[Question #7413] [Question #7235] follow up

4 months ago
Sorry to return after asking a question 2 months ago. I know this is against protocol. I want to thank the expertise and advice given by Dr Handsfield previously. I return here, as I am really worried about my health and my hiv test results. I know this looks like aniexty or hiv paranoia, but please hear me out. To recap, in 2014 I had vaginal exposure with female of African origin (condom tear), status unknown, at least 20 minutes exposure. This person had links to west Africa and now worried about hiv2, or rare strain such as group O, N or P. Apart from a uti infection in 2017, I have been well, but in February this year was ill with bad chest, cough, sore throat. This went on for 7-10 days, but sore throat lingered for 6 weeks. After this noticed thick white coating on tongue, some pain and bleeding when brushed. Oral thrush. This still lingers to this day. Medical literature relates this to late stage hiv. Other symptons over last 7 months include Terry's nails (whitening of nails), muscle aches and pains, especially lower back, spasms, fungal foot infection, pain under one foot, waking up in night with numb hands or feet, and small white circular patches on my calfs,  which I have been told could be fungal infection. All these symptoms appear alongside HIV. The tests I have taken:March-x2 hiv1/2 ab home self finger prick tests. negative. June-  4th gen ab/ag blood drawn at hospital, with hep B, hep c, syphilis. All Negative.August -  MPX HIV1/2-HBV-HCV PCR . (Groups M, O and HIV-2)  HIV1/2 PCR negative (rna) HCV PCR negative (rna) HBV PCR negative (dna) (however another Dr has said that above test is useless after this period of time,? Also no idea what limit of detection was? October-4th generation home sampling test sent to lab. VIDAS HIV DUO Ultra (groups M, O, and HIV-2, p24). Negative. With the symptons I have I strongly suspect hiv infection. If hiv is still suspected, what other test can I go for? I am really worried Dr.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
4 months ago
Welcome back. If you'll re-read my closing comments in your previous thread, I expected you would be back. Unfortunately, I don't see how I can help. Everything you ask now was answered then -- or at least you could predict the ansswers from my responses last time. My replies now are brief; for more detail, I suggest you go back and carefully re-read your previous thread.

A basic principle, which I see I didn't explicitly say last time but still was clear and understandable:  The HIV tests you had are, individually and certainly collectively, among the most accurate diagnostic tests ever developed, for any medical condition. The results overrule all else:  no matter how high the risk of HIV at the time of exposure and no matter how typical the symptoms may seem to be, the test results tell the truth. There has never been a single case of HIV reported in which someone was infected despite the test results you report. None. You aren't going to be the first.

"bad chest, cough, sore throat. This went on for 7-10 days, but sore throat lingered for 6 weeks. After this noticed thick white coating on tongue, some pain and bleeding when brushed. Oral thrush. This still lingers to this day....." and "...whitening of nails, muscle aches and pains, especially lower back, spasms, fungal foot infection, pain under one foot, waking up in night with numb hands or feet, and small white circular patches on my calfs...." Despite what you think you have learned online or elsewhere, none of this points to HIV. Every symptom that can occur with HIV, including EVERY ONE OF THESE occurs more commonly with conditions other than HIV.

"Medical literature relates this to late stage hiv"  but also to a large number of other conditions. Your test results PROVE that HIV is not the cause in your case.

"however another Dr has said that above test is useless after this period of time":  I'm not sure which test s/he was referring to, maybe PCR? Either s/he was wrong or you misunderstood. All the tests you had would be positive if you had HIV.  "no idea what limit of detection was':  Doesn't matter. Negative PCR proves HIV infection is absent -- or, in infected person, in total control by the immune system or antiviral treatment.

"what other test can I go for?" No other tests are available or necessary.

"I am really worried Dr."  Re-read my closing comments in your earlier thread, which include "That you "can't move on with [your] life at the moment" is a cri de coeur that indicates a level of emotional distress that demands professional counseling. It simply is not normal to remain as anxious and fearful as you are in the face of the overwhelming scientific evidence that you do not have HIV and the repeated, reasoned, science-based advice and reassurance you have had from your doctors and this forum. I advise mental health evaluation and care from compassion, not criticism. Please take it seriously."

I hope repeating these facts will finallly help you move on. Mostly I hope you'll in fact follow through with counseling. Either way, there is nothing more this forum has to offer you.

HHH, MD
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4 months ago
Dr Handsfield, I want to thank you for answering my questions. I appreciate you are a leader in your field, with decades of experience in this area. I want to apologise if I have irked or offended you with my repeated questions. I don't mean to doubt you, and I am sorry if it comes across this way. As it is my last time on the forum, I will try to explain why I returned, with the realisation  that you may not reply, and that you have already answered questions in detail, and take on board that this forum cannot offer anymore and the need for counselling. I returned due to ongoing symptoms (also have bleeding gums which didn't mention), fear infected current partner(they have had chronic cough (non smoker) , fatigue, skin/fungal infections this year, and difficulty getting appt with HIV Dr. Is there really no cases that you know of that has taken several tests to diagnose, even with chronic infection? My limited, distilled understanding of why hiv might not be picked up by tests (albeit rare) are: impaired humoral response - no antibody response mounted due to Immunodeficiency . Late stage hiv-seroreversion. Antibodies no longer detectable. HIV 2 patients nearly always have undetectable viral loads. And finally elite controllers. I'm sorry, I know you have answered this before, and I am throwing the kitchen sink at you. Hiv2 worries me, as uk like usa, only has 200-300 people with hiv2, usually West African origin or their partners, so limited specialist tests and expertise. The test the Dr said was of little use was the hiv1/2 pcr rna naat test. He said only relevant in early infection when viral load high. He didn't expand on this. Not sure how true this is.? Appreciate nigh on impossible to diagnose anything online, but what about other tests such as full blood count, or cd4/cd8 count. Would this flag anything? The only other tests mentioned to me were hiv1 proviral dna test, and separate hiv2 rna pcr test. I appreciate you may not answer this (understandably) as I have repeated myself again, in which case thanks for your time, advice and expertise, I appreciate it, and I will seek counselling if necessary.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
4 months ago
*Sigh*

I'm not the least offended by your questions.  Don't confuse frustration with offense. But I do find it amazing that after all the time and energy you have put into this, with obviously extensive online searching, you so poorly understand HIV infection and its diagnosis. Clearly you have been focusing, as anxious persons often do, on websites that inflame your fears, while missing information that should refute them. This just reinforces my central advice about the obvious conribution of underlying emotional or psychological issues and the importance of professional attention to them. As I have said previously, I suggest counseling out of compassion and professional experience, not criticism.

I've read these additional questions very carefully. They do not change my opinions or advice.

"Is there really no cases that you know of that has taken several tests to diagnose, even with chronic infection?" Yes, really.

"Late stage hiv-seroreversion. Antibodies no longer detectable." With the current tests, including the ones you had, these simply never occur. Even with the early antibody-only HIV tests, not used for over 20 years, late or delayed seroconversion was very rare. It has never happened with today's antibody tests. And if antibody somehow were not to develop, the antigen component of the AgAb (4th generation) tests, and the RNA/PCR tests, would be even more strongly positive than otherwise.

"The test the Dr said was of little use was the hiv1/2 pcr rna naat test. He said only relevant in early infection when viral load high." See my reply above. You misunderstood the doctor or he is misinformed.

"The test the Dr said was of little use was the hiv1/2 pcr rna naat test. He said only relevant in early infection when viral load high." Pointless in regard to HIV. This forum makes no comments on or diagnostic advice for conditions other than HIV and STDs, which you do not have.

"The only other tests mentioned to me were hiv1 proviral dna test, and separate hiv2 rna pcr test." I see no need to waste your money, time, or emotional resources on these or any other tests.

You have one final brief follow-up comment/question coming on this thread. Use it wisely:  I will not respond to any question that repeats what you've already asked, using different words.
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4 months ago
Thank you Dr for answering my questions. I appreciate how frustrating this must be for a man in your position, faced with repeated questions from some gripped by fear, armed only with 6 months intense Internet research. Unfortunately, once this belief gets hold...Its fair to say it has taken over my life somewhat. I take on board you mention counselling from compassion not critcism. It is just conflicting sometimes what you read and the advice given by some. Majority say no chance of infection with these tests, some say small chance. OK, my final question is that several weeks ago, I tested positive for coronavirus and was pretty ill for a week or so. The national blood service have been in  contact with me to donate plasma, I think to use antibodies I may have against covid-19? As a medical professional, would you feel happy, confident, relaxed in me donating blood with what I have outlined? No room for doubt? I know they would have rigerous checks for HIV in place anyway, but I  somehow feel reluctant, nervous about doing this just in case. I appreciate this may be hiv paranoia again. I will take on board all that you have said, and I am truly grateful for your time, patience, expertise and straight forward answers.Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
4 months ago
There are no scientifically valid experts or professional resources that would disagree with any of my opinions and advice. You are obviously being highly selective in the questions you are asking, the sources you select, and/or you are misunderstanding them.

I'm glad to hear you recovered from COVID-19, and I imagine you are correct about why they have invited you to donate blood. From an HIV standpoint -- not knowing what your risks might be for other bloodborne infections -- there is absolutely no reason for you not to donate blood. You're also correct your blood will be tested for HIV, using some of the tests you have already had.

That completes the two follow-up exchanges included with each question and so ends this thread. Please note that repeated anxiety driven questions on the same topic are against forum policy. This being your second, it must be your last on your fears about HIV, testing, etc. Excessive questions are deleted without reply and without refund of the posting fee. We have found that continued replies often simply prolong anxiety rather than resolving it, when professional counseling would be a better approach--for which I am convinced in your case. And ASHA is not keen on collecting fees when the answer is unchanged, obvious and predictable. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thank you for your understanding. I do hope the discussions have been helpful. Best wishes and stay safe.

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