HomeAnswersHIV/AIDS specialistfourth generation hiv testDo symptoms remain after negative test results of HIV exposure?

Can HIV symptoms persist for a long time despite getting negative HIV test results?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At April 1, 2023
Reviewed AtJanuary 22, 2024

Patient's Query

Hello doctor,

I was exposed to HIV (Human Immunodeficiency Virus) some 15 weeks ago and I have gone for a fourth generation test at two weeks, four weeks, seven weeks, nine weeks, 11 weeks, and 14 weeks and a rapid test at 15 weeks and all came back negative. But I have some symptoms that are not going away like flu, sore throat, numbness of fingers while sleeping, and itchy ears. I am worried. Please help.

Hello, Welcome to icliniq.com.

I suggest you calm down and do not panic. And while there are certain gaps in the information provided by you, allow me to first make and establish certain axiomatic deductions about your situation: Presuming that your exposure to HIV (human immune virus) was non-occupational (presumptively, via sexual exposure to a known, suspected, unknown-status partner) around 15 weeks ago. You got tested by the fourth generation assay, which refers to a standardized serological test based on the detection of combined p24-antigen-cum-anti HIV-1 or 2 antibodies (IgM, IgG) on multiple occasions, including during the 2 nd and 4th weeks and latest at the 15th week, with all results negative. The fourth generation test being negative right in the first four weeks of exposure and remaining negative for no less than two to three additional weeks beyond 12 weeks or three months is conclusive of your negative serological status, or not having acquired HIV. The window period of the 3rd generation HIV tests (based on antibody detection alone) or rapid antigen/antibody tests were taken as 90 days or, 12 to13 weeks. The window period of fourth-generation tests is considered as being less than 45 days or six weeks. Third generation and rapid HIV tests after the three-month window are also more than 99.97 % accurate. The fourth-generation tests work for all types and subtypes of HIV, are 100 % accurate, and do not require any testing further if negative till six weeks or 45 days post-exposure. The flu-like symptoms although seen in the so-called acute HIV syndrome, are in all likelihood representative of some other concomitant and transitory viral infection Features like numb fingers, and itchy ears may also be due to the same and/or associated nutritional deficiencies like vitamin B-complex, especially B12, untreated dandruff due to insufficient scalp cleansing. Additionally, exposure-related stress and anxiety can also produce symptoms that are similar to HIV in some individuals. I would not suggest going in for any further blood testing for HIV. Although three tests as suggested below must be done to rule out concomitantly transferrable blood-borne diseases. So just relax, meditate, and chill. And see your family physician, only if the symptoms persist or become bothersome, which might need ruling out other issues such as nutritional deficiencies, hypothyroidism, and stress anxiety. I request you to report back with details of the recommended blood tests, excluding other associated blood-borne diseases and conditions. Some of these non-specific symptoms are also known to be experienced in post-COVID-19 (Corona Virus Disease of 2019) syndrome or post-COVID vaccination. I hope I have cleared all your doubts.

Thank you.

The Probable causes

Exposure to HIV, associated stress, and anxiety.

Investigations to be done

1) RPR (rapid plasma reagin) or VDRL (venereal disease research laboratory) test for syphilis. 2) Anti-Hepatitis C antibodies. 3) HBsAg (Hepatitis B surface Antigen). 4) Complete blood count. 5) Liver enzymes. 6) Fasting blood sugar and TSH (thyroid stimulating hormone) levels. 7) Serum Vitamin B12 and D levels.

Differential diagnosis

HIV hypochondriasis.

Probable diagnosis

HIV phobia.

Treatment plan

Additional blood screening for non-HIV blood-borne infections. Management of stress, anxiety, and relevant evaluation on the persistence of symptoms. Referral to FP or GP (general practitioner) as required. Report back with results.

Preventive measures

Future measures for prevention of transmission of HIV via sexual and non-sexual routes. Universal precautions.

Regarding follow up

Please follow up asap with the test reports.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Sidharth Sonthalia
Dr. Sidharth Sonthalia

Dermatology

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