[Question #6793] Follow up [Question #6699]

13 months ago

When I first started on the site I did not know how to use it, I ended up paying twice and asked one question, thus I decide to use the other payment.

Doctor Hook has been very helpful, my concern is I have too many symptoms that came up after  my two tests that are strongly  linked to HIV:

1- One single swollen lymph node on one side of my neck for nearly 6 months now, it did decrease, but I still can feel it. Lymph node that stay swollen for 3 months or more are strongly linked to HIV

2- chronic Xerostomia and white tongue at 4 months post exposure till now. Xerostomia is linked to HIV.  I don’t have have sjogren syndrom. I snore and suffer sleep apnea though.

3- Leukoplakia diagnosed by ENT at 5 months post exposure till now. I don’t smoke and don’t chew tobacco, why would suddenly I get Oral Leukoplakia in my inner cheeks?

4- Body wide fasciculation at 92 days post exposure till now.

5- Small white dots on one side of my tongue for 2 months till now

6- Worm like blood in my pee for one day at 6 months post exposure.

Before the exposure, I was never sick and never had any issue at all.I know it is difficult  to diagnose me online without knowing my medical history.

If I were your patient wouldn't you recommend another test since the symptoms came up after the HIV tests and are very suspicious?

In the province that I am, they don’t offer PCR/RNA test that’s why I only did Duo tests.

If the symptoms came up before my last test, I would have moved on after the 3 months negative test, but what really scares me is the fact they come after the tests, which makes me wonder the reliability of these two tests.

I wanna move on and past this, it was a silly mistake, please be compassionate and let me know what you think?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
13 months ago
Welcome back to the forum, but sorry you found it necessary. (If you paid for a question that wasn't answered -- i.e. if this second question represents a third payment -- we are happy to reimburse you. I'll ask the Admin office to look into it.)

All your questions boil down to different symptoms, wondering if they could be due to HIV despite your negative tests. If you think about it, the answer really is available in your earlier discussion with Dr. Hook. His opening reply included this: "I can completely assure you that you did not acquire HIV or any other STI from that encounter.  Your tests prove this." The remainder of that discussion repeated that advice again and again as you asked about different symptoms. He also reassured you of the low risk of your exposure: that condoms work to prevent transmission by vaginal sex; and that transmission by cunnilingus is rare, if it occurs at all: to my knowledge, there has never been a proved case of HIV acquired by cunnilingus.

Just remember this:  The current HIV diagnostic tests -- specifically the antigen-antibody (AgAb, 4th generation) and PCR/RNA tests (and especially the combination of them) -- are among the most accurate diagnostic tests ever developed, for any medical condition. The results always overrule everything else:  no matter how high the risk at the time of exposure, and no matter how typical someone's symptoms might be, negative testing proves HIV is absent. There has never been a single reported case in which this did not hold up. In addition, the tests themselves are highly automated, and include internal controls to assure the results are reliable. You can be very confident there were no errors in performing them or the reliability of the results.

Therefore, I'm not going to respond separately to your numbered questions about specific symptoms. It is confirmed 100% you do not have HIV.  And all the symptoms described occur much more commonly in people without HIV. (Even if you had not been tested, I would not consider any of those symptoms suggestive of an HIV infection.) One of them, occasional blood in your urine, should definitely be medically evaluated if it happens again. Any and all occurrences of blood in urine should be professionally evaluated. But this isn't an HIV symptom.

So in response to your closing question:  No, I do not recommend any further HIV testing. It would be a waste of money. If you again notice blood in your urine, for sure see your doctor. But do your best to accept the scientific evidence and the reasoned reassurance you have had on this forum and go about your life with confidence you do not have HIV.

I hope these comments help you do that. Let me know if anything isn't clear.

13 months ago
Thank you for your feedback and insurance Dr Handsfield, Everything is clear. I am trying to work by faith and not by sights since the symptoms in my mouth are scary. Even the CDC stated that the Window Period for Antigen/Antibody test is 18 to 45 days, I did a test that double that window period and I do not have any pre-existing condition, I don't do drugs, no organ transplant and i'm not on chemo. 

Would the assessment be the same if the person I did the act was known to be HIV positive and I was experiencing the symptoms after the tests? The woman in question tested 13 days after and was negative but she did want to further test.

What started the "what if" after my 13 weeks test, I've learnt that corticosteroid could delay antibodies production and as I explained in my previous interaction with Dr Hook, I had a mild plaque psoriasis flare and used a cream Hydrocortisone-17- Valerate 0.2% and I used only 9g out of  the 15g, I didn't even finish it. but this got me thinking with all the stress that I was enduring, what if that prevented my system from creating antibodies if I was infected. I used the cream in two batch, first batch last used 10 days before the 35 days test and the second time I last used it more than 7 days before the 92 days test. I know your view on this, i.e. Only highly potent systemic steroid could have an effect on HIV test, considerate the potency of the steroid that I used was mild, and it was a cream applied locally, that shouldn't have a systemic effect and alter an HIV test. Let's say I used the cream for a total of 2 weeks out 13 weeks, that leaves my immune system 11 weeks to create antigens/antibodies, the test should have picked up something as they are highly sensitive or at least be indeterminate if there was something.

I would like to mention that the two tests I did were Duo test at 35 days and 92 days post exposure, I did not do PCR/RNA since they don't offer them in my province, did your assessment stay the same?

I have an appointment with my physician next month to discuss the ongoing symptoms, i'll see what he has to say specially for the blood in urine, which happens only once, I am monitoring to see if it reoccurs.

Due to a Sciatica pain that I experienced, late December till beginning of Jan 2020 I took Naproxen, I stopped the Naproxen since I was feeling dizzy each time i took it, I switched to Tylenol for maybe 10 days (at least two 500mg pills a day), it was after that I start experiencing the dry mouth. Do you think these pills along with severe prolonged anxiety could cause chronic dry mouth? at the same time I was also taking vitamins supplements. Tylenol and Naproxen both have dry mouth as side effect, and I also read that vitamin supplements can cause dry mouth.

I realize that now you don't really go into details to explain the p24 antigens/antibody like you used to do at MedHelp, do you still have the same point of view  (i.e. if there is no antigens there should detectable antibodies since they are lock and key)? Your explanations really help me, when I am down i keep telling myself if there is no Antigen there should be Antibody.

What is your position on the second window period with 4th generation test?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
13 months ago
"Would the assessment be the same if the person I did the act was known to be HIV positive and I was experiencing the symptoms after the tests?"  Yes.

It is an urban myth that immunosuppressive drugs prevent development of antibodies. Even with potent chemotherapy or very high dose corticosteroids, it is rare if it happens at all. And certainly not possible with topical steroids on the skin; very little is absorbed beyond the skin. And you correctly understand the AgAb (Duo) tests and nohting has changed from other replies you have seen. Your negative resutls are 100% reliable. You do not need RNA testing.

Also no other medications have any effect on reliability of any HIV tests. None. No medical condtions of any kind. NOTHING makes HIV tests unreliable. Suck it up, believe it, and move on.

The second window is rare and theoretical, with no reported cases that it actually happened, to my knowledge. If it occurs, it's a brief period (a few days, max) 2-4 weeks after exposure. There is no such thing as a second window beyond that time.

Trust me on this:  you do not have HIV. Do your best to stop focusing on every little twinge or tingle or worrying about (or looking online) for reasons your test restuls are not reliable. There are none. Time to stop worry and stop asking. There nothing that will come to mind or that you'll find online that has any possibility of changing the advice you have had in this and your previous thread. Please don't ask.
12 months ago
Hi Doctor Handsfield, (So sorry for the late feedback)

I tested at 7 Months (210 days) with Insti rapid test and it was negative. That same  day,  I also tested with 4th Gen test from the public system lab, they had not contacted me since and it's been 21 days, normally it means that the result is negative, i'll confirm next week.

My symptoms are the same (Chronic Xerostemia, growing leukoplakia in my cheeks, fasciculation and subsided lymph node that is still there since October 11th 2019, I want to test with PCR/RNA to really put this behind me, but my province does not offer this test.

I am less anxious now, but i need to find a way to put this behind for real, I have learnt my lesson, I will never put myself in such predicament.

Most of my doubts of the first two 4th Gen lab tests are gone, my two tests were with the same company, now I have tested with a different technology i.e. Insti and a different lab. I did not use any corticosteroid for 4.5 months.

Should i trust the results?

- If my body were to not make antibodies, P24 antigens would be there in case of HIV1. There is that case "Extremely prolonged HIV seroconversion associated with an MHC haplotype carrying disease susceptibility genes for antibody deficiency disorders" in which someone could not make antibodies for HIV-1 but P24 was detectable for 4 months, which proves your point that antibodies are the ones that clear P24 out, if there are no antibodies, P24 will be detectable for longer period, too bad two months after when antibodies were detectable they did not test for p24.

- If i would have to be infected with HIV-2 and not be able to make antibodies. The 4th Gen test would have missed it, because there would be no P24 in HIV-2? But, if someone don't make antibodies at 8 months they would have been in AIDS stage? I am perfectly healthy aside from the above symptoms.

Would you recommend your patient PCR-RNA after negative INSTI and 4th Gen lab at 7 months if they show symptoms of HIV?

What makes me scared is someone on this site that had multiple negative 4Gen tests after 5months, but tested positive at 7 months (Question #6433), I don't know if it were a false positive since I could not track the follow up. My apologies if i reference someone else post in my feed, hope i have not broken the forum's policy or privacy.

(I have an appointment with a different ENT next month to analyze the leukoplakia in my cheeks)

Thank you very much for this forum and your will to help us.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
12 months ago
"Should I trust the [test] results?"  Good grief. We don't expect much of those who come for our advice, but we do imagine that they read our replies. Every statement by me and by Dr. Hook in your previous question have stressed that your test results prove youu don't have HIV. The results are equally valid for HIV2 as HIV1. There is nobody in whom the 4th generation tests fail to detect HIV. No, I would never recommend PCR testing in this situation.

That completes the two follow-up comments and replies included with each question, and so ends this thread. Please note that repeated questions on the same topic are not permitted, especially when anxiety driven as yours have been. This must be your last; future questions about this exposure, your symptoms, and HIV testing will be deleted without reply and without refund of the posting fee. Repeated answers tend to prolong rather than relieve anxiety. In addition, repeated questions have low educational value for other users, one of the forum's main purposes. Thanks for your understanding.

Really, just move on without worry. I suggest you go back and read all the replies in both threads. If you continue to worry,consider professional counseling. It is not normal to remain as fearful as you are in the face of repeated, expert, science based reassurance. Best wishes and stay safe.