[Question #6709] Lymph Nodes - Scarred of Symptoms

13 months ago
Hello

The situation is as follows:

November 23rd had a high risk exposure to potential HIV infected individual. Won’t get into details but actual high risk as you have classified in previous discussions.

Symptoms:

About 28 Days after exposure came down with a heavy flu like illness: High Fever above 38.2-38.5 Celsius, chills, night sweats, herpes on the lip, dry mouth/white tongue, weird feeling in armpits (physician was able to palpate 1 swollen lymph node in armpit). Symptoms subsided in about 7-9 days except uncomfortable feeling in armpits (both).

-Also swollen 2-3 nodes in groin area, not sure may have been there before- Not painful -

Day 64 large painful swollen lymph node  (about size of a kidney bean) appears behind ear. Stays swollen and painful for about a week. Armpit pain(both sides) gets worse around this time.

Day 90 another lymph node appears behind same ear about the size of a pea. At this time (day 98 lymph node still swollen).

Tests (Mine)

- 38 Days - RNA Qualitative TMA – Neg

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

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

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

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

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

- 94 Days - 4th Generation Ag/Ab – Neg


Tests (My Wife, days from last unprotected sex)

- 18 - 4th Gen - Neg

- 25 - 4th Gen & RNA Qual - Neg

- 54 - 4th Gen - Neg

We have a baby that my wife was still breastfeeding at the time, I made her stop about 30 days from last unprotected sex.


1. Could my swollen lymph nodes be caused by an HIV infection that was missed by all of my tests?

2. Chances that all of the tests missed my HIV infection? Rare Type, HIV2, Late Seroconversion? Should I get HIV 2 RNA test?

3. Chances that I have infected my wife we had sex 2 times before I got sick and once after my first HIV RNA test.


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

Welcome back to the Forum.  Thanks for sharing the information regarding your wife and baby- that helps to explain why you have asked this repetitive question.  The answers however are not going to change.  Your tests have repeatedly proven that you do not have HIV, including HIV-2.  Your testing looked for indications of infection three different ways- by looking for HIV antibodies, HIV antigen, and the viral RNA at  would have been positive after times when the result of each test is definitive.  You do not have HIV.  Lymph node swelling is non-specific with many, many causes and can be chronic.  If your lymph node swelling had been due to HIV the tests you have had would have detected it.  In addition, your wife's tests conclusively rule out HIV as well.  In answer to your specific questions:

1. Could my swollen lymph nodes be caused by an HIV infection that was missed by all of my tests?

Absolutely not!

2. Chances that all of the tests missed my HIV infection? Rare Type, HIV2, Late Seroconversion? Should I get HIV 2 RNA test?

Zero

3. Chances that I have infected my wife we had sex 2 times before I got sick and once after my first HIV RNA test.

Zero chance.

I urge you to address the concern and gulit you have regarding your misstep, to accept your test results and move forward.  EWH

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13 months ago
Dr. Hook

Once again thank you for your response and time.

Yes you are correct there is a good deal of anxiety and guilt associated with this whole incident especially because my wife and daughter have been put at risk. I am dealing with that and this whole experience has made me reevaluate life goals and priorities in general.

The reason I keep taking up your time is completely associated with my lymph node swelling. I have read that generalized/ persistent generalized swollen lymph nodes are a clear indicator of HIV infection and that is also the reason for the excessive testing and retesting.

Some additional questions:

1. Am I wrong or did the initial symptoms that I describe closely resemble ARS?
Is the medical community as a whole in agreement that after ARS symptoms pass that antibody tests are reactive?

2.  Regarding generalized lymph node swelling, is this not a classic sign of body wide bacterial/viral infection?

3. Do you know of any other infectious deceases that cause Gen. Lymph node swelling? 

4. Are the antibodies that these tests look for the same for all of the different types of HIV1 and HIV2?

5. You recommend not testing for HIV2 because it has been eliminated with previous tests or because it is statistically improbable in the US?

6. In your past clinical experience have you ever dealt with Gen. Lymph Node swelling and negative HIV tests? If yes what was the end cause of the swelling?

7. Could my body be suppressing the virus and that be the reason that RNA test is neg?

8. Would one last DNA PCR Quantitative (not RNA Qual TMA) be of any use since I heard that it has a lower detection limit?
DNA PCR as low as 20 copies/ml
while
RNA TMA detects at 100 copies/ml or above

Again thank you in advance for your time and expertise.
Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago

You are repeating internet-mediated misinformation.  Brief answers to your follow-up questions:

1.  The ARS is a flu-like illness.  Most people with these symptoms do not have HIV.  This year there will be more than 20 million cases of influenza in the U.S. and less than 50,000 new cases of HIV.  Yes, the medical community is in agreement.

2. Lymph node swelling is non-specific.  That is the reason that tests are performed if there is a concern.

3. Most infectious diseases cause lymph node swelling, so does dental diseases.  Atheletes foot casues inquinal lymph node swelling.

4.  Yes

5. Both reasons.

6.  Silly question. See response no. 3.

7.  No

8.  For diagnosis, the detection limit is irrelevant.  Persons with untreated HIV have tens of thousands of viral particals in every drop of blood.

EWH

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13 months ago
Thank you for your reply and reassurances.

To be honest Doctor I am at a loss. I was of perfect health before this whole experience and never had a single lymph node swell up like this. After the possible exposure I started having this lymph node swelling and the lymph nodes in my armpits scare me the most.

I am not even going to go into what kind of emotional and physiological roller coaster this has been.

1. Do you know of any other infectious deceases that would cause swollen lymph nodes in the armpit/chest on both sides?

2. Do you have any suggestion on how to proceed further with diagnosing the cause of my swollen armpit lymph nodes and the lymph nodes behind my ear? What kind of specialist would be best suited to help me with this?

3. From your previous replies I understand that you do not recommend any additional HIV testing but I will probably go for another HIV test (4th Gen and PCR) at 4 or 5 months. If you leave this discussion open I will post my results.

4. From your experience have you ever had a patient with an HIV infection that did not show up on the RNA TMA test? Because of exotic strain or mutation.

5. The reason why I was thinking about an HIV-2 test was because with the P24 antigen part of the DUO and the RNA Qualitative Test would not be reactive to HIV-2. Your thoughts in this?

Thank you for your reply 

13 months ago
To be honest, at this point I am ok with whatever happens to me. Even would prefer cancer to HIV because of the fear of hurting my daughter.

I am convinced that I have HIV and will test positive at a later date, do not quite know why the tests so far have been negative. That is why I keep asking about HIV2 and wether I should get additional testing to rule it out.

What are the chances of HIV transmission through breastfeeding for a period of 2 months?

Mostly terrified that I have ruined my young daughters life.
Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago

Final responses to these repetitive questions:

1.  Absolutely.  Most people have lymph nodes which can be felt in this area.  The list of possible causes is HUGE. If it concerns you, instead of worrying about HIV which you clearly do not have, you should see a doctor to find out what is really causing it.

2.  I would see a general internist or, possibly an infectious disease specialist.

3.  I will not reply further but will leave the thread open so you can post results. Further testing is a waste of time and money and your tests will be negative.

4.  NEVER!!!!!

5.  But the antibody test is reliable.  Believe your results.  Give up on your internet-fueled paranoia

HIV is occasional transmitted from infected persons by breast feeding but neither you nor your wife have HIV.  Your daughter is not at risk. 

There will be no further responses.  EWH


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13 months ago
Hello Doctor,

So at this time about 15-16 weeks post possible exposure I am still having swollen lymph nodes and pain in the armpits.

At 105 days I had 3 additional tests done:
3rd Gen Insti POC - Neg
HIV 1 RNA PCR QUAN (Quest D) - Not detected
HIV 2 RNA/DNA PCR QUAL (Quest D) - Not detected 

This is in addition to:

- 38 Days - RNA Qualitative TMA – Neg

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

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

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

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

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

- 94 Days - 4th Generation Ag/Ab – Neg


From this large amount of testing I have to believe that I do not have HIV and so my doctor has scheduled a biopsy of the swollen lymph nodes to see what exactly is going on.

Doctor do you agree that at this point HIV has been totally ruled out?


Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago
Final responses (I should have closed this thread previously).  You have completely and repeatedly ruled out HIV.  EWH
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