I know you have asked me to consult with an ID doctor about the CMV but there are none near me. 

I am still finding that, in European guidelines for testing, that co infection with CMV can extend the window period. Does the CDC mention anything about This? Are there any examples in literature? Have you ever seen a cmv coinfection before and did it extend the window period? is still terrifying me greatly as I have had the ARS symptoms three weeks after exposure, neurological symptoms, a rash , etc, and continue to have many symptoms now, most recently being oral thrush (confirmed by doctor) and cervical lymph nodes swelling (also confirmed by doctor) I am almost six months in from my exposure and horrified although I was negative at 14 weeks, I can’t shake the feeling. 

Despite these symptoms I am facing, should I consider a retest for hiv now that is nearly six months post exposure? 

Thank you so much. 

Welcome back. Unfortunately, I'm afraid this information doesn't modify my assessment.

Remember the evidence you don't have HIV:  your partner's negative HIV AgAb test 8 weeks after the sexual contact; and your own negative result at 14 weeks. There has never been a proved HIV infection with negative AgAb test results more than 6 weeks after acquiring the infection -- and in your situation, that would have had to happen twice. Any effect of CMV on all this (or HCV, which has been dismissed) is on HIV antibody production. But if HIV antibody (Ab in the AgAb test) didn't develop, antigen (Ag) still would be present -- in fact, perhaps in elevated amounts. (It's the antibody that clears antigen from the blood, which is why Ag or Ab is present, and thus the AgAb test positive, in all infected persons.)

As for your symptoms, they are entirely consistent with CMV -- more prolonged than the usual case of CMV mononucleosis, but that doesn't make ARS more likely. If anything, in general ARS symptoms clear up more rapidly than those of primary CMV infection. And there is great overlap in the symptoms of ARS and mononucleosis, whether due to CMV or EBV. There is nothing in your symptoms that favors ARS over CMV. If we could assemble the world's top 100 most experienced clinicians in ARS and/or CMV, none would be able to tell which you have without doing the lab tests.

One option to consider is to have a PCR test for HIV RNA (also called a viral load test). To my recollection, that hasn't been done -- but I might have missed it in scanning your previous thread. I suggest it not because I think it might be positive, but for reassurance -- another bit of evidence to help convince you.

Another idea -- which might be alarming, but I think you want and need an answer above all else -- might be evaluation for certain malignancies. Some hematologic cancers (particular kinds of lymphoma, for example) can cause widespread inflammatory symptoms, and also can be associated with CMV reactivation. (And some such diseases can be very effectively treated and often cured. This is way outside my expertise, but something to ask your doctors about, perhaps including consultation with an oncologist.)

Finally, I'll repeat my advice that you find a way to see an infectious diseases specialist, both to advise about CMV and help reassure you about HIV. I don't buy that none is available, unless you live in an exceedingly remote area. If you're within 100 miles of any metropolitan area, most likely there's an ID specialist. It definitely would be worth it in reassurance, convenience and (probably) cost. You could try contacting the Infectious Diseases Society of America to find an ID doc somewhere fairly nearby:  https://www.idsociety.org.

I do hope this helps. Let me know (again) if anything isn't clear.

HHH, MD

I’m sorry if I’m repeating myself, but So CMV does have some bearing on delaying seroconversion? I have been unable to find any cases of this online, and I remember you saying that there are none to your knowledge. 

An RNA PCR test probably won’t be covered my my insurance, and I’ve read they are quite expensive, would it suffice to do another 3rd Gen HIV 1/2 AB test at this point? What are my chances of it becoming positive with these negative results on hand? 

I will pursue seeing an ID doctor, I also wanted to ask, can covid interfere with antibody production? He told me he tested positive for covid shortly after seeing me. Could that have any bearing on antigen production as well? 

Thank you. 

I have already told you my estimate of the chance any HIV test ever will be positive:  zero. If I were in your position, I would seek no further HIV testing at all. But I can tell you that PCR is the gold standard test that all ID specialists recommend if there is any uncertainty at all about a diagnosis of HIV. So if YOU feel you need further confirmatory testing, I would advice the PCR test. I cannot imagine health insurance that would pay for HIV AgAb testing but not PCR. That sounds like nonsense to me.

There are NO medical conditions documented to affect the reliability of any of the standard HIV tests. None. Even immunosuppressive drugs have only theoretical effects that, even before Ag testing was added, had little or no real-world impact on HIV test reliability. Sorry, but I will ignore any and all further questions that ask about HIV test reliability or the certainty of your test results. It's a waste of time and energy. I understand seeking certainty, but that's not the same as repeatedly asking the same question in different words!

I have also had petechial rashes, a dry cough that comes and goes, dull pelvic pain, chest heaviness that comes and goes, fungal infections, and at one point I had nausea for a couple weeks, some light vomiting, and diarrhea. This was when I was taking ciproflaxin (when uti returned but is now gone) is this something you have seen with this particular antibiotic? My fear is that this was acute HCV, but as you said transmission is low amongst heterosexual sex. Just Wanted to get further reassurance. 

"If someone for sure has acute hiv,  and has repeated “reexposures” to the virus? would this slow their seroconversion? Or production of Ag and or Ab?"  Already answered; see my previous statements (two or three of them, I believe) that no medical conditions or drugs have any known effect on timing or reliability of the HIV blood tests?

I have never head the term "seroconversion sickness", but apparently it refers to symptoms that may accompany and immune response to many kinds of infection. ARS symptoms probably are partly but not entirely due to seroconversion (antibody development), but this is not a commonly used term in regard to HIV infection.

That concludes this thread. While I appreciate your thanks and your kind comments about the forum, this will have to be your last question on these issues. Repeated question on the same topic are not permitted, especially when anxiety driven -- and you can be sure there is no information, new symptoms, or other circumstances that would alter the advice you have already had. And such questions have limited educational value for other users, one of the forum's main goals. Excessive or repetitive questions are subject to deletion without reply, and without reimbursement of the posting fee. Thank you for your understanding. (And I really do hope the discussions have been helpful. If further concerns arise, I suggest you carefully re-read all your questions and replies in both threads. Probably the answers will be there.)

Best wishes and good luck.