[Question #9305] Negative Tests and Many Symptoms

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34 months ago
Hello Drs., I am having ongoing anxiety about an encounter that happened nearly 6 months ago. I am male and had insertive vaginal sex with two women of unknown status who could be considered high risk. The condoms were quickly applied and may have not been applied properly. I started PEP around the 44 hour mark and took it as directed for 28 days. Since then I have had many symptoms, which began around the one week mark. Some have subsided, some are ongoing, including: joint pain mostly in the legs, muscle tightness in calves and triceps, nausea in the stomach, dry cough, several mouth sores, diarrhea and migraines (relatively new,) red bumps on right arm and scalp (ongoing), and strange pen-tip sized white bumps on my the sides of my fingers and hands (ongoing.) These bumps are painless but don't seem to heal, they do scrape off easily as they seem to be air-filled and leave temporary scars, then more form. I've had 8 negative HIV tests during the window period, spread pretty evenly between 1 day post PEP and 140 days post PEP. Seven of these were 4th-Gen and one was RNA. I would accept the test results except that symptoms do not seem to be abating. Could another ongoing infection such as HSV-2, liver or gallbladder problems, or cancer be affecting test results? I tested negative for all other STDs as 3 of the tests taken were full panels but I am questioning the confidence in tests as I've heard the HSV IGG is unreliable.. Should I test again at the 6-month post PEP mark? Finally, should I consult a doctor about testing for other rare forms of HIV? Thank you for your expertise.
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Edward W. Hook M.D.
34 months ago
Welcome to our Forum.  Thanks for your confidence in our opinions.  I'll be glad to comment.  Before I do, let me state clearly that I am NOT discounting your symptoms. OTOH, I am confident they are not due to HIV and it is time for you to work with a trusted physician to determine what is causing them- it is not HIV.  Let me elaborate on my reasoning:

1.  Your encounter.  
      A.  Most women, even those considered "high risk" do not have HIV.  
      B.  If one or both of your partners had HIV, the risk of HIV infection is low.  On average, HIV is transmitted through unprotected vaginal intercourse only once for every >2000 encounter, (thus more than 99,9% of encounters with infected women do NOT lead to infection)
      C.  You reduced your risk still further with PEP and condom use (I will not debate how well the condom worked or whether it was used improperly, that is in the context of all else, immaterial)
2.  Your tests.  Currently available test for HIV are among the most reliable and most sensitive tests in all of medicine.  you have effectively tested for HIV in three different way- for antibodies to the virus, for the virus protein, and for viral DNA.  There is simply no way that this combination of tests would have missed an infection.  Anything you have read about "variants", non-O serotypes, etc. is irrelevant. There is no scientific evidence that any HIV infection would be missed by the combination of tests you have had.
3.  Your symptoms.  For better or worse, the symptoms you describe have many, many potential causes.  Good clinicians use laboratory tests to refine their possible diagnoses and guide further work up.  At this point, you have PROVEN you symptoms are not due to HIV.  When symptoms are due to HIV tests are ALWAYS positive.  The question now is what is causing your symptoms. It is not HIV. Concurrent gall bladder disease, HSV-2 and other confounders would not change this assessment

My sincere advice is for you to seek evaluation by a trained internal medicine specialist who you feel comfortable with in order to evaluate other possible causes of your symptoms.

I hope this perspective is helpful.  EWH

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