“HIV tests can result in false negatives if they do not test for the correct subtype: for instance, subtype B is most common in Europe and that is usually what they test for when doing a PCR test. However the primers for B do not work with types A,C, or D. Subtype C is more prevalent in Asia, especially Thailand, so it could be something picked up when abroad, and that’s why the doctors are struggling to diagnose it. that doesn’t explain how the p24 test is negative, though. If it is actually HIV, there are a few things to know (these are currently being researched and I have done research on this directly): people infected with HIV fall into two general categories progressers (PR) and “elite” controllers (CO). PR act like typical HIV infected cases, their body cannot fight off the virus and they progress to AIDS. CO however can vary and their body is able to fight off the virus (keeping its viral count low) and are usually able to delay the progression to AIDS, without Treatment. Nevertheless, CO will still progress to AIDS without treatment. I have never heard of a CO being able to completely control the virus below the detection limit (50U/mL), but I can confirm from personal experience with samples, that if the viral count is two low, false negatives can be extremely common. Normally anything lower that 1000 U/mL can be tough to detect (speaking from my own experience). CO usually possess a mutation in their HLA that makes it difficult for HIV to enter the cell. This gives the immune system more time to clear the virus without having to deal with rampant viral production. Unfortunately this also puts a good deal of selective pressure on the virus. Envelope genes (and the protein) efrom CO are significantly (statistically speaking) different from those belonging to PR. Hypothetically speaking, if you were HIV+ and you are also belonging to this rare CO subgroup, it is possible that you are controlling the virus to make detection difficult, while slowly progressing towards AIDS. This would also explain why the PCR and p24 tests are negative, since the PCR Primers likely wouldn’t work well with a controller, and the viral load could be too low for the p24 test to detect the virus presence. This is assuming a lot, but as I have done research on this specifically, I can say that it is not impossible. If you were started on antiretrovirals and your lymphocyte counts normalized, this would confirm the hypothesis, but if I’m right, standard tests could be difficult to get an accurate result until the virus completely overwhelms your immune system.

Regarding your question about persisters and reservoirs in a long-standing infection, yes it is possible, although the reservoir has not been identified yet and could be the places you mentioned, or immune/lymphoid-rich paces like the illeum (ie: germinal Centers or Crypts of Lieberkühn). This is likely why CO eventually progress to AIDS, as even they are not able to effectively clear the reservoir.

The cell counts are obviously concerningly low, which is likely why you seem to get sick from everything and you seem to suffer from so many symptoms.”