[Question #7672] Drs Hook & HHH HIV symptoms first year after possible infection

1 months ago
Dear Drs, thank you very much for your time. To put it in a nutshell: I (male) indulged in heterosexual risk behaviour in mid January 2020 (short vaginal penetration of Thai Sex worker in India. I had mild symptoms - no fever and throat  ache but rash - some  days afterwards. I slept with another woman and she had  very typical ARS symptoms a  few days later - strong fever, throat ache, extremely strong joint ache, all started in just one or two hours. she described  them as strong as never before in her life. I did Combo tests around 6 weeks (my conservative estimations say it was 41 days, my liberal estimations say it was  47 days - since i can't remember the exact date of risk behaviour. Test came back negative. All was fine  and  I  forgot about it. Then, during 2020 in Western Europe I developed several long-term symptoms that are still on-going: a dysbiosis of the gut flora, body fatigue, short breath, difficulty breathing, back and shoulder pain, and now infection of nose hair follicle (nasal furuncle). I read online that the latter is often caused by weak immune system caused by HIV as  are the others. I never had any of these  symptoms beforehand. I am going crazy again. What are the chances that my immune system was weak and therefore 4th  Gen test didn't pick up infection around 41 days? What are the chances that I have such symptoms after around 1  year since infection? Shall I test again? Thank you very much for your help!
1 months ago
So just to clarify, I particularly would like to know when the so called asymptomatic hiv period (after acute infection) could be over at the earliest. I have read that generally patients might not have any symptoms like I have been having since June/July 2020 but rather years later, generally 8-10 years. But some other experts mention that it can start already months after infection. Might such an early onset of chronic hiv be related to a weak immune system, as I might have?
One more question, if I may: if I had an extremely high viral load right after infection and I infected the other woman because of that, wouldn't the 4th gen tests I have done 2 weeks after intercourse with that woman definitely show the virus via antigen? If the combo test still didn't show any infection around 40 days, what was going on in my body then? Until then no high viral load? Even if these are extremely rare cases who get detected between 4 and 6 weeks, what do they have in common? Excluding pep treatment of course.. 
Edward W. Hook M.D.
Edward W. Hook M.D.
1 months ago
Welcome to our forum. Thanks for your question. I’ll be glad to comment. Before I get into specifics regarding your situation let me comment that it appears that in your efforts to use the Internet to sort out your symptoms and the potential for infection you have discovered one of the great weaknesses of the “information” found on the Internet - All too much of the information found there is wrong: it is either out of date, taken out of context, misinterpreted, or represents the all too common mythology surrounding HIV. What’s more, there is no way to sort out what is correct and what is not.

Let me first address your question of whether you have HIV and infected your partner who developed intense flu like symptoms shortly after your encounter. You are not infected!. Persons with negative  generation, combination HIV antigen/antibody tests cannot transmit HIv to other people.   Further once the HIV test becomes positive, it stays positive and will not become negative at any point in the future.

Secondly, let me comment on your symptoms. The symptoms you describe are not typical of HIV. One of the other problems with using the Internet for information is that most any symptom can all too readily be listed as potentially being a sign of HIV infection.  Furunculosis is not strongly associated with HIV, nor is fatigue, muscle and back aches, nor gut dybiosis.  While I am not in a position to comment on your immune system, I am confident that your test results taken between 41 and 47 days after your encounter would have been positive.  I will further point out that the antigen detection portion of 4th generation tests is totally independent of the immune response.

I hope these comments are helpful.  I am confident that you do not have HIV and that infection was not missed by your testing.  If that testing nearly a year ago was your only test, you may want to retest but I am confident that repeat testing will also be negative.  If any part of my reply is unclear, please use your up to two follow up questions for clarification. EWH 
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1 months ago
Thank you so much for your immediate reply. So to be sure, if I had infected the other woman, a 4th generation test taken afterwards, even if it was only 3 weeks after the original risk encounter, would have been positive? Meaning risk encounter day 0, infecting the other woman day 15, and 4th gen test at day 21. The test would have been 100% positive? 
Edward W. Hook M.D.
Edward W. Hook M.D.
1 months ago
Correct, as I said above persons with negative 4th generation tests virtually never transmit infection and as I understand it, your test was taken after your encounter with the partner who then went on to experience symptoms.  I should also point out that many other community acquired infections such as influenza and even COVID-19 cause similar flu-like symptoms.  When formally studied, over 99% of at risk persons seeking care for flu like symptoms have processes other than HIV.  EWH ---
1 months ago
Yes exactly. My fear of being infected started after I saw my partner having ars like symptoms some days after our intercourse. Then I started testing, my last 4th gen test being around 6 weeks after my initial risk exposure , coming out negative.

If you leave the question open for a few more hours I will get back with fresh and final test results. I'm at the urologist now. 

Thank you very much for your great help. I'll try to cool it with internet self diagnoses from now on. 
Edward W. Hook M.D.
Edward W. Hook M.D.
1 months ago
Thanks for offering to post your results.  I’m confident they will be negative and will keep the thread open so you can post your results.  Appreciatively EWH ---
1 months ago
Just a quick update. I will know about the test results next Tuesday. Then I will post them in this thread, if you agree. I'm trying to calm down in the meantime and try to focus on the negative results of the 4th gen test I have done after minimum 41 days. I really want to believe that this was a 100% reliable result. If you don't mind, could you please quickly share your expertise with regard to my question about the percentage of hiv infected people who suffer from tangible symptoms after ARS during the first year? I would be still interested in how often it occurs that an hiv infection messes up the body during the first year after infection. Thanks so much for your help and your great advice! I promise I will not ask anymore questions and will only post the results next Tuesday. 
1 months ago
I'm sorry but I forgot to ask one question for clarification. Why did you suggest that I may want to retest if the test I have done was the only one? I thought you stated that 4th gen tests at 6 weeks would be 100% conclusive? Sorry for not understanding your reply and asking only now. I can't think clearly right now. 
Edward W. Hook M.D.
Edward W. Hook M.D.
1 months ago
There are no precise answers to your questions regarding non- specific symptoms in the interval between the ARS and the onset of AIDS- defining opportunistic infections.  Because most person have aches, pains and “usual” infections like furunculosis or back pain, the period between the resolution of the ARS (always within 30 days of acquisition of infection) is considered asymptomatic without specific tell-tale symptoms.

I look forward to hearing about your results next week.  No additional questions please. EWH 
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