[Question #6843] questions relating to ARS

10 months ago

Hello doctors thank you for taking the time to answer my questions.This is the second question i am asking; the first question was answered by Dr Hook as such IF possible i would greatly appreciate it if i could direct this lot of questions to Dr Handsfield in the hopes of essentially doubling up on expert advice from 2 sources and 2 opinions ( i know you state you have differing writing styles but essentially the same advice as you have worked together for many many years ) 

My questions are in relation to my persistent sore throat(pain is not severe it is more of a discomfort) however when i look at the back of my throat with a torch in the mirror it looks terrible . There is severe inflammation of the tonsils, the very back of the throat is white and there is  1 ulcer oval in shape ,white in colour and surrounded by a red ring at the back of my mouth next or on my gums.I also had 1 swollen lymph node in left side of my throat which seems to have pretty much gone.My concerns are i have been put on numerous anti biotic  as my doctor thought it was strep but it never cleared up even a little so after 3 courses of different anti biotic i was given anti fungal medication which also did not help at all either.I took a EBV test ; result was previous infection from a while back and did a CBC and a C reactive protein test both came back normal.

The duration of this persistent throat issue has been going on 7 weeks now and does not seem to be getting better.These symptoms started to appear about 5 days after a potential hiv (dr. hook has assured me that it was a no-low risk event ) but for the sake of argument if we can assume it was high risk event in relation to my questions.(I know this is not usual but my persistent symptoms that are not responding to treatment in conjunction with the fact numerous Drs have no idea what is the problem is making me incredibly anxious in these already very anxious times ) 

10 months ago

My question are as follows :

1. Is this duration of 7 weeks too long for ARS to still be present ? ( doctor hook said 3 weeks was to long for ARS symptoms however i have seen posts where Dr Handsfield says symptoms would not last more than 4-6 weeks ) is it at all possible that ARS could remain past 6 weeks? 

2.does my normal CBC and c reactive protein tests give any indication whatsoever in relation to the ARS or lack of ?

3.i did not notice any fever in the last 7 weeks, is fever really essential part of ARS? Meaning without fever it cannot be ARS? I have seen studies in medical journals that say it is indeed possible what is your view?

4.i did a 4th Gen Combo test about 7 days post this “high risk” event and about 3 days since the onset of symptoms and it came back negative; can this give me any reassurance? Obviously it would be too soon for conclusive results in relation to this “high risk” exposure but is it soon enough to say that these symptoms in my throat were not due to ARS?

5.I noticed a rash on my chest it it was not wide spread and it was more noticeable after a hot shower which consisted of pimple like red dots some of which had come to a white head like a normal pimple ( is the ARS rash pimple like? Is it wide spread i.e. not just on the chest? ( I’m worried because I have lots of tattoos on my chest so its hard to notice something like a rash because of the black ink so I think maybe it was more “severe” that what I can see ) 

6.This will sound like paranoia but this 4th gen test that came back negative I’m worried because when I called the dr. office to see if my results were in yet or not the receptionist said yes they are in then she said oh wait no they sent me your old 4th gen tests ( from about a month or 2 ago which I did as part of routine testing ) then she said call back in a few hours to collect your results. I’m afraid they say I had done the test very recently and just sent those results as oppose to testing the new sample I submitted to them for test ( especially since it was during this whole corona epidemic so maybe they were stretched with time/testing equipment) would this be at all possible?

7.Are mouth ulcers with red halos a sign of ARS?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
10 months ago
Welcome back, but sorry you found it necessary. FYI, it's by chance I'm answering and not Dr. Hook:  as you correclty surmise, you won't hear anything different from me. I reviewed your recent discussion with Dr. Hook and agree with all he said.

First, I don't accept "for the sake of argument" that your exposure was high risk. It was not. Second, symptoms are never useful in judging when someone might have HIV; and most sore throats do not respond to antibiotics, because most are not due to bacterial infections -- but that doesn't mean HIV is a likely cause either.

If I correctly understand, the only blood test you had was only 7 days after the exposure you're concerned about, right? If so, it is meaningless:  nobody has a positive result that soon. But now at 7 weeks, you can have a conclusive result. Repeat the test. You can expect it to be negative. My replies to your numbered questions are brief -- I'll be happy to comment further if and when you get tested and report the result.

1) Yes, 7 weeks is too long for ARS. 

2,3,5,7) Your CBC and CRP results all these symptoms make no difference one way or the other. None of the symptoms are typical, and many people lack fever -- but the evidence remains overwhelming that you do not have HIV.

4) As noted above, 7 days is too soon. And three days is too soon for onset of ARS, as Dr. Hook advised last time. I look forward to hearing the result of a follow-up test, which I expect will also be negative.

6) I think you're seriously overthinking this. There's no chance your doctor, or any other, would falsify or withhold accurate test resuts. And even if you caught HIV, your test couldn't be positive that soon.

Looking forward to hearing the result of another antigen-antibody (4th generation) HIV test done at least 6 weeks after the sexual exposure you are concerned about. I won't have any other comments or advice until then. OK? But truly, stay relaxed in the meantime. Perhaps you'd also like to know that in the 15 years Dr. Hook and I have been moderating this and a preceding forum, with thousands of questions from people worried they caught HIV, not one has actually turned out to be infected. You won't be the first! If and when it happens, it undoubtedly will be from a truly risky exposure, not a minor event of the sort you have described.

10 months ago
Thank you for your reply doctor I appreciate your time. 

As for testing at the 7 week mark , I am wanting to go to test but with the corona going around I am afraid to go into a hospital setting and additionally many GPs offices are closed and I need a request to be made by my GP for the testing ; as such this is why I have come to you to for advice in the mean time.

if I could just take a moment more of your time and ask you a fe more questions after which I will try control my anxiety and wait till it is feasible to do another 4th Gen test . 

1. Is the fact that that this throat problem I'm having is lasting 7 weeks tell you that it is almost for sure not ARS ? (EVEN IF this was a high risk exposure )

2.Dr Hook said that if these symptoms were infact ARS the test would have been positive; is this not the case if the test was done 7 days post exposure? i.e even with ARS symptoms 7 days is too soon to give and indication that these symptoms were ARS?

3. In your reply to my questions 2,3,5,7 you say" none of the symptoms are not typical " do you mean not of the symptoms of HIV are typical or none of the symptoms that I have been experiencing are typical?

4.in reference to my question number 6; what I was trying to say was I thought It was strange that they sent my month old 4th gen results to my doctor in the first place so as a results when I got given my results that were printed out for me I had doubts about whether these were the old results and not the new sample I had submitted for the most recent testing. what is your view in relation to the lab sending my old results to the doctor in the first place?

5.Finally you tell me to re test at 7 weeks is this because you want to put my mind at ease or because you believe there is perhaps a slight reasoning behind testing following this event? ( I have seen previous post you have comment on in regards to how long HIV can survive outside a human host in the environment and they seem to say that HIV could survive for atleast a few mins ; as such I don't understand how it could not be atleast theoretically possible to get HIV from the exposure I referred to in my previous post ( certainly there would be at least a suspicion considering the symptoms that followed shortly after ? ) 

I would also just like to point out that were you have said many people experience ARS without fever Dr Hook said in my pervious post " It would be extraordinarily unusual for the ARS to occur without fever .  I have never seen or heard of such a case." this doesn't seem to correlate with you view that your opinions don't differ. I certainly mean no disrespect but surely you can understand my anxiety when i see advice from 2 highly regarded experts in their field who's advice or opinion seem to vary on certain topics/issues.

I hope you can take the time to answer this final lot of questions after which I will certainly follow your advice at take a 4th gen test as soon as feasibly possible . many thanks Dr

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
10 months ago
Maybe I missed it in your previous question and the discussion with Dr. Hook. I thought the only test done so far was at 7 days. But apparently you had another negative AgAb (4th generation) blood test about 4 weeks after exposure, right? If that had been positive, you can be certain your doctor would have told you. If you remain worried they have ignored the 4 week test and were again giving you the result of your test at 7 days, call and ask them to clarify it. But the rest of my comments assume you had a negative test at 4 weeks.

That result proves 100% that none of your symptoms are due to ARS. It is true that ARS symptoms depend on the body's immune response, and that HIV antibody therefore is always present on testing. The way to interpret your negative 7 day test is that it was irrelevant:  it is true that if your sore throat at that time were ARS, it probably would have been positive. But the combination of the early onset (only 3 days) plus negative result PROVE that the sore throat wasn't ARS. And now your negative 4 week result PROVES that your symptoms are not ARS.

Beyond that, these follow-up questions are splitting hairs. There is simply no chance you have ARS; ALL your symptoms have other causes. You're also splitting hairs in trying to parse out details of the words Dr. Hook and I have used both in responding to you and perhaps in reading our responses to other questions. There is no rigid definition of ARS; some authorities would consider fever as always present; others would diagnose ARS in some persons without fever, if they had other evidence for it. The important thing is to IGNORE ANY AND ALL SYMPTOMS. THEY ARE NEVER, EVER USEFUL IN JUDGING PRESENCE OR ABSENCE OF A NEW HIV INFECTION. ONLY HIV TESTING CAN DO THAT!

If you have another blood test more than 7 weeks after your non-exposure event, plesse return to let me know the result. Until then, I will not reply to any other comments on this thread and will close the thread. And this is your last change for our input, so don't blow it:  repeated anxiety driven questions about the same exposure, symptoms, testing, etc are against forum policy. This being your second, it is your last:  future questions along these lines will be deleted without reply and without refund of the posting fee.

In summary, you have one more comment coming on this thread, for the sole purpose of posting your final test result. In the meantime, may I suggest you go back and re-read your previous thread with Dr. Hook and carefully re-read all most comments above. Concentrate and do not split hairs. All the reassurance you need is there.