say that I am 100% negative with your expertise and experience? I know you said you haven't seen similar cases before, but I think I still need to hear.

In the 4th generation tests, they are only looking for antibodies when it comes to HIV2. On day 220, can we say 100% even for the antibody-only test?

Thank you for your patience, dear professor.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
We never alter our advice for "comfort" or reassurance. On this forum you get only science based information and our best understanding of the data and unvarnished, objective advice to the best of our ability.

Perhaps you would also like to know that in the 15 years of this and a preceding forum, with thousands of questions about HIV risk, not one person ever reported back that they had acquired HIV. You won't be the first. If and when that finally happens, it won't be from a trivial risk event like yours!

The internet is not your friend here. Like many or most anxious persons, you are being drawn to (or looking for) items that inflame your fears, and missing or not even looking for the reassuring information available. I have no idea what online scientific papers you found (if anything scientific at all), but reports in 2018-19 still usually refer to testing done years ago, with older tests. Trust me on this:  there has NEVER been someone with HIV who had the negative test results you have had. It doesn't happen.

Your non HIV blood tests mean nothing one way or the other. Most people with new HIV have normal results on all those tests. 

And who cares what testing your partner had?  She could have looked at tea leaves and decided she didn't have HIV. The important fact is that YOUR tests PROVE you do not hvave HIV. All other quesitons you ask are therefore irrelevant.

I never said there is "a chance of a one-in-a-million for seronegative case." You misread or misunderstood something.

If anything else comes to mind, don't ask until you carefully re-read my original reply and these comments, where you will find the answer. I'm sure there is nothing you will think of that could possibly change my opinions or advice. If you cannot accept and believe the scientific evidence and the reasoned, science based reassurance you have had -- both here and probably from your own doctors -- all I can recommend is professional counseling. It is not normal to be so fearful despite all this and suggests a potentially serious underlying mental health issue. I suggest this from compassion, not criticism.

14 months ago
Dear Doctor,

I have followed your advice and went to a psychiatrist. There's still not much change in my condition. I still think about the possibility of HIV all the time. But I hope it will change.

I wrote an e-mail to the woman whom I have been with in this suspicious exposure. As I have already mentioned she is from spain. She told me that she got tested 4 months later after our exposure. And it was also negative. I felt a little relieved. Yet my fear continues

I still have some questions.

1) I saw a strange event in one of the questions you were asked today. The person says his/her result seroconverted after 7 months. It scared me. It made me crazy. How is this possible doctor?
You know, I want to be a father, and I want to 100% forget about that the possibility. Can you compare my results with this fellow's results? Are the tests which we have taken similar? So I want to ask you again, do you see a one-in-a-million chance of seroconversion for my testing, or am I 100% negative?

2) Another question is a bit of a technical question. On some lab sites, I see a type of test called HIV 1 / O / 2. This confused me. What is this HIV O (not zero, letter O), doctor? Can you explain? Can you give me some information about this? Is there any possibility that normal HIV 1/2 tests would not catch this HIV O? Why do those labs need to specify HIV O? Is it scientifically possible that HIV cannot be captured by tests and remain uncertain? Are there only two types of HIV, right?

3) You told me to see an infectious disease specialist about EBV and CMV. I went but I could not get a proper answer. I want to write to you my results. Maybe you can interpret them for me. 

My  EBV VCA lgM is negative  3.92      Range: 9-11
My  EBV VCA lgG is positive    15.2      Range: 9-11
My  Anti CMV IgM (CLIA)  negative 0.31    Range: 1 - 1.2
Anti CMV IgG (ELFA)  positive 3.23      Range: >0.5>

In light of these results, what are the likelihood that lymph glands are associated with EBV or CMV?

I want to ask you one last time. Should I have any fear of being a father? Can I forget about HIV and become a father?
Dear doctor, thank you for everything. I wish you a merry Christmas. Thank you for your help.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
1) As I said above, the internet is not your friend. Your compulsive searching is leading to misinformation and misunderstanding. Almost certainly the person in the thread you saw does not have HIV, but a false blood test -- perhaps because he misused the test. Your situation is not similar in any way.

2) HIV type O and related strains are unusual types of HIV, mostly limited to parts of Africa. Older blood tests did not pick up some infections with these types. The current tests is normal use, including the tests you had, detect all such infections. Nothing to worry about.

3) Those test results look normal to me. You have evidence of past or current EBV infection, but so do almost all adults. It is conceivable you currently have infectious mononucleosis due to EBv. However, we do not diagnose anything on this forum and I have nothing more to say about it. If you "could not get a proper answer" from the ID specialist, you misunderstood or s/he misunderstood the question. He or she is the one to ask for clarification.

See answer no. 4 in my first reply. I see no reason to repeat it; I haven't changed my mind.

That completes the two follow-up exchanges included with each question. I hope the discussion has been helpful. Do your best to move on with no worries about HIV. As I'm sure your psychiatrist advised you, don't confuse your anxiety, guilt or shame about a sexual decision you regret with health problems from that event. They aren't the same. Do whatever is necessary to address the former issues, including continued work with your psychiatrist. But forget HIV.

Best wishes and stay safe.