[Question #9038] HIV-2 - Question #8961 Question #8958 follow up -

36 months ago

Hi. I had Unprotected oral sex on a sex worker, protected vaginal sex but penis wasn't fully erect. – 2 weeks after, joint pain, feverish (couldn't test it) loss of appetite- lasts 2 weeks. At 7 weeks – a foot rash, joint pain, Nausea, mouth ulcers, night sweats, chills and feel fatigued (no fever, but feverish) – lasts 9 days. - From week 12 to week 13 (ongoing) I have hay fever, and I never get hay fever that lasts this long. Tests - Urine Gonorrhoea and Chlamydia at day 17 - neg Day 18 - Neg HIV-1 PCR test Day 32 - neg 4th gen hiv test Day 50 ish - negative oral swab for Gonorrhoea and Chlamydia Day 60 - neg Syphilis, Hep ABC, and 4th gen HIV-test Day 68 - neg 4th gen HIV test Day 80 - General blood test, Slightly small red blood cells, positive EBV Igg antibodies but not Igm. Day 82 - follow up test says no Iron deficiency. HIV 4th gen neg Day 90 - neg 4th gen HIV test NEG.

My concern’s that my first bout of symptoms are due to EBV reactivation by weakened immune system due to HIV (I got a really bad sore throat and tested negative for covid about 9 weeks after kissing a girl late last year) - makes sense as IGM wasn't detected. My second bout of symptoms were ARS. My Hay fever issue is due to the effect of HIV increasing IgE. HIV-2 (my only concern now) may take longer to produce detectable antibodies AND EBV weakens the immune system.

1. Is there anything wrong with my assumptions in my worse case scenario above - would ebv not be reactivated at 2 weeks post-infection, would HIV not affect hay fever this early, does ebv not effect antibody production, could ARS happen at 7 weeks i.e. does this whole story seem consistent with HIV infection. 2. Even IF all or some of my scenario doesn’t work with HIV, would the remaining things have resulted in a positive test by now anyway i.e. if HIV was, say, altering IgE, or if it was indeed ARS, my HIV-2 antibody would be positive 3. Regardless of all this, is my test conclusive for HIV-2?

H. Hunter Handsfield, MD

36 months ago

Welcome back, but I'm sorry you found it necessary.

Your negative antigen-antibody (AgAb, "4th generation") HIV blood tests prove 100% you do not have HIV, either HIV1 or HIV2. Negative test results overrule all else: any and all symptoms, not matter how typical for HIV they may seem to be; and exposure history, no matter how high the risk at the time of exposure. As Dr. Hook commented in your other threads, you are over-focused on details that do not matter. For example, anemia and iron deficiency are irrelevant in judging whether or not someone has HIV, and the test results overrule all other lab tests anyway. Finally, there are no medical conditions, medications, or other health issues that have any effect on the reliability of HIV tests: none at all, no exceptions. (If you think you have found comments online or elsewhere that contradict this notion, feel free to let me know. I can assure that they are wrong or you have misinterpreted what you found, but will be happy to explain.) Based on your symptoms, I suppose it is possible you had an acute EBV infection, or perhaps CMV or other similar virus. But if so, it has had no effect on judging your HIV test results. It is 100% certain you do not have HIV.

To your specific questions:

1. Yes, your assumptions are mistaken, as described above. EBV does not delay positive HIV AgAb test results; neither do any other infections.

2,3. You're looking at things in too much detail. IgE antibody responses are meaningless in regard to interpreting HIV test results. If you had HIV2, the antibody component of your AgAb tests would have been positive. (And anyway, HIV2 remains extremely rare in the US, still under 500 total cases in all the years of the HIV epidemic, mostly in people who acquired the infection in Africa and their regular sex partners (e.g. spouses).

Do your best to stop obsessing about all this. See a doctor if you continue to have symptoms that concern you.

HHH, MD

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36 months ago

Thanks for the the reply doctor.

You say negative test results overrule any symptoms no matter how typical. I get that but if possible I’d just like to explore my symptoms a bit, with the understanding that the tests overrule them anyway, as that can help me let go.

To recap -

My first ARS like illness was two weeks after the event. It was joint pain, a feverish feeling with fatigue, and loss of appetite.

My second was 7 weeks after and started with a rash, felt feverish and tired but no fever (if anything my temp was low), joint pain, and nausea. All came together and went together.

I highly doubt this was ACUTE mono/ebv as I didn’t kiss the sex worker but I did kiss a girl October LAST YEAR and came down with the worse sore throat I ever had 9 weeks after that and a negative COVID test. I had a general blood test through the NHS at 80 days and they found I had EBV antibodies but not IGM, only IGG. Also it can’t be CMV as the blood test would’ve found it. I look at all this and my pattern of symptoms and find it hard to believe that it wasn’t HIV that’s reactivated EBV causing the first symptoms, and the second set of symptoms was acute HIV ARS itself.

Then I have my current congestion and general hay fever symptoms since week 12 and i connect that to HIV as well which I understand correlates to more allergies and IgE antibodies.

(For the record I DON’T have an iron deficiency after a follow up test so that’s not part of my concerns anymore)

I know all these symptoms are non-specific but I’m a healthy 20 year old and all these changes to my health are hard to ignore and HIV seems to match up well. So, with the test overruling everything in mind, could you please tell me how typical each of these things are for HIV as the info is confusing online

My initial set of symptoms- could HIV cause a reactivation of EBV 2 week after exposure?
Could HIV effect stuff like Hay fever in a noticeable way within 3 months of exposure, and only a month or so after ARS?
IF both of these things above are possible, could HIV cause these effects WITHOUT a detectable antibody response? i.e if IgE is in higher levels then so would HIV IGM etc.
To add on to 3 really, my general blood test at 80 days indicated a normal immune system according to my doctor. So even IF the answer to questions 1 and/or 2 is YES and 3 is NO, it doesn’t matter because IF my immune system was weakened to HIV at 2 weeks, re-triggering EBV, the recovery of my immune system from week 2 to my test at 80 days would be caused by a detectable level of antibodies.
The reason I worry about HIV-2 is because the girl was from Venuzeula, and may work in Spain as well. Further I am from the UK, where it is rare but less so than the US, and the place I met her is one of, if not the, most deprived neighbourhood in the country, with a lot of people of West African heritage - in other words if there’s any HIV-2 in the UK, I’d imagine it’s concentrated in areas like that. With that in mind I’ve looked at this old Medhelp article in which you commented https://www.medhelp.org/posts/HIV-Prevention/HIV-2-seroconversion-period/show/1803834

Essentially, I look at the fact that HIV-2 antibodies weren’t detected at 6 months in those women, you saying a later window period is possible, and EBV delaying HIV antibodies (I didn’t read it anywhere, I just saw that EBV can weaken the immune system, and concluded myself that therefore it could weaken the response to HIV). I look at all that and think - maybe 90 days isn’t enough for HIV-2 to develop antibodies conclusively. So I guess my question is - Even IF there’s some validity to the idea that HIV-2 being less virulent would delay antibodies, sometimes over 6 months, that wouldn’t apply if someone experienced ARS and/or worsened hay fever so soon/reactivated EBV?

Sorry to bring up your words from nearly a decade ago!

H. Hunter Handsfield, MD

36 months ago

I'm sorry, but as I said, the test results overrule any and all symptoms. Therefore, I see no need to take the time and energy to address all this. The fact is that your tests prove you do not have HIV. All you're doing is asking "yes but", "what if" and "could I be the exception" sorts of questions. The answers would make no difference in the overall assessment you have both here and in your previous threads. Accept our advice or not, believe it or not, I don't care -- but this isn't a debate and I see no need to justify and rejustify any of the advice you have had. You do not have HIV, either type 1 or 2. I also disagree with your conclusion of a high risk of HIV2 on account of your partner's origin and HIV2 epidemiology in Venezuela or the UK. Finally, I see nothing in my comments on MedHelp that have any bearing on your chance of having HIV of either type.---
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36 months ago

Thanks for the reply. I admit the HIV-2 window period questions are very what if but I think a lot of the other stuff is actually just me trying to get some optimism- i.e the few who don’t have detectable antibodies wouldn’t included those with ARS etc. I appreciate that the line of questioning is quite excessive but I just wanted to cover all bases. But maybe you could answer a streamlined set of questions

What is the HIV-2 window period? Have you ever seen it longer than 90 days?
Would the few that don’t develop detectable antibodies not include those with an ARS like illness as that would indicate an immune response that wood he detectable at the latest by 90 days?
Given that you said you’d be willing to explain, why am I wrong and in saying that EBV can delay antibody production even though it can weaken the immune system? Is it because it weakens it within a normal range and thus the normal window period, which accounts for all normal range immune responses, accounts for things of this nature anyway?
Would you recommend a PCR test or can I move on and resume my sex life?

Finally, I’m sorry if I come across as argumentative or not accepting of yours or Dr Hook’s advice. I just have a lot of stuff in my head and no one who’s knowledgeable to talk to about it in real life, so I wouldn’t forgive myself if I didn’t ask everything.

Finally, something off topic, but when doing all my research I came across Annie Luetkemeyer. I was wondering if you know her personally as her sister is Julie Bowen, who is an actress on one of my favorite shows, Modern Family. Just something I found comforting when worrying for the past 3 months.

Regardless, thank you and Dr Hook for helping me and helping everyone here and in real life. You’re real heroes.

5. Just to check again, I have to, I conclusively don’t have HIV of any type, or any other STD I tested for (I tested for Syphilis, and Hep C and B at 90 days too, negative of course)?

H. Hunter Handsfield, MD

36 months ago

1. Eight weeks for the AgAb tests and the 3rd generation standalone antibody tests.

2. It is the immune response to HIV, not the virus itself, that causes ARS symptoms. Of course it possible to have "ARS like" symptoms with negative HIV test results, but that's because those symptoms are not caused by HIV. It isn't possible to have actual ARS symptoms with a negative HIV AgAb test. It has never happened. (The opposite occurs all the time, however: positive test with no symptoms at all.)

3. Not all immune deficiencies have any effect on antibody response and detection in response to infection. Most have no such effect. There simply have never been any proved medical conditions or medications that have any consistent effect on timing or reliability of the current (3rd gen, 4th gen) HIV blood tests. (The only exception is when PEP is take to prevent HIV and doesn't work. In that case, the testing window begins when PEP drugs are completed, not at the time of exposure.)

4. It is already certain you do not have HIV; no more testing is needed.

5. Correct.

That concludes this thread. This being your third question long these lines, it also must be your last. Repeated questions on the same topic are not permitted, especially when obviously anxiety driven, and are subject to being deleted without reply and without refund of the posting fee. ASHA is not keen on continuing to collect fees on repeated questions with unchanged answers; continued replies tend to prolong anxiety rather than relieving it (there's always a "yes but" or "could I be the exception" sort of thinking); and such questions have little educational value for other users, one of the forum's main goals. Thank you for your understanding. I do hope the discussions have been helpful.

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H. Hunter Handsfield, MD

36 months ago

Note corrected typo: No. 2, sentence 2 now correctly reads "Of course it is possible to have..." (not "impossible"). Sorry if there was any initial confusion.---