[Question #8731] HIV Concern Follow-up
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40 months ago
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Hello Drs,
I asked a question last week about the risk of exposure I had back in February. Please let me know if you need me to include additional detail or if you’re able to refer to that question.
I wanted to follow up to confirm I went in for my follow up HIV (Gen 4) and syphilis blood tests yesterday. I am still awaiting results.
However, I wanted to mention that after my last post, I experienced significant pain in my groin on Saturday night which lasted (off and on) until overnight on Sunday. I had to take Advil on Sunday before bed due to the discomfort. No fever during this. The mild redness under both of my forearms has begun to appear more as flesh toned hives, spanning from close to my wrist down to near my elbow. Can this be seroconversion occurring? I began taking Benedryl today hoping it will help.
All in all, my symptoms have been over the course of about 10 days, not all occuring at the same time (please see previous post).
I still don’t have a fever.
I took a third Oraquick test on Sunday (day before my follow up visit yesterday) and that also came back negative.
I’m extremely anxious about all of this and any extra reassurance would be greatly appreciated.
Thank you.
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Edward W. Hook M.D.
40 months ago
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Welcome back to the form. Aaron I remember our interaction last week quite clearly. Could you please characterize the discomfort in your groin a bit more. Was there local tenderness? Had you been probing to feel for swollen lymph nodes? When you say that the discomfort came and went, can you tell me about the time intervals involved?
The absence of fever and sore throat make the possibility of the symptoms you are experiencing most unlikely to be the ARS. Did Russia describe on your forearms is not suggestive of the rash of the ARS either.
Overall, the atypical nature of the symptoms you describe as well as your recent negative repeat Oraquick test all make the possibility of this being an HIV seroconversion very unlikely. When you test tomorrow, if the results are negative, you could be 100% sure that your symptoms are not due to HIV.
It is clear from your posts that you are very anxious over the encounter which you have described. My overall assessment is that it was quite low risk for all of the reasons I described previously and the likelihood that you acquired HIV from the exposure is virtually zero. I believe that your continued testing will prove this. On the other hand, I also believe that you have a substantial amount of anxiety and perhaps guilt over the exposure you described and that this is causing you to focus on signs and symptoms which you might otherwise overlook. This is common amongst our clients who regret the steps. Please try not to worry. EWH
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40 months ago
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Thank you, Dr. Hook.
The pain in my groin was on the right side and appeared overnight on Saturday, waking me from sleep. It felt almost like a pulled muscle and the pain would come and go probably every several minutes during the night- this was without even touching it. Almost a throbbing sensation, but it wasn’t constant.
The next day, I felt the pain when moving around, and I did feel for swollen lymph nodes, it did seem like there was a couple of swollen ones on the right side and the muscle also felt swollen. So local tenderness, but the pain was tolerable.
When leaning over to stretch, it also felt tight, leading me to wonder if I had pulled something. The pain would return randomly during the day on Sunday, but it’s hard to say how constant it was. When I went to bed on Sunday night, lying down made it feel “sore”, almost achey.
Taking Advil helped after a few hours and it felt ok on Monday and since then. If it was a pulled muscle my thought was that it wouldn’t feel better so abruptly and soon?
I’ve never had hives before and rarely ever have had a rash. Having it persist on the underside of both forearms has been a concern. It’s odd because the intensity of the rash and hives seems to wax and wane. The fact that I’ve never experienced this sort of symptom has made me very uneasy and I’ve had a hard time not assuming it must have to do with my exposure.
If not, perhaps a delayed reaction to the PEP treatment?
I appreciate your patience and reassurance with this matter.
You are right that I feel very guilty. I am terrified that a single mistake may have ruined my life.
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Edward W. Hook M.D.
40 months ago
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Thanks for the additional information. Unfortunately it does not allow me to make additional suggestions other than those that I made in my original reply. I continue to anticipate that your test will be negative proving that this is not HIV. Please let us know your test results. EWH ---
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40 months ago
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Good Morning Dr. Hook,
Following up to let you know that my test results for the "HIV-1/HIV-2 Ag/Ab" (as well as my test for Syphilis) returned today as Negative (non-reactive). My clinician said they were going to send out for the "HIV Gen 4 test". However, although it says that on the chart for my initial visit, on the results it just reads as "HIV-1/HIV-2 Ag/Ab". With this negative result, you mentioned any symptoms I have been experiencing could not be due to HIV infection? Could the symptoms be too mild for a test to detect (or PEP may still be interfering)? As a numbers person, I wonder how much faith can be put into these results? This test was taken exactly 1 week since completion of PEP., and it has been 5 1/2 weeks since my exposure. I have a follow-up visit/test scheduled for May 23 as well, which will be 8 weeks post completion of PEP and just over 12 weeks after exposure.
The hives/redness under my forearms is still there, so I am having a difficult time knowing what to attribute that to, and there's a part of me that thinks it could still be tied to HIV infection. Again, maybe it's a delayed response to the Truvada/Isentress I was prescribed for PEP?
The clinic I have been seen at throughout this situation is closed today (I accessed my test results via the online patient portal). I've been taking Benadryl as advised since yesterday. Do you think I should make arrangements to see my Dr. or go to quick care if this doesn't clear in another day or so? (Again, I noticed the initial irritation/redness on Saturday and development of hives which seem to come and go since Monday).
I would like to post my next set of results on May 23, but I understand we reach a certain limit with these posts.
Apologies for the long reply. Thank you for your kindness and for all that you do.
Following up to let you know that my test results for the "HIV-1/HIV-2 Ag/Ab" (as well as my test for Syphilis) returned today as Negative (non-reactive). My clinician said they were going to send out for the "HIV Gen 4 test". However, although it says that on the chart for my initial visit, on the results it just reads as "HIV-1/HIV-2 Ag/Ab". With this negative result, you mentioned any symptoms I have been experiencing could not be due to HIV infection? Could the symptoms be too mild for a test to detect (or PEP may still be interfering)? As a numbers person, I wonder how much faith can be put into these results? This test was taken exactly 1 week since completion of PEP., and it has been 5 1/2 weeks since my exposure. I have a follow-up visit/test scheduled for May 23 as well, which will be 8 weeks post completion of PEP and just over 12 weeks after exposure.
The hives/redness under my forearms is still there, so I am having a difficult time knowing what to attribute that to, and there's a part of me that thinks it could still be tied to HIV infection. Again, maybe it's a delayed response to the Truvada/Isentress I was prescribed for PEP?
The clinic I have been seen at throughout this situation is closed today (I accessed my test results via the online patient portal). I've been taking Benadryl as advised since yesterday. Do you think I should make arrangements to see my Dr. or go to quick care if this doesn't clear in another day or so? (Again, I noticed the initial irritation/redness on Saturday and development of hives which seem to come and go since Monday).
I would like to post my next set of results on May 23, but I understand we reach a certain limit with these posts.
Apologies for the long reply. Thank you for your kindness and for all that you do.
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Edward W. Hook M.D.
40 months ago
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Thanks for sharing your test results. The negative test results you receive prove that your symptoms were/are not due to HIV (the symptoms of the ARS are due to antibody/antigen reactions). You can be sure of this. I see no reason to emergently see your doctor or any other health care professional at this time. RAther, try to keep your anxiety in check and wait for the testing window to close.
As you also know from my prior response, it is too early to be sure that you did not get HIV from the encounter you took PEP for. While PEP failures may show up at any point during or following completion of PEP, experts agree that your follow-up tests are not fully conclusive until six week after completion of PEP.
I will keep the thread open so that you can post your results but will not answer further questions. Should you post further question, the thread will be closed. EWH
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39 months ago
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Hello Dr. Hook,
Thank you for keeping this thread open and allowing me to reply with my test results.
I had my blood drawn this Monday, May 23rd, 8 weeks post completion of PEP. I received the results last night and they came back non-reactive for both HIV and Syphilis.
My question is, this time the test panel is showing as: Panel Description: HIV-1/HIV-2 Ag/Ab but the "component" is showing as "Syphilis/HIV 4 Combo - HIV 4" and before it showed as simply "HIV-1/HIV-2 Ag/Ab".
For my Syphilis result it is showing as: Panel Description: Syphilis and component as "Syphilis/HIV 4 Combo - Syphilis".
I tried to attach the photo showing my results this time around as compared to back on April 4 (not sure if it attached successfully). Will a lab run a combination syphilis and HIV gen 4 test, is this possible? Would you recommend I reach out to the lab for confirmation that it was truly an Ag/Ab HIV test? I am concerned it may have just been an Ab test.
How much faith should I place in these results?
I still have symptoms of intermittent sore joints and the redness/rash on the underside of my forearms waxes/wanes but has remained. My PCP sent out for an ESR a couple weeks ago which came back low (normal), Rheumatoid factor which came back low and an ANA which came back positive, 1:320 titer with dense fine speckled pattern. He said this could be a false positive, but am being referred to a Rheumatologist for follow up and more testing. My Dr. said this could ultimately be my continued reaction from the drug that will fade with time. Do you think this could have to do with any of the above, or perhaps how my body reacted to PEP treatment? I don't have a history of any rheumatic disease.
Thank you again for your help and reassurance with this. Your services are greatly appreciated, more than these words can express.
Thank you for keeping this thread open and allowing me to reply with my test results.
I had my blood drawn this Monday, May 23rd, 8 weeks post completion of PEP. I received the results last night and they came back non-reactive for both HIV and Syphilis.
My question is, this time the test panel is showing as: Panel Description: HIV-1/HIV-2 Ag/Ab but the "component" is showing as "Syphilis/HIV 4 Combo - HIV 4" and before it showed as simply "HIV-1/HIV-2 Ag/Ab".
For my Syphilis result it is showing as: Panel Description: Syphilis and component as "Syphilis/HIV 4 Combo - Syphilis".
I tried to attach the photo showing my results this time around as compared to back on April 4 (not sure if it attached successfully). Will a lab run a combination syphilis and HIV gen 4 test, is this possible? Would you recommend I reach out to the lab for confirmation that it was truly an Ag/Ab HIV test? I am concerned it may have just been an Ab test.
How much faith should I place in these results?
I still have symptoms of intermittent sore joints and the redness/rash on the underside of my forearms waxes/wanes but has remained. My PCP sent out for an ESR a couple weeks ago which came back low (normal), Rheumatoid factor which came back low and an ANA which came back positive, 1:320 titer with dense fine speckled pattern. He said this could be a false positive, but am being referred to a Rheumatologist for follow up and more testing. My Dr. said this could ultimately be my continued reaction from the drug that will fade with time. Do you think this could have to do with any of the above, or perhaps how my body reacted to PEP treatment? I don't have a history of any rheumatic disease.
Thank you again for your help and reassurance with this. Your services are greatly appreciated, more than these words can express.
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Edward W. Hook M.D.
39 months ago
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Thanks for returning to the Forum to share your results. On occasion laboratories "bundle" tests together. Perhaps the "Syphilis/HIV Combo" reflects this sort of bundling. I think it would be worthwhile to check with the lab or your doctor to find out just what was included in the test but suspect that this is confirmation that you did not acquire HIV from the exposure for which you took PEP. I'd be quite surprised if it was only an antigen test. I anticipate that this is conclusive (based on timing) that you did not acquire HIV
If you are going to check on what is in this test, I'd appreciate it if you'd share what you find. I'll leave the thread open for a few more days.
Appreciatively. EWH
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39 months ago
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Hello, Dr. Hook.
Thank you for keeping the thread open for me to report back.
I heard back from my clinician today and she confirmed the test they sent out for was in fact the HIV 1/2 AgAb test. Can I feel confident in my negative result at 8 weeks post PEP? Is the negative syphilis result also conclusive at 12 weeks post exposure?
(I meant to mention earlier that also had my regular Dr send out for HIV 1/2 AgAb around 4.5 weeks post PEP while I waited to see my clinician for this most recent test, and that was negative also).
For my ongoing forearm irritation and intermittent joint soreness, are there any STIs that could’ve been missed, or is this more likely due to some other process or prolonged reaction to PEP?
Thank you kindly, again!
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Edward W. Hook M.D.
39 months ago
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Thanks for the additional information. Both your HIV and syphilis results are entirely conclusive. No need for further testing.
I would not worry that your arm soreness is due to either an STI or Pep. If it gets worse or continues, I’d discuss it with your physician.
This completes this thread. Take care. EWH
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39 months ago
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Thank you, Dr.
I appreciate your patience throughout this ordeal and am extremely thankful for the reassurance you’ve provided along the way. It has been a long 3 months.
I unfortunately won’t get to see the Rheumatologist until August (earliest they could see me), and will hopefully get answers on my rash and overall joint soreness (if it persists until then).
Take care and God bless.