[Question #7376] Elite Controller. Hiv not showing up

5 months ago
Hello doctors,
I am a male.  I had an exposure to a suspected hiv woman.  Approx 3 weeks later i developed a 2 week bout of headaches,mild sore throat, very mild fever. A week later i started developing tongue and mouth issue sores etc.  I then had 2 night sweats and dry mouth.   Started noticing some skin issues pimples and maybe a rash on my torso of white dots.  I also started to develop stomach pain and stomach noises a few weeks later.  I noticed a large bruise on my knee that i thought was kaposi sarcoma. I then developed tinnitus at 4 months, folliculitis and muscle twitching which i still have now.  Also have a white tongue. Been tested for all STDS with  negative results.  Tested for lyme and a bunch of other things with negative results.  I spoke to an RN at a  NYC clinic and they told me that they have had many patients test positive after 6 months.  Another clinic told me that people that are in very good shape and have a strong immune system test later as well.

Is it possible that i am an Elite Controller and my body is keeping the virus,p24 and antibodies at an undetectable level?  

CD4 Has come in at 580 and then 700
CD8 was high percentage on the range scale but barely. 
CD4/CD8 Ratio was   1.06


I had an anti body test at about 4 weeks and it was negative.  
6 weeks 4th gen test and pcr rna negative
2 months  4th gen test and pcr rna negative
3 months  4th gen test and pcr rna negative
4 months  4th gen test and pcr rna negative
5 months  4th gen test and pcr rna negative
6 months  4th gen test and pcr rna negative
7 months 4th gen test and pcr rna negative.. Pro Viral DNA test negative
8 months  4th gen test and pcr rna negative


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
5 months ago
Welcome to the forum. Thanks for your confidence in our services.

You have been way overtested, and you misunderstand some basic issues. First, HIV elite controllers have slow progression (or non-progression) of immunodeficiency, with long term survival. That's all. They have entirely normal diagnostic tests for HIV. Your tests prove don't have it.

Your second misunderstanding is about symptoms and HIV testing. The current HIV tests, including the kinds you had, are among the most accurate diagnostic tests ever developed, for any medical condition. When done sufficiently long the last possible exposure-- 4-6 weeks, depending on the particular test or combination of tests, overrule everything else. No matter how high the risk of HIV infection at the time of exposure, and no matter how typical the symptoms might seem to be of an HIV infection, the test results rule. The nurse you spoke with is mistaken or you misunderstood:  trust me on this -- using the tests just mentioned, she has not seen any patient, ever, who took 6 months for positive results. Nobody has:  no such cases have been reported in the medical literature. (The only rare exception is in people who take anti-HIV drugs for prophylaxis, in whom postive testing can be delayed if prophylaxis doesn't work. Even then, they always have positive results within 2 months of hte last dose of drug.

In addition, the symptoms you describe really are not suspicious for HIV to begin with.

So the bottom line is good news. For sure you do not have HIV. You have been way overtested already and shouldn't have any more tests.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
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5 months ago
Thanks for the fast response.  I also have experienced rapid heart rate of 130 and now have high blood pressure. I also had a slightly raised alpha feto protein tumor marker.  Hemoglobin level is also high and i do not smoke. I had an MRI of the body and they noticed multiple hemangiomas on the liver thought it might be KS.  Do any other illnesses come to mind with the information that i provided?  Do you suggest any other test in regards to infectious disease?  Is it possible for T cells to suppress the virus instead of antibodies. 

Thank you 
5 months ago
Hello Doctor H
i found some studies on the internet. Any thoughts? Very rare?

Thank you very much

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjAgqSP1-fsAhX2hXIEHQAhDm44FBAWMAV6BAgFEAI&url=https%3A%2F%2Fwww.bag.admin.ch%2Fdam%2Fbag%2Fde%2Fdokumente%2Fmt%2Fp-und-p%2Frichtlinien-empfehlungen%2Feksg-rec-window-period-hiv-diagnosis.pdf.download.pdf%2Feksg-rec-window-period-hiv-diagnosis.pdf&usg=AOvVaw1csC2OFnHq0agmpIqvWkVY

https://pubmed.ncbi.nlm.nih.gov/19800288/
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
5 months ago
As for your symptoms, they do not even hint at HIV. Even if they did, re-read my comment above. It doesn't matter what symptoms you have or may develop in the future. Your test results prove HIV isn't the cause. And anyway, every symptom caused by HIV occurs more commonly in other medical conditions -- includibng yours. However, this forum addresses only HIV and STD issues. I will not speculate on other possible explanations for your symptoms. But all things considered, I doubt anything serious is going on.

The potential rare exception is reported in the medical literature exactly because it is rare. 


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