[Question #7545] Query about hiv symptoms and testing

3 months ago
Dears Dr's,
Thank you for your help and support, Really I need your opinion about my symptoms and testing. I had 2 exposure one on 11/10/20 which I had protected vaginal sex and unprotected oral sex. And second one on 24/10/2020 and it was unprotected oral only with matual maturation. Both exposure I received the oral sex from 2 women I do not know them before and they are not sex workers. I just met them that day.I regret what I have done a lot and was very worried about Hiv, So I decided to do pcr test and 4th Gen test on 17/11/20 after 24 days of the last exposure and both came back negative. On 20/11/2020 I started to have swollen tonsil only on my left tonsil and little pain in my neck at left side from lymph node. Dr asked me to take antibiotic and prednisone I took the antibiotic for one day then I started to have something strange in my mouth my lips top and lower were very sensitive to a limit that my teeth started to make marks on my lips no local cancer sores or ulcers. I took the antibiotic for 5 days but no improvement then I stopped as per my Dr instruction as he told me may be what happened to your mouth is from the antibiotic. The swollen tonsil and sore throat (only left side also) did not improve with antibiotic but after like 10 days the symptoms disappeared but only the little pain in my neck remained for 3 weeks then disappeared. That time I was thinking a lot about hiv as I was afraid that this is acute phase symptoms. I visited infectologist and explain the situation then he told me you did pcr and 4th Gen  test 24 days after exposure and the risk was low so forget and move on(tests were done 3 days before the sore throat started) but I could not calm dow by reading the articles from the internet. On 28-12-2020 I did hiv 4th Gen test, hep A, B, C,syphilis and cbc test all tests are negative but what made me very worried is the cbc test. My normal wbc in my test always will be low between 3500 and 4000 but this time my wbc was 2700 with 1134 neutrophil, 1215 lymphocytes and 54 atypical lymphocytes. I was very worried by this result and I heard that hiv causes leukopenia in acute phase then I repeat the test next days, on 29-12-2020 09:30 am wbc 2300,neutrophils 786, lymphocytes 1076 it become less more then same day went to hospital there was only a general Dr available he repeat the cbc test again at evening and the result was wbc 3700,neutrophils 2172,lymphocytes 1106.then next day 30-12-2020 morning wbc 2600 neutrophil 1378,lymphocytes 780 range for this lab from 720 to 5040,atypicall lymphocytes 52. Same day I observed a lump under my left arm, no other symptoms, except little tension in my neck muscle I was terrified as the lumb was like a grap size but painless. Next day morning 31-12-2020 I went to do hiv pcr , 4th Gen test(67 days after last exposure) both came back negative. I did also cbc test, wbc 2800, neutrophils 1204,lymphocytes 1064. Again on 05-01-2020 after 72 days from last exposure I did hiv 4th Gen and came back negative test and cbc, wbc 3340, neutrophil 1510,lymphocytes 1299.

Regarding the lymph node I found on 30/12/2020 next day it was checked visually by a general Dr and he told me it is lymph node but when he pressed I observe a little liquid come from a little hole in skin when I went home I checked again and squez it little bit pus came out and after that it became very small still there but very small. So to summerize my symptoms I had a lymph nod under my left arm which became small after the liquid came out but still there, right armpit when I check it I feel pain in one point but cannot feel a swollen lymph node, feeling pain some times specially at night in inguinal lymph node (I can feel the nodes as I am a skinny person but cannot confirm it is swollen or not) some times right and left. loss of appetite ( I do not know it is real or from the extreme anxiety I live with). changes in my wbc counts. NO fever and no fatigue. These symptoms started after 2 weeks from the full recovery of my throat. 

Test summary
Last exposure on 24-10-2020
17-11-2020 PCR AND 4TH GEN TEST(24 days after exposure) 
08-12-2020 4TH GEN TEST
28-12-2020 4TH GEN TEST
05-01-2020 4 GEN TEST (72 DAYS after exposure) 

I understand that testing will be positive after some days from symptoms so my tests is done after enough time from sore throat. But for the lymph nodes symptoms underarm I did the pcr test after one day from observing it this time will be enough to exclude that the lymph node not because hiv? 

I consulted an infectologist by telephone explaining the symptoms and the test results he asked me to test for EBV, CMV and toxoplasmosis. 

So Dr what's your opinion about what I have explained? 
Are my test result for hiv conclusive or I need to do further testing? 

I read that if some one was infected by very less quantity of virus it can take more time to replicate to be above the Pcr testing limit (my test limit was 40 cp/ml) is that true? 

As I mentioned always I have little bit less than normal wbc (my normal always between 3500 and 4000) does that mean I have weak immune system and I take more time to produce antibodies? 
I had an exposure in 06-06-2020whic a condome broke and I started PEP in same day till 06-07-2020.Can this PEP course affect my result of my current tests Pcr and 4th Gen , for the last exposure? 

This leukopenia made me very worried as it comes with the lymph nodes symptoms this made me very anxious and cannot sleep or do my work. I am under extreme stress trying to find out is that acute phase of hiv.
I am a 34 years old, straight male
Sorry for long explanation and thanks for your time. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Welcome to the forum. Your question greatly exceeds the limit of 1500 characters; you must have written it in another program and pasted it -- otherwise it would have cut you off about half way through all this. But I'm answering anyway, because the key information is covered with your summary of test results.

The doctor you saw was right:  your negative PCR plus negative AgAb (4th generation) test 24 days after your last possible exposure was conclusive and proved you didn't catch HIV. All by themselves, i.e. without PCR, the AgAb tests are conclusive after 6 weeks, so your later tests confirmed with 100% certainty that you do not have HIV. These tests are among the most accurate diagnostic tests ever developed, for any medical condition, and the results overrule all other considerations:  no matter how high risk at the time of exposure, and no matter how typical someons's symptoms might be for a new HIV infection, the test result tells the truth. The same is true for any and all other lab results:  your WBC and other lab test results are irrelevant. Your slightly low WBC count does not indicate a health problem. Further, no antibiotics or other medications have any effect on the reliability or timing of reliable results on the HIV tests you had. PEP can delay a positve result, but only when taken after the exposure in question; your prior PEP several months earlier has no effect. I'll also point out that you had a very low risk exposure for HIV, and your symptoms are not highly suggestive of a new HIV infection. But even if they were, the test result proves that HIV isn't the cause.

So my advice is to stop worrying about HIV:  you don't have it. If you remain concerned about symptoms, your WBC count, or anything else, keep working with your doctors.

My final thought is that you seem very overwrought about all this, way beyond what is appropriate based on your exposure, symptoms, and everything else. Do your best to accept the reasoned, science based reassurance you have had, both from the infectious diseases specialist you saw, perhaps other doctors, and now this forum. If you continue to worry and have trouble accepting these truths, professional counseling may be in order. I suggest it from compassion, not criticism.

I hope these comments are helpful. Let me know if anything isn't clear.