Hi doctors. Thank you so much for you answers on my previous questions. I come back with some additional info and questions that I would like your input. I keep following with my doctor on why Ive been having these recurrent tonsillitis and flu like symptoms for the past 4 months. Maybe 3-4 cases of tonsillitis (1 monthly). I did some tests and this is what came thru:

Protein C Levels = 0.43 mg (High)

ASO = 89.0 IU/ml (Normal range)

EBV VCA Igg = >750 U/mL (Positive)

EBV VCA Igm = <10 u/mL (Negative)

1) What does this results means? What about the protein c levels and the EBV results??

2) I had Hepatitis blood tests 6 months post exposure and this was my results if you could please tell me the meaning and if its conclusive or not:

HbsAg = non reactive

Anti HAV Total = 1.06 (Indeterminate)

Anti HAV Igm = negative

HCV Ab = non reactive

3) HIV still is a concern for me, you will be surprise to know this is one of the very FEW sites that states HIV is conclusive before 3 months. Even my local doctors advise to test up to 12 months but I cant wait that long. I have negative HIV Ag/Ab test up until 8 months and I have one PCRH HIV-1 non detected at 6 months. My concern now is medications Ive been taking for this tonsillitis and sinus problems which includes corticosteroid in various form between nasal spray and pills. I understand this can affect HIV testing. How does this work?

4) Is it possible to have no detectable viral load at 6 months post exposure if I was infected? Is this whats call an elite controller? How reliable is my PCR test at this time?

5) My exposure was with a Colombian CSW, do you happen to know if HIV 2 should be a concern?

Thanks

1.  These results are not helpful and are non-specific.  There are no medical STI or HIV conditions for which protein C values are a clue.  As for your other values, you do not have ongoing streptococcal infection and, like most people, have had Epstein Barr infection in the past.  It is not active at this time.

2.  You do not have hepatitis A, B, or C

3.  The persons/sites that have told you that your results are not conclusive are incorrect and out of date.  You have proven you do not have HIV

4.  No.  Elite controllers have positive tests.

5.  It is not.  HIV-2 is rare everywhere but most common in India and West Africa, not South America.

I hope these responses will help you move on.  You need to.  You also need to stay off the internet which, I suspect, is the source of some of your anxiety as well as misinformation.  EWH

1) Regarding my HIV questions I would like if you could expand on what I asked about corticosteroids and HIV test because it seems that theres actually some interference between that medicine and HIV testing. As I shared above Im taking corticosteroids in different forms from nasal spray to pills. Most recently applying Avamys 2 times a day and some prednisone by pill around 10mg a day.

2)About elite controllers, is the antibodies that make them not have any viral load? That means that elite controllers have the most amount of detectable antibodies? Just trying to understand if my 6 months PCR test was accurate

3) How exactly do condoms protect against HIV and other STIs? I thought HIV could not pass through condoms AT ALL, period. But I understand now that in just decreases the risk to 90-99%, sometimes CDC stating that is less like 60-80% and that really worries me. The encounter I had was protected and I the condom was intact and the end and I understand that micro holes are a myth (right?). And this was a just one time incident outside of my monogamous relationship so we're talking about just ONE condom protected encounter y the last maybe 5-6 years. How effective could I expect the condom to be?

4) Could the pain Ive been experiencing in my throat be caused by Herpes? Ive dont several throat cultures and nothing comes back. Maybe is Herpes and this doesnt show up in cultures? Ive had Herpes 1&2 Igg and Igm test at 6 months post exposure both negative, is this conclusive? I ask because sometimes the pain is so intense it literally feels like I have an open wound in my throat, even hurts just by opening my mouth wide

5) Do you think throat HPV is a possibility? To be causing recurrent sore throat and inflamed tonsils

1.  Steroid medications may slightly delay or reduce maximal antibody response. Topical steroids (like nasal sprays have less effect than pills or injections but none completely prevent antibody response.   Should that happen however, the amount of virus in the blood would be even higher than average, giving a positive result in the antigen detection part of all 4th generation combination HIV antigen/antibody detection tests.   There is simply no way that your tests months after exposure would miss HIV infection.  

2.  Antibodies are part of the immune response that make elite controllers able to have very low HIV virus levels without therapy.  If you were an elite controller, both your 4th generation test and your PCR would have been positive.

3.  Condoms completely block the infection by preventing contact of infected secretions with mucosal surfaces.  They do not work perfectly because people do not use them correctly or, about 1% of the time, they break.  When used correctly and consistently they are virtually 100% eff4ctive

4.  No, Your situation in NO WAY suggests HSV and your tests confirm that you do not have herpes.

5.  No.  When HPV occurs in the throat it is typically asymptomatic  

You have one follow-up remaining.  Use it wisely because once this thread is closed future anxiety-driven, repetitive questions of the sort you are posting may be closed without a response and without return of your posting fee.  It is becoming evident that you have been misinformed (perhaps by the internet) and that, combined with guilt and/or anxiety over your misstep month ago are hindering your ability to accept that you did not get an STI, including HIV.  You need to move on.  Further tests for STIs will not help.  Seeking the assistance of a trained counselor to help you address your misplaced concerns however might.  I say this out of concer, nothing more.  EWH

Ive searched some more in this same forum about the effects of corticosteroids on HIV testing and adding to your previous answer these are some of Dr Handsfield say in the matter: 

"The internet claims about corticosteroids (like prednisolone) and other immune suppressive drugs on antibody production are wildly inaccurate. It's simply a non-problem, for HIV testing or any other antibody testing, at least at the doses and durations of treatment used 99% of the time."

"There are NO medications that have any proved effect on HIV testing accuracy. Even immunosuppressive drugs have little or no effect. in theory, they could reduce antibody production, and thus delay positive results with the antibody-based blood tests. Even this is rare, if it occurs at all."

Both answers seem to be stating that theres no risk but just a theorical one, adding this to your answer I believe theres in fact sme little risk in this.

In case the steroid actually messed up with my testing, I understand antibodies would go down and antigens re appear, making the test positive so:

1) Whats the time between antibodies maybe disappearing and antigens coming to live? I ask because my last dose of steroid was 2 months prior to my last 8 months post exposure test. Maybe just as antigens were appearing, antibodies began to form again and maybe there could be a gray area between them two?

2) How long before steroids completely leave my system and all antibodies resurface as normal after last dose?

3) HIV 1 is protected by the Antigen detection part in case of any source of immunosuppressive status. What about HIV 2? What would be the reliability of the test in detecting HIV 2 if antibodies were delay or reduce?

4) In regard of the condom effectiveness, what would you say was my protection level in my case as I described? ONE time protected encounter, condom was normal at the end (at least to the naked eye).

5) Do you think is possible I could be getting a "fake" or not so good Ag/Ab test? I know is a long shot but trying to cover all my bases.

6) With all my symptoms (recurrent cold/tonsillitis, weight loss, night sweats, and more) and the fact that I have until now almost 10 negative HIV blood tests (some antibodies only and some Ag/Ab test) up until 8 months post exposure, and one undetectable PCR HIV1 test at 6 months. Would you by any chance suggest I should keep testing up until some point to discard any possibility of HIV?

7) In the middle of all this like 3 months post exposure I got COVID an was pretty bad. Could that affect my tests at that moment or after? A few days after I got my "90 days" mark test and was negative as all the others.

8) One last thing, maybe like 3-4 months post exposure I got a "bump" near my penis head on one side. I got an ultrasound and it was described as "warm soft nodule" with "no doppler outake (or output, not sure about the translation)". Will you care to guess what that sounds like? It looks like a little bump but  you cannot actually feel anything in there and is color skin. Sounds like any STI?

If it wasn't for my recurrent symptoms I think I would be able to move on a lot easier, is just that Ive been feeling ill ever since that exposure and no clear reasons why.

Thanks doctor

9) What are this "co infections" my doctos refers to that could delay positive test until 12 months or more? Tu be exact my doctor told me "Only a case of co infections could delay HIV reliability up to one year or more"

Thanks

1. There are no gray areas.  The virus/antigen appears first and the antibody appears soon thereafter. In untreated person, both the remain detectable.  Your As per the quotes you provided above, there is really no conceivable way your steroids could have prevented making an accurate diagnosis of HIV if you had been infected.

2.  The antibodies do not disappear and then "resurface".  Once present they stay present.  The theoretical impact of steroids is on initial antibody formation only.  Steroids and any hypothetical effect they might have typically are present in the body for only a few days after taking them,

3.  Already discussed.  The test would have detected HIV-2 antibodies if present.  HIV-2 is not present in South America

4.  Virtually 100%

5.  Oh please!   All of your many tests, including the PCR?  Get real 

6.  Further testing of any sort of a waste of time and resources

7.  COVID in no way impacts the accuracy of HIV test

8.  This certainly does not sound like an STI.  I would suggest you discuss it with the doctor who ordered the test for you

9.  This is an inaccurate supposition.  No co-infections would be expected to delay as positive test.  Anyone who makes this statement is incorrect

This ends this thread.  Future returns to the Forum with additional anxiety-driven questions may be deleted without a response.  Please believe your test results.  EWH