[Question #6922] Will HIV ARS infection occur late?

11 months ago
Dear Dr. Hunter Handsfield: 
I am a student in Taiwan, I've read a lot of your post in the forum you host in medhelp, but still i am worry about my symptoms, I had a combo test at 84 day and it came back negative, but at 86 day I felt sore throat, and lymph nodes in the neck are a little swollen, those symptoms were so alike to the ARS of HIV, but I didn't had a high risk sex in the period. Are my tests reliable? Can ARS of HIV happen so late? Do i need to test again? Can i stop worry now? Thank you so much for taking the time to answer.
11 months ago
I am the person who asked the question, sorry for the reckless behavior, I did not pay much attention to the wording when asking the question, please allow me to amend the beginning of the question, it should be '' dear dr '', Instead of specifying the expert to answer.
11 months ago
I think I must describe my experience in more detail. I had sex with CSW on 2/14 with a condom, and did not use condoms for oral sex, which also included me serving her. After that, I was very worried, so I had RT-PCR(40cpoies/ml) on 3/9 and the result was negative. On the same day, I also had a combo rapid test, and the results were also negative. Later, because I was too worried, I had an ab / ab comb test on days 45 and 86 and the results were all negative. But actually, on the 82nd day, my throat started to ache, have a fever, and my lymph nodes were swollen. Due to these symptoms, I want to ask:

1) Is it possible for HIV ARS to happen so late?
2) Is my symptom typical of HIV ARS?
3) Can I still trust previous inspections?
4) Do I need to do other related tests?
5) Can I be sure that I am not infected?

Thanks again to the experts for taking the time to explain.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
11 months ago
Welcome to the forum. Thank you for your confidence in our services.

The tests you had are among the most accurate diagnostic tests ever developed, for any medical condition. If done sufficiently long after the last possib le exposure to HIV, the results are absolutely reliable and overrule all other factors. No matter how high the risk of exposure at the time, and no matter what synptoms someone has, the test result rules and those other factors should be ignored. As it happens, you had a virtually zero risk exposure -- so low risk you really didn't need testing at all. And there are many conditions that can cause the symptoms you describe. Common colds and strep throat are the usual causes; infectious mononucleosis also is possible; or even COVID-19 (although enlarged lymph nodes aren't common for coronavirus). Your AgAb test result was conclusive, and the 86 day test confirmed it.

Those comments address all your questions, but to be sure there is no misunderstanding:

1) No, this is much too late for ARS. Symptoms always start within 2-3 weeks.
2) ARS can cause such symptoms, but so do many other conditions as discussed above. These symptoms have nothing to do with the sexual exposure almost 3 months ago.
3) Not sure what you mean by "inspections". If you mean test results, the answer is yes.
4) No other testing is needed.
5) It is 100% certain you do not have HIV.

If your potential sexual exposure in the future are like this one, it makes little sense to be tested after every such event. If such events happen a few times a year, then routine STD/HIV testing once a year would make sense. But not after every event unless th risk a a lot higher, such as known infected partner, condom failure, etc. 

I hope these comments are helpful. Let me know if anything isn't clear. Best wishes and stay safe.

HHH, MD
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11 months ago
Thank you Dr. for the detailed explanation. I want to ask a few more questions to solve my doubts. If my symptom is ARS from HIV, then at least my P24 antigen test will be positive, not to mention that ARS  can't happen so late. After 12 weeks any type of test is conclusive.

I want to thank you again. I read your articles since I started to worry about being infected with AIDS , and they help a lot to ease my fear.  i think that there are many people as worried as me gain a huge relief after reading your article. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
11 months ago
Yes, you correctly understand

 Thanks for the thanks-- I'm glad to have helped, and I certainly hope our forum is as helpful as you say. That's why we're here.
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11 months ago
panic just like shadow and i can't wave it off. i know that theorilly i am confirmed to be unaffected, but i have fever, sore throat, swollen lymph nodes, the symptoms are so scary, i can't help thinking if i was wrong about my test. Can the test still can be conclusive when I still have the symptoms? Is it possible that the virus keep a very low load till three month and then suddenly grow? Is there any case with 4th generation test show positive after three month? Can I believe that I don't have HIV?

I'm really sorry that i failed you Dr. I feel so panic and I don't know what to do. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
11 months ago
I have nothing more to say. You do not have HIV. See a doctor about your symptoms and follow his or her advice. You cannot possibly have HIV unless you were reexposed after the events described above.

Perhaps it will also help you to know that in the 15 years Dr. Hook and I have been moderating this and a previous similar forum, with thousands of questions from people worried about HIV exposure, testing, and/or symptoms, not one has turned out to have HIV. I am confident you will not be the first.

That concludes this thread. I hope the discussion has been a little bit helpful.
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