[Question #8199] HIV like Symptoms after PEP 8 Months

47 months ago

From Sri Lanka I had a girlfriend , my last exposure (unprotective) with her on 20th of December 2020. She had HSV 2. But she tested HIV antibody tests April this year and 4th generation test mid June and NEGATIVE. After that I had vaginal sex with commercial sex worker with condom (but oral sex done without condom) on 3rd January. After that, got PEP (very next day started due to fear even STD doctor told not to) and completed 24 days only as lots of side effects ( but cant remember name of PEP and I feel poor compliance). After that I took AstraZeneca 1st dose 6 days after completing PEP. Then, after 15days of stopping PEP (mid February) developed back pain and it increases while I was driving. Then, (after 1 and half months of stopping PEP) I developed urine infection (culture negative and chlamydia and Gonorrhea NAAT) alone with that on and off lower abdominal pain tingling sensation, itching of penis, frequent urination with urging, burning sensation when urination and painful defecation (proctitis may be).Also had burning of feet. Went to STD doctor and did all the tests HSV1 & 2, syphilis, TPHA and HIV. ALL negative except HSV 1 ( that is positive from 2006). STD doctor started Acyclovir as he thought this was due to HSV 1. End of March repeated all the tests including HIV , all Negative. Continued acyclovir for 3 weeks but symptoms remained. However developed headache from beginning of April on and off. Then, mid April developed skin itchiness without any rash ( after 2nd dose of AstraZeneca). Then from end of April I do HIV tests until now ( 8 months passed) all negative. All are 4th generation tests and did 2 weekly until now including 3 time HIV 1 real time PCR detection , 1 time HIV 2 real time PCR detection 1 time HIV 1 real time PCR and HIV 2 real time PCR viral load NOT DETECTION. But now I have submandibular lymph node enlargement with chronic sore throat ( continuously 3 months), back pain (continuously), fatigue, neck pain and frequent bowel opening (continuously). Can I stop worrying?

H. Hunter Handsfield, MD

47 months ago

Welcome to the forum. Thanks for your question and your confidence in our advice.

Some questions can be accurately answered based only the title of the question. That may be the case here. Before reading the body of your question, I will point out that the symptoms of HIV are nonspecific -- meaning they can result from many medical conditions other than HIV, and therefore do not point to HIV or any other particular condition as the cause. Stated another way, the vast majority of people with symptoms absolutely typical of acute HIV in fact do not have it. At the same time, the standard HIV blood tests are among the most accurate diagnostic tests ever developed, for any medical condition. A negative result done long enough after the last possible exposure (6 weeks for the standard AgAb [fourth generation] tests) is 100% proof against HIV, and that result overrules any and all symptoms someone may have. So unless there is a big surprise when I read the body of your question, I am confident you can relax and not worry about having HIV.

Now I have read the rest. Guess what? First, with your girlfriend's negative HIV test, for sure you were not exposed. Second, the sex worker event was also risk free: any single vaginal intercourse event with an HIV infected female has an average HIV transmission risk of 1 chance in 2,500 -- and that's without a condom, and only if that woman is infected. Third, oral sex is zero risk: there has never been a scientifically proved case of known HIV transmission mouth to penis. So it really made no sense for you to take PEP. Fourth, the COVID-19 vaccine made absolutely no difference in your risk for HIV or the validity of your test results. Finally, your negative HIV tests prove for sure you do not have HIV.

As for your symptoms, they do not suggest either HIV or herpes, and I don't understand why your doctor prescribed acyclovir. That your symptoms have continued despite that treatment is additional evidence that herpes isn't the cause either. In any case, even if your symptoms were highly suggestive of HIV, the test results -- as well as lack of risk for HIV in the first place -- are to be believed. If your symptoms continue and/or you remain concerned, keep working with your doctor about the cause. (However, I do suspect that many or most of them are psychological, i.e. your fears and anxieties magnifying minor symptoms or even normal body sensations that you would otherwise ignore or not even notice.)

In other words, the answer to your closing question is definitely yes: For sure you can stop worrying about HIV!

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

HHH, MD

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47 months ago

Thank you sir, as a health personal I know I have to trust the tests but symptoms like culture negative UTI, Back pain, Bowel upset, continuous light headedness, itching without rash, enlarge submandibular lymph nodes made me upset. Also Lymph nodes, back muscle pain, light headedness, bowel upset still there. Also, I heard combo tests kits not 100% reliable in countries like Sri Lanka (even I did all tests from our best labs) and HIV 1 subtypes and HIV 2 detection also still questionable in some countries (in term of window period). When I asked about HIV 2 from national STD center they tell no HIV 2 and HIV subtype cases not reported Sri Lanka. Even I tested 3 time monthly from National STD center, I am not believing their answer as may be hidden cases their. You are giving great service.

1. Is it all HIV tests’ reliabilities same around the world?

2. If symptoms related to HIV, could it detect from any of tests irrespective of type of virus?

3. Is there any chance not to detect HIV antibodies and P24 antigen due to any medical conditions (I have Vitamin D insufficiency and taken Vit D) and covid vaccine.

4. Is it possible to alter my results due to PEP ( Can window period go more than 6 months) ?

5. Can every tests equal and detect all the subtypes with HIV 2 even took PEP?

H. Hunter Handsfield, MD

47 months ago

1. Yes. While I am unaware of the situation in Sri Lanka, in general almost all labs worldwide use the same commercially produced HIV blood tests, and also the automated equipment to run the tests. The tests are more or less foolproof. Further, you had multiple tests: there is no chance that all of them gave falsely negative results.

2. Yes. There are no HIV types not detected with the standard tests.

3,4. No medical conditions or medications have any effect on reliability of the tests you had, with the sole exception of anti-HIV drugs, i.e following PEP. If PEP doesn't work, positive results may be delayed -- but only by 6 weeks. Your test results prove you don't have it. There is no such thing as such a long delayed window period. Among other things, it is not HIV itself that causes symptoms, but the immune response to the virus. It is impossible to have HIV symptoms with negative antibody tests. There are no exceptions.

5. Yes, the antibody component of your AgAb tests would have detected HIV2 if you had it.

In addition, you completely misunderstand the symptoms of HIV infection. Your symptoms are not highly suggestive of HIV. However, many or most of them are consistent with the physical manifestations of anxiety or stress.

Let's stop any furhter "yes but" or "could I be the exception" sorts of questions. There is nothing more that will think of that have any chance of changing my evaluation and advice. Do your best to move on without further worry about HIV.

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47 months ago

Thank you for your reply sir. Due to lots of problem I visited to one doctor and he analyzed my symptoms and did blood tests. Finally he said all normal and it could be HIV as it is a tricky virus that hide inside CD4 cells and create inflammatory response. Also T helper cells having problem to activate B cells. So antibodies in this case not formed. So he says if have symptoms I need to retest another 3 months time. I aske how rude this is because I already suffered a lot. Then he says there are cases HIV detected even after 2 years. 1.Is it possible in my case sir? 2. Other thing is I HIV élite controllers has problems to detect HIV. But for them HIV test negative but without symptoms isn't it? So If iam a elite controller my symptoms should be absent isnt it? 3. I have skin dryness, hedache which prominent in morning, Bowel problem, 2-4 time per day(bristol bowel scale type 6 and 7)and muscle pain. Why pcr hiv 1 & 2 not reliable in this case. (if virus causes all these matters ,virus could be detected isnt it?) Otherwise if those symptoms are due to inflammatory response , not the virus i understand that pcr hiv 1&2 not detect it. Sir I am a normal person I dont have any immunity issue. 4. Could all sort of thins happened in my body and not detect hiv antibodies even at 6 momths. 5. That doctor said P24 is not reliable when time passed. 6. Also I know fair amount of people suffer with symptoms but hiv negative even after 3 months and some at 6 months. I know One person diagnosed hiv at 9 th month and earlier tests negative. Is it possible in this world now sir? thank you very much.

47 months ago

Dear Sir I greatly appreciate your service as we have no access to such experts. My question is not repetitive and it is truly based on my experience. Please help me and answer me. Thank you. I know this is my last question.

H. Hunter Handsfield, MD

47 months ago

Sorry for the delayed response.

Your doctor is mistaken: with the AgAb tests, there has never been a reported case of HIV not giving positive test results any later than 6 weeks after exposure, except that positive results may be delayed when people take PEP that doesn't work. So your window for conclusive testing is 6 weeks (some experts say 3 months) after your last dose of PEP. Also, your doctor may misunderstand elite controllers. Such persons have normal diagnostic test results: elite control is about progression of immune deficiency, not accuracy of the standard tests.

Equally important, perhaps, is that even if your test results were not conclusive, they DO prove without doubt that HIV is not the cause of your symptoms. Symptoms of HIV are not due to the virus itself but the immune response to it. It is impossible to have symptoms caused by HIV and not have a positive antibody test.

Your doctor is correct that the p24 antigen component of the AgAb test usually becomes negative over time. But that is because antibody clears it from the blood. Therefore, when p24 antigen is gone, antibody is present. That's why the AgAb tests are so reliable. There has never been a reported case of someone with HIV after a few weeks who did not have a positive AgAb test. You can be 100% certain you do not have HIV. (In the 15 years of this and a preceding forum, with thousands of questions from people worried about HIV, not a single forum user has reported they ever tested positive. You're not going to be the first! If or when that happens, undoubtedly it will be following a real risk -- like unprotected sex with a known infected partner -- and not a low risk event like yours. Please do your best to accept and believe the reasoned, science based reassurance you have had and move on with no further worry about HIV.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful.

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