After the negative result on the second Ag/Ab test, I ceased being anxious about HIV until - just today - I began developing cold-or-flu-like symptoms: Sore throat, aches, possibly a mild fever. If I were assessing myself from the outside (i.e., as a neutral third party observer), I'd think it very likely that this is either COVID or some cold, and highly unlikely that it's HIV. (After all, I spend my days at a university where semester just began; surely there's plenty of COVID and cold going around.) But, sadly, I'm not a neutral third party observer, and it was not even a week ago that I was in the headspace of thinking I probably had HIV, and so of course my mind leapt at the possibility that these new symptoms are due to HIV.

And then I started researching, and was surprised (and mortified) to discover that there's apparently such a thing as latent HIV infections. According to Chavez et al. 2015, "In most cases, integration of the viral genome leads to productive infection, in which viral genes are transcribed followed by virion production. However, in rare instances, latency occurs instead of productive infection and is characterized by a provirus that produces little-to-no viral transcripts." ("HIV Latency Is Established Directly and Early in Both Resting and Activated Primary CD4 T Cells: Introduction). (For a supporting article, see, e.g., https://hivinfo.nih.gov/understanding-hiv/fact-sheets/what-latent-hiv-reservoir.)

This came as a shock to me, as it seems to be in tension with what I was told (by the aforementioned MD this past Tuesday, after the second Ag/Ab results came in, as well as by some internet MD from the admittedly-academically-distant year of 2008 here: https://www.thebody.com/article/long-can-hiv-lay-dormant-body), viz., that HIV isn't the sort of thing that goes dormant after the point of infection. In other words, though you may go awhile without symptoms, if you aren't receiving effective treatment you will still have an active (and detectable) viral infection ongoing within you.

So - as you might've gathered by now - my brain put the following horror story together: Somehow, your first test was in fact accurate and your most recent negative Ag/Ab test was either false or else misleading. The absence of anti-bodies and the absence of detectable viral load is due to the fact that your infection started off by going latent, but has now (for whatever reason) become an active infection, thereby causing your new cold-or-flu-like symptoms. You should go get re-tested for viral load.

I'm reaching out in the hopes that you might help me gauge the plausibility of this horror story - and the sense (or lack thereof) of getting re-tested again - by (i) explaining what the deal is with latent HIV, and, perhaps, by (ii) helping me to see where I may be going wrong in my thinking about it. Particularly, I'm wondering: Is the existence of the phenomenon discussed in Chavez et. al (2015) actually in tension with what I was told by my MD and the internet MD I cite above? Maybe it isn't. The articles don't say that the entirety of a person's HIV infection might be latent, such that they show up as having no viral load at all; so far as I've read, they only say that, sometimes, some infected cells don't start churning out virus, which is obviously consistent with other infected cells churning out virus. In light of this, perhaps the scenario I'm afraid of - where a person has no detectable virus whatsoever, because the entirety of their HIV infection is latent - is outlandish. Either way, I'd love to know.

Thank you again for your help with this. All the best.