[Question #6690] Swollen Lymph Nodes - HIV Tests Negative

14 months ago

Hello,

I had a very risky exposure on November 23rd, 2020 On about December 23rd (30 Days post-exposure), I came down with some very severe flu-like symptoms: fever about 38.2 Celsius, Night Sweats, Loss of Appetite, Headache, Chills. Symptoms onset was very rapid, within 2 hours of feeling normal I had a high fever and chills. The symptoms lasted for about 7-8 days altogether, after the symptoms had subsided I was left with a weird feeling in my mouth (occasional bad taste and dry mouth) and a white tongue. Also a weird feeling in my armpit (both sides), the doctor was able to palpate one swollen lymph node but said it was not big enough to warrant concern.

After all of the other symptoms had subsided on about the 65th-day post-exposure I had a lymph node swell (diagnosed by a doctor) behind my left ear to about the size of grape the node was red and painful. After about 3 days the lymph node decreased in size and no longer hurt, at this time the lymph node is no longer inflamed but still has not returned to pre-swelling size. The HIV specialist that I saw (I have seen 1 GP and 2 ID Specialists) said that it was most likely due to a tooth infection that I had recently been diagnosed with and prescribed me Amoxicillin for 10 days.

Tests

- 38 Days - RNA Qualitative TMA – Negative

- 43 Days - Insti HIV 1/ HIV 2 3rd Generation POC – Negative

- 48 Days - 4th Generation Ag/Ab Test and full STD Panel - Negative (except HSV type 1 - positive)

- 57 Days - 4th Generation Ag/Ab Test – Negative

- 63 Days - 4th Generation Ag/Ab Test & RNA Qualitative TMA – Negative

- 93 Days - Insti HIV 1/ HIV 2 3rd Generation POC – Negative

- 94 Days - 4th Generation Ag/Ab – results tomorrow

At this point, all my symptoms have gone except my lymph nodes. I have 1 large swollen inguinal lymph node on the right and 2 shotty lymph nodes on the left side. In addition to the lymph node in the groin area, I have had pain for about 10 days in both armpits (what feels like the side of the chest muscle).

Are my swollen lymph nodes caused by HIV?

Could I still be positive after all these tests?

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

Welcome to the Forum and thanks for your question.  I'll be glad to comment.  I am confident that your recent repeat test will be negative as were your earlier tests which unequivocally prove that you do not have HIV.  I realize that when a person searches the internet for swollen lymph nodes the possibility of HIV comes up prominently but this, like so much on the internet is misleading.  Swollen lymph nodes are a non-specific reaction as the body fights infection and inflammation.  Every day flu-like, non HIV viral illnesses, tooth abscesses, other infections and other sorts of inflammation can cause swollen lymph nodes.  Further, if one looks hard enough, a good health care provider can find "shotty", swollen lymph nodes in most people, particularly in the groin or under the arms.  Tests play an important role in evaluation of swollen lymph nodes and in your case, you have three different types of tests (for antigen, for antibodies, and for the virus itself [the RNA test], all of which are negative.  You can be confident that your swollen lymph nodes are NOT due to HIV.  I hope that between your own doctor and me we can convince you that there is no need for further testing related to your prior exposure.

I hope this information is helpful.  EWH

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14 months ago
Hi Dr. Hook,

Thank you for your prompt reply.

I have several follow up questions if you will indulge me, and I will post my 4th Gen 94 Results tomorrow.

1. Would you say that the tests so far have conclusively ruled out HIV infection?

2. Should I have gotten an RNA Quantitative PCR instead of the RNA Qualitative TMA?

3. Are you familiar with the RNA Qualitative TMA? Is it a good and reliable test?

4. Would my 3rd Generation Insti POC Test at 93 days negative result more or less rule out HIV infection?

5. Do you think there is any need for an HIV 2 RNA PCR to exclude HIV 2 infection?

6. I have not been exercising or doing any strenuous tasks. The pain in my Arm Pits is the symptom that worries me most, would ARS cause swelling of lymph nodes in the pectoral muscle?

Thank you for your reply 
Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

I think you are worrying unnecessarily and some of these questions are repetitive.  Brief replies:

1.  Yes, there is no doubt that you do not have HIV.

2. No, the quantitative RNA test of used for following response to therapy.  Believe your RNA test result

3. Yes, it is a superb test.

4.  It was repetitive.  AS I have said above, you already proved more than once that you do not have HIV.

5. No!!

6.  Sigh. If you had the ARS, your test would be positive.  Further, it is too late for you to have the ARS which occurs in the first 2-3 weeks following infection.

Believe your tests.  EWG

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14 months ago
Hello,

So I got the results back from my 94 Day post-exposure 4th Generation Ag/Ab Test and it is Negative.

All of the tests so far:

- 38 Days - RNA Qualitative TMA – Negative

- 43 Days - Insti HIV 1/ HIV 2 3rd Generation POC – Negative

- 48 Days - 4th Generation Ag/Ab DUO Test and full STD Panel - Negative (except HSV type 1 - positive)

- 57 Days - 4th Generation Ag/Ab DUO Test – Negative

- 63 Days - 4th Generation Ag/Ab DUO Test & RNA Qualitative TMA – Negative

- 93 Days - Insti HIV 1/ HIV 2 3rd Generation POC – Negative

- 94 Days - 4th Generation Ag/Ab DUO – Negative

I am still having pain/soreness in my armpits and will probably go for an ultrasound in the next couple of weeks to determine the cause.

I had a couple of additional questions for you (I understand that some of them are repetitive and some have been answered in other discussions but I ask that you bear with me)

1. If my swollen lymph nodes were being caused by HIV infection would my latest 4th Generation Test be positive?

2. Since all of my tests so far are negative can that conclusively rule out HIV infection as a cause of my Armpit Pain/ Swollen Auxillary Lymph Nodes?

3. In your many years of experience have you ever seen someone test positive for HIV after the 90 window period? (taking into account all of the previous negative tests)

4. My GP has suggested another HIV test at 6 months, would you agree with this suggestion?

5. Would you recommend another RNA Qualitative Test for HIV-1 or RNA Quantitative Test? Since lymph node swelling occurred after the last HIV RNA Qual. 

6. Are LabCorp test reliable or should I have done some of the tests at Quest Diagnostics or Local Hospital to rule out lab error?

7. With the latest tests can I also rule out HIV-2 infection or is there still a slight possibility?

Look forward to your response and thank you for your time.

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

I’m not the least bit surprised at your test results since you have previously repeatedly proven that you were not infected by HIV.  I cannot fathom why you continue to ask these repetitive questions.  Currently available tests for HIV are amongst the most reliable tests in all of medicine.  In my own experience, when persons such as you cannot accept their test results when they have been misled by the internet where much information is taken out of context, is out of date or is just plain wrong, when they have been influenced by guilt over an encounter that they have come to regret or a combination of the two

 

1. Yes

 

2. Yes

 

3. Never, and you will not be the first. 

 

4. I disagree and see no need for further testing.  Your results are not going to change related to the encounter you described. 

 

5.No.  If your lymph node swelling were due to HIV your 4th generation test would be positive.  .

 

6.  LabCorp is a respected, highly reliable laboratory.  Believe your test results   There is no need for further testing of any sort at any lab.

 

7. HIV-2 has been ruled out.  Believe your test results.

 

This will complete this thread.  Please believe your test results.  EWH


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