Hi Dr's, My ex partner is a 45 YO female, she spooked me a few weeks ago when she said she had undergone tests for Gyno issues, but did not have a HIV test. 

 She has a child who is 5, so I assume she would have been tested (As per NHS guidelines) back in 2016. Since her son and before me, I assume 2 - 3 partners.

We last has sex on 08/21, following a brief 4 month relationship, where we had unprotected vaginal intercourse probably 20 times.

Although symptoms do not diagnose HIV, below are what I experienced:

8 Days post last sex - sore throat and very fatigued

10 days post - sex saw GP, advised I had Tonsillitis & potential chest infection, given Pred 40ml for 5 days and Antibiotics, CRP was elevated to 31, and WBC to 11

14 days post sex - extremely painful shoulder muscles for 5 days

I managed to get a test today, it was only an 'Insti' Antibody test, not Antigen element, it was negative on day 25. 

My ex has said to me that around 11 years ago when she worked abroad, she had seen people inject drugs, yet faithfully told me she never was involved in this, and I have no reason to not believe her.

12 years ago I went through hell with HIV testing, it went on for 15 months until I eventually believed my results.  

I am not in that place any longer, but hope you can assist with the below questions:

1 - Should the symptoms above be of any concern for potential HIV infection?

2 - Is my negative Insti test on day 25 a reasonable indicator that the above symptoms were not ARS?

3 - Given my ex was likely tested 5 years ago when she had her child, and I assume a limited number of partners, do you feel I am worrying unnecessarily?

4 - If I were to seek further tests, would an RNA and a POC 4th Gen Combi on day 26/7 be conclusive?

Thank you Dr's, appreciate your insight.

1.  No, while sore throat and muscle aches are both symptoms of recently acquired HIV, when they are due to HIV they are typically accompanied by high fever and occur simultaneously. The fact that your symptoms occurred several days apart make it most unlikely that they were due to HIV.

2.  Yes. The symptoms of recently acquired HIV infection including, as I mentioned above, sore throat, high fever, and muscle aches, are due to the interaction of the HIV virus and antibodies being formed to the virus. As a result, when symptoms are due to HIV fourth generation HIV tests are virtually always positive and antibody tests taken more than two or three days following the onset of symptoms likewise rule out the possibility of HIV if they are negative. FYI, in careful scientific studies, less than one percent of ar risk persons seeking medical care for recently acquired flu like symptoms of the sort you report are due to HIV.

3.  Please see my comments above. This is an encounter I really would not be worried about.

4.  If you choose to seek further testing a fourth generation, combination HIV antigen/antibody test at any time would add further proof that your symptoms were not due to HIV. In addition, a fourth generation test taken anytime more than six weeks following your encounter would absolutely rule out the possibility of HIV infection. I can see no benefit to taking an HIVRNAPCR test.

 I hope the information I provided is helpful to you. Please don’t worry. EWH

Thank you for your very clear reply.

I forgot to add into the 1st part that my temperature did get to 100.6 and over that week, I did also have light night sweats.

A couple of further questions if I may:

1 - if my sore throat (Tonsillitis) had been due to ARS, the Insti test would have conclusively been positive as it was 16 days post the first symptom, even in light of the 5 days of Pred at 40mg per day?

2 - As a standalone POC AB test at 24 days, is it fair to say that this would pick up c80% of new infections?   

3 - other than for my peace of mind, would you suggest clinically a need to re-test?

I am of course basing this on our last sexual contact, so there is all of the exposures before which would, I guess, have been picked up as they go back to 38 days.

Finally, is it still the case that you and your colleagues / known experts, have never seen a 4th gen test (which I did not have) turn positive after 28 days?

Thank you, Dr 

1.  Correct

2.  Yes

3.  Retesting  With a fourth generation combination HIV antigen/antibody test at six weeks is still recommended. Not everyone who requires HIV develops the ARS. Results at that time would be entirely conclusive, even having taking prednisone.

Yes it is still the case that we have not seen a patient who developed a positive fourth generation test in the interval between four and six weeks following exposure.

EWH 

Thank you for your answer below.

Today, day 43, I took a 4th Gen POC test at a clinic who drew blood from my arm, it was negative. 

It was definitely a 4th Generation POINT OF CARE test, can I take this result as conclusive  without the need for further testing?

Does the 5 day course of Prednisolone make no difference to the above result?

Any context you can provide Dr would be appreciated.

Thank you for your help.

As you know, we provide up to three responses to each client's questions.  This is my 3rd response.  Therefore this thread will now be closed without further responses.  Be confident that you do not have HIV.  EWH

I really appreciate your clear and precise reply.

All the best.