[Question #7137] HIV Concern

7 months ago

Following up on prev. question w/additional concern. Time course:Unprotected vaginal w/person of unk. status, mechanical abrasion on penis shaft AM after (from vigorous oral sex during potential exposure). 1.5 wks later, single shallow painful oral ulcer(no Hx of canker sores) plus myalgias in both legs (no vigorous exercise or obvious cause). Myalgias lasted 2 days, ulcer lasted 2.5 wks. 4th gen HIV test, HIV RNA plus full STD panel 62 days post potential exposure (negative). Repeat HIV 4th gen. (for peace of mind) at 172 days post potential exposure (negative). Developed rash on trunk and legs 6 months after potential exposure, continues to this day. Discrete red and itchy papules, occur with about 2-3 lesions at a time, lasting 2-3 weeks, not responsive to triamcinolone ointment. I am concerned for papular pruritic eruption of HIV since characteristics and appearance match description/pictures in published literature (I have no other good explanation for the rash). With this concern, completed another HIV ag/ab & HIV RNA now 1 year and 2 months after potential exposure (both negative). Ordered CD4 count to reassure myself since PPE of HIV often associated with low count and opened a can of worms. CD4 835, 36.3%; CD8 elevated to 1017, 44.2%; CD4:CD8 low at 0.82; CBC normal. I have additionally developed an enlarged non-tender mobile lymph node in my axilla in the interval between the second and most recent round of HIV testing. This was associated with a lesion similar to the itchy red papules in the flank region. The lymph node was enlarged to the point of being clearly visible when I would raise my arm and was not there previously. It has since decreased in size although it is still palpable. Is there any chance I have HIV? I know CD4 and CD8 counts are not diagnostic for HIV, but what else could account for this given my story that is consistent with HIV?

H. Hunter Handsfield, MD

7 months ago

Welcome back, but sorry you found it necessary. I reviewed our previous discussion several months ago, concerning the same exposure. It turns out your questions this time really were answered last time, when my main reply was:

The HIV AgAb tests are among the most accurate diagnostic tests ever developed, for any medical condition. When done 6+ weeks after the last exposure, the results always are conclusive and outweigh all other factors: no matter how high the risk of HIV at the time of exposure, and no matter what symptoms are present, the test result rules. Your negative result at 54 days proved you did not catch HIV during the sexual exposure mentioned. The second test confirmed that result, but was superfluous. Do not have any more HIV tests. If your symptoms continue or you otherwise remain concerned, see a doctor. But you can be sure you do not have HIV.

I don't understand the abbreviation PPE in relation to HIV. But your CD counts are normal for all practical purposes. They vary naturally within the range of your own. For example, when following known HIV infected patients, they should always be drawn at the same time of day, preferably in the morning. But CD4/8 testing was irrelevant; such counts are NEVER done to evaluate HIV in people with negative blood tests, especially the various sorts of tests you had -- negative in 3 categories, antibody, antigen, and RNA. All the symptoms you describe are nonspecific -- which with your apparent medical understanding, you probably know mean they do not point to any particular cause. They are not nearly as suspicious for HIV as you seem to think. And HIV would never cause inflammation or enlargement of only a single lymph node.

It sounds like you're essentially examining and testing yourself. Regardless of your level of medical expertise, that's bad practice: see a knowledgeable physician you trust, perhaps an ID specialist. You may need evaluation for EBV, CMV, vasculitis, or other autoimmune condition. But all the evidence is unequivocal that you do not have HIV, and probably no infection at all from the sexual exposure you have described.

Let me know if anything isn't clear.

HHH, MD

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