[Question #888] Hep C, HIV worry

51 months ago
Dear doctor,

Just over 9 weeks ago, 66 days to be exacted I had protected oral and vaginal sex with a csw in Prague who I believe was of African origin. The condom remained intact for the duration and the csw finished me off with her hand with the condom still on. 8 weeks after the exposure I received news of abnormal liver function tests which caused me great anxiety of hepititus. They have remained abnormal on a retest. I also experienced symptoms starting that week of some night sweats, only badly once, although I did not feel hot during the day, and a mild reddening of my neck and a small part of my upper chest that lasted maybe 4-5 days. I never had a sore throat. I have since had some white coating on my tongue about 9.5 weeks. I did feel very anxious after the liver tests which I received at the point I started to get the symptoms. I had a negative 4th gen lab duo test after 31 days, and a 4th gen alere rapid duo test at 9 weeks, also negative. I also tested negative for hep b and c at 4 weeks on a lab test and 9 weeks rapid test. My questions are:
1. Is there a risk of hiv-2 due to the African origin of the CSW, and do you think this could give ARS symptoms at 9 weeks? 
2. Do you think my  symptoms could be ARS after 9 weeks? Do you think my intense anxiety could cause these symptoms?
3. If I have hep c could this have delayed seroconversion? 
4. Have you experienced cases of positive HIV and or Hep c when a condom has been used and remained intact like this as there are virtually no instances on the Internet?

Many thanks! 

Edward W. Hook M.D.
Edward W. Hook M.D.
51 months ago

Welcome to our Forum.  I'll be glad to comment but to really evaluate what sounds like it could be hepatitis, it would be best to see your doctor.  He/she may need to see you several times to give you the information you need.  Hepatitis is a term for inflammation of the liver and is detected by abnormal liver function tests. Hepatitis may be caused by many, many things including viruses, toxins (like alcohol, prescription drugs or any number of chemicals) and even obesity.  Hepatitis is acquired in lots of ways other than sex including by eating contaminated food.Your negative HIV test provides definitive evidence that you do not have HIV and your negative tests for hepatitis B and C are strong but not quite definitive evidence that your hepatitis is not due to these viruses.  As o said above, I would suggest that you work with your doctor to evaluate to he cause of your illness further.  As for your specific questions:

1. Is there a risk of hiv-2 due to the African origin of the CSW, and do you think this could give ARS symptoms at 9 weeks? 
HIV-2 is quite rare, even in West Africa where it has been described.  Further, if your illness were due to HIV-2 your HIV tests would have detected it.

2. Do you think my  symptoms could be ARS after 9 weeks? Do you think my intense anxiety could cause these symptoms?
Nine weeks is too late for the onset of ARS.   Hepatitis can cause fever.  Your other symptoms (tongue, skin redness are non-specific but do not suggest HIV).

3. If I have hep c could this have delayed seroconversion? 
See above.  Unlikely.  further, the exposures you describe are not risky for hepatitis C.  Sexual transmission of hepatitis C is quite rare and when it occurs it is usually the result  of receptive rectal intercourse. 

4. Have you experienced cases of positive HIV and or Hep c when a condom has been used and remained intact like this as there are virtually no instances on the Internet.
I have not seen or heard of such cases.   While I am pleased to hear that you did not find reports of this on the internet, I would urge you to stay off the internet- you are more likely to be mis-directed or mis-informed from the internet than to get correct information.

I hope these comments are helpful.  EWH
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51 months ago
Doctor thanks for your quick response. I am currently going through the process with my doctor to investigate the liver tests.
So to follow up on your responses....

Even if I was exposed to HIV-2, you think the antibodies would of been detected at either 4 or 9 week tests? As I know the antigen element of the duo doesn't apply to HIV-2. 

If what I experienced in week 8-9 following exposure did turn out to be seroconversion, how long following this do you think antibodies could be detected by a 3rd gen test? Or do you believe that 8-9 week ARS could not happen and that there is no need to retest?

In your experience, do you see a lot of people with very "classic " ARS symptoms that turn out to be negative? Do you believe that anxiety can present a lot of the symptoms?

Again thanks for your help!

Edward W. Hook M.D.
Edward W. Hook M.D.
51 months ago

Yes, you would have had antibodies to HIV-2 by 9 weeks.  suggesting that you are having the ARS at 8-9 weeks simply is not something that we have seen clinically and it makes know scientific sense when one considers the replication rate of the virus in infected persons. 

Most people with "classic ARS" do not have HIV but have some other viral illness, including influenza.  This is true not only in my own experience but, more importantly, it carefully conducted scientific studies. 

Anxiety often leads to persons noting "symptoms" that are normally present but go undetected and are noticed because of heightened, anxiety-related awareness.  EWH

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51 months ago
Hello doctor,

I received my liver function re-test results back, and my ALT is normal which rules out an acute hepatitis infection. While this is a relief, it now means I cannot attribute any symptoms to this. 

I am hoping that the onset of night sweats correlates to the anxiety I started to feel when I thought I may have hepititis after my initial liver test. I haven't slept since without worry, do you think this would cause night sweats? I haven't recalled feeling hot during any day like I would assume a fever would cause.

Other symptoms I had are:

An eczema like rash on my collar bone and neck which has cleared after around 5 days, a white tongue with enlarged circumvallate papillae, a loss of appetite and upset stomach (coincided with anxiety over discovering liver test results). 

Still no sore throat, sickness, aches or tiredness or any swollen glands or lymphnodes. 

While I am planning to do another duo test at some point, I have a few final questions:

1. Now hepititis cannot be an explanation, do you think these things sounds like potential ARS? Why do you feel it is implausible to have ARS at 8-9 weeks? Perhaps HIV-2 can onset later?
2. How many times in your career have you seen negative tests at 9 weeks turn positive? As I feel it is going to happen due to no explanation for symptoms...
3. If I was experiencing ARS since a week ago, how soon after would antibodies be detectable? So I can do a definitive test to determine if it was?
4. Do you think a CSW from Africa is highly likely to be hiv+? 

Thanks for helping out, I guess I'm just looking for a final opinion as I'm still In disbelief that I could of caught HIV after using an intact condom, although can't think of an explanation for the symptoms....

Edward W. Hook M.D.
Edward W. Hook M.D.
51 months ago

In my opinion, you are trying entirely too hard to attribute your current symptoms to the exposure you described which occurred over two months ago.  it is time for you to move forward and put your anxiety and guilt aside.  As for your questions:

1. Now hepititis cannot be an explanation, do you think these things sounds like potential ARS? Why do you feel it is implausible to have ARS at 8-9 weeks? Perhaps HIV-2 can onset later?
Once again, this is NOT ARS. ARS occurs when persons have antibodies being produced which interact with circulating virus.  All ARS occurs within a few weeks of exposure and virtually all patients have antibodies long before now. 

2. How many times in your career have you seen negative tests at 9 weeks turn positive? As I feel it is going to happen due to no explanation for symptoms...
NEVER

3. If I was experiencing ARS since a week ago, how soon after would antibodies be detectable? So I can do a definitive test to determine if it was?
You were not experiencing ARS a week ago.  Antibody tests are all positive within 8 weeks of exposure and usually by 6.  HIV-2 does NOT have later onset.

4. Do you think a CSW from Africa is highly likely to be hiv+?
You said in your initial post that you did not know that your CSW partner was from Africa but that she might be.  Even if she were, most CSW in Africa do not have HIV- even in Africa and HIV is still less common in African CSWs who move to Europe.


This is my third and therefore final response to your questions.  In closing I URGE you to realize that you did not get HIV from your virtually no ask exposure over two months ago.  If you cannot accept this, rather than searching the internet, ordering more unneeded tests or worrying, I would suggest that you speak with a mental health professional or counselor who can help you address your unjustified concerns.  I say this out of concern for you, nothing more.  EWH


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