[Question #6746] Possible HIV - Exposure and Symptoms

13 months ago

Hello,

I had an encounter with a Trans Escort at the end of November 2019, protected insertive anal sex (I was on top). The condom did not break from what I can recall.

About 30 days after the encounter I experienced ARS symptoms that lasted about 10 days consisting of:

- High Fever (101-103 F)

- Headache

- Night Sweats

- Painful Armpits

- Dry mouth with white tongue

- Insomnia

After the above-mentioned symptoms subsided I had two painful lymph nodes swell up behind my ear each lasting about two weeks until they returned to original size. The pain/discomfort in my Armpits is still present (going on 60+ days), the doctor was able to palpate several swollen nodes and has referred me for an ultrasound.


- 5 W - RNA Qualitative TMA – Neg

- 6 W - Insti HIV 1/ HIV 2 3rd Generation POC – Neg

- 7W - 4th Generation Ag/Ab Test and full STD Panel - Neg (except HSV type 1 - positive)

- 8W - 4th Generation Ag/Ab Test – Neg

- 9 W - 4th Generation Ag/Ab Test & RNA Qualitative TMA – Neg

- 13 W - Insti HIV 1/ HIV 2 3rd Generation POC – Neg

- 13 W - 4th Generation Ag/Ab – Neg

-15 W - 3rd Gen Insti POC - Neg, 

HIV 1 RNA PCR QUAN - Not detected

HIV 2 RNA/DNA PCR QUAL - Not detected 


1. Doctors, could the above-mentioned tests have missed an HIV infection?

2. Some sources say that HIV tests will be positive if symptoms are present, is this true?

3. Could HIV be hiding in my lymphatic system and because of this not showing up on the test?


Please help me figure this out.


Thank you

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

Welcome to the Forum and thanks for your question.  I’ll do my best to help.  You do not have HIV.  The flu-like symptoms you experienced occurred late for the ARS and even more importantly, each of the 7 tests you have had since week 7 is conclusively negative for HIV.  There is simply no way that tests for HIV antibodies (including HIV-2), for HIV antigen, and for HIV RNA would all be negative if you had HIV. It is far more likely that your flu-like illness was a coincidental, non-STI illness of the sort that most people get from time to time.  In answer to your specific questions:

 

  1. Doctors, could the above-mentioned tests have missed an HIV infection?

    Absolutely not.

 

2. Some sources say that HIV tests will be positive if symptoms are present, is this true?

This is true, both HIV RNA tests and 4th generation HIV tests will be positive if your symptoms are due to HIV.

 

3. Could HIV be hiding in my lymphatic system and because of this not showing up on the test

No

 

If your swollen lymph nodes are troubling you, it is time to look for other, non-HIV, non-STI causes.  I hope this information is helpful.  EWH


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13 months ago
Hi Dr. Hook,

Thank you for your prompt response to this thread.

Yes, my ID Specialist told me the same thing that if the symptoms (especially lymph node swelling was due to HIV my tests would pick it up.

1. The doctor recommended another HIV test at 6 months to rule out the possibility of late conversion. Although she said she has never seen a 6 weeks negative 4th generation turn positive later. Would you agree with this suggestion or is this unnecessary and I should focus on finding another reason for my swollen lymph nodes?

2. I have read that "lymphogranuloma venereum" can cause swollen lymph nodes like this. Would a regular chlamydia test pick this up or is there a specific test for this?

3. My concern is that I have never had swollen lymph nodes like this in my entire life so I am worried that I might have gotten either HIV (seems to be excluded with all of the tests) or another infectious decease. Could Hep C cause swollen lymph nodes?

4. In your clinical and research experience have you ever had an RNA test be negative after 3 months and then turn positive? Or have a patient with swollen lymph nodes caused by HIV but negative 4th gen and HIV RNA?

5. Is there any other STI that can cause these symptoms that I should be tested for? I took a standard STI panel on about the 6th-7th weeks after possible exposure and everything was negative except for Oral Herpes HSV-1. Could HSV-1 cause swollen lymph nodes in the armpit or chest area?

Thank you for your attention to this inquiry, I understand that some of my questions are repetitive but  I am sure you can understand my circumstances.

Look forward to your reply.
Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago

1.  With all due respect to your doctor, I believe she is being overly conservative.  There is no further testing needed to rule out HIV.

2.  Yes, a regular test for chlamydia would also detect lymphogranuloma venereum.

3.  Hepatitis C is not acquired sexually with the rare exception of persons engaged in receptive rectal intercourse.  Lymph node swelling of the sort you describe is not suggestive of LGV.

4.  No to both questions.  Believe your results!

5.  HSV-1 would not be expected to cause lymph node swelling of this sort.  The only possible STI which might cause lymph node swelling of this sort is syphilis and if you had syphilis it would have been detected by your 7 week STD panel.  As I said above, , if this lymph node swelling  is troubling you, I would suggest you look for other, non-STI causes of the swelling.  Lymph node swelling can be caused by a vast number of problems/illnesses, most of which are NOT STIs.

Hope this helps.  EWH

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12 months ago
Hello Doctor,

From the last time that I wrote on this forum, I have had a battery of tests done and seen several specialists.

The findings are as follows:
Lymph Nodes in Armpits and Chest are of normal size
- Although I still have slight discomfort -

Lymph Nodes in the neck and under the jaw are all slightly swollen - confirmed by Ultrasound

Salivary Glands slightly swollen - confirmed by Ultrasound
- Onsets of dry mouth have gotten better, almost gone -

- Last HIV Tests -

13 W from exposure/ 9 W from symptoms - 4th Generation Ag/Ab – Neg

15 W - 3rd Gen Insti POC - Neg, 

HIV 1 RNA PCR QUAN - Not detected

HIV 2 RNA/DNA PCR QUAL - Not detected

17 W - HIV PCR Qualitative Negative

18 W - ARCHITECT HIV Ag/Ab Combo - Negative


-Blood Work - 
High Percentage of Lymphocytes  42% - Ref. Range 19.0 - 37.0
Low Percentage of Neutrophils  47% - Reg. Range 48.0 - 78.0
- Lymphocyte and Neutrophils Abs counts are within the normal range -

Phagocytosis Analysis-
High Percentage of Granulocytes 97% - Ref. Range 82 - 90%
High Percentage of Monocytes 89% - Ref. Range 75 - 85%

Have also been tested for:
HTLV - Neg.
Toxoplasma -  Neg.
Ebstein Barr - Neg. 
Syph RPR - Neg.


-Cytomegalovirus - 
Positive for Antibodies 182 units/ml IgG
IgM Negative
Negative on RNA Quantitative

My questions are as follows:

1. Could a prolonged seroconversion be causing this disbalance in my white blood cell count?

2. Several of the Infectious Decease Specialists that I spoke with recommended retesting for HIV up to the 24-week mark. Your thoughts on this? 

3. What usually happens to a person's Neutrophil and Lymphocyte counts during HIV infection?  Are my bloodwork results alarming to you?

4. Questions about Cytomegalovirus
1. Could all of my symptoms have been caused by cytomegalovirus initial infection or reactivation? I have read that IgM antibodies are usually present during initial cytomegalovirus infection but then disappear after several months (I took the test about 3+ months are symptoms).

2. In the situation above would the PCR Cytomegalovirus test be positive? Or could it be negative at this point?

5. Can I be certain that HIV infection has been ruled out at this point?

6. Is there any situation when HIV RNA would not be detected but HIV Proviral DNA would be present by itself? Should I get an HIV Proviral DNA PCR?

Edward W. Hook M.D.
Edward W. Hook M.D.
12 months ago
It saddens me to see that you continue to worry about HIV in the face of overwhelming and conclusive proof that you do not have HIV.  Your questions are repetitive and therefore my responses will be brief.

1. No
2.  Repetitive.  I have previously Told you that six months testing is not necessary. Repeating the question does not change the answer.
3.  Your bloodwork is not the least bit alarming. Fluctuations within and just outside the normal range are not the least bit uncommon. Your bloodwork findings are non-specific and of no concern, particularly in the face of an otherwise normal WBC.

CMV
1.  Yes, CMV can cause a mononucleosis like syndrome. You have had symptoms and concerns long enough that and IgM test might not be positive.
2.  A CMV PCR might or might not be positive. Positive or not it is irrelevant. There is no treatment for CMV infections. One only needs to wait them out.

5.  Repetitive, see above.
6.  No.

This will be the final response as part of this thread. Your anxiety – driven, repetitive questions serve no purpose for you. You need to move forward from your inappropriate an incorrect concerns. Should you have trouble doing that I suggest you seek professional counseling to do so.  I must also warn you that should you return to this forum with further questions regarding this encounter and whether or not you have HIV, your thread may be deleted without a response and without return of your posting fee. I wish you the best. Please seek counseling. EWH

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