I tested negative for HIV twice. Can I be a case of late seroconversion?

Dear doctor,

Under a lot of alcohol, I had vaginal intercourse with a lady. I was wasted but I remember that I was protected with a condom. The condom did not break nor leak but maybe was not put perfectly. I did not manage to cum, removed it, and masturbated in a very aggressive way with my bare hands for some minutes. She spits twice on my dick, that is all. Since then, I had major symptoms starting from day-2 with a burning sensation and painful urination for some days and my genital organ was tender and painful. I took Ceftriaxone and a short course of Ciproxen on my own assuming I had gonorrhea/chlamydia without any test. On day-5 started a very weird tingling numbness in all the limbs which continued for a week or a bit more, sores in my mouth on and off starting from the first week including a huge one in the roof of my mouth, a headache, low appetite, weakness, and myalgia.

Later on, I started to realize changes in the nails after one month, joints pain still ongoing, no fever nor lymphadenopathy, most importantly I lost a lot of pounds and lost appetite and lost weight especially in my face - around the eyes and mouth. I want to mention that I never stopped crying from the very first day of being horrified by HIV. I got psychological and psychiatric consultations several times with no help.

Combo fourth-generation lab test and syphilis test were performed in a very reliable center and were negative. After eight weeks, the second combo fourth generation test at almost 16 weeks in another major hospital was also negative. Can I be a case report of late seroconversion? I am scared to death. Gonorrhea, syphilis, chlamydia, and PCR negative as well. Nowadays, I am almost asymptomatic apart from the joint pain that might not be related (got examined by an orthopedic who suspects a particular problem) and of course my shrinking face and the changes in my nails which are still there.

It seems so far that nothing could reassure me. I admit that there is a psychological or perhaps psychiatric element because of the huge persistent stress. But I must tell you that I always had a big round face and since the event, I lost a considerable amount of facial volume, facial wasting indeed and this was confirmed by a dermatologist. I managed to regain my body weight but not my face. I read online about HIV causing apoptosis of facial fat cells. What is your opinion in that regard?

I am only four and a half months from the event. I am really confused. Should I do an HIV viral load test? What are the chances for the duo test to miss twice after the window period? Have you ever heard of or seen a duo turning positive after such a long period? I do not feel like becoming an international case report you know. Thanks in advance. These facial changes that I am experiencing are simply driving me crazy. I want so much to move on with my life but I am "losing my face" which is my social ID. I do not know how to explain it.

My relationship with my wife, my social life, and my career are already destroyed and a total mess cause this "thing" had taken a huge toll on me. So, I am desperate. Again, I am talking about shallowness around and under eyes, temporal wasting, maybe a prominent change in my facial contour, much smaller cheeks, and some empty holes in my forehead and in my skull just behind my ears. It is just weird. It was not there before, it is advancing and I cannot find any explanation for it apart from the potential relationship with that one-time unfortunate exposure. I asked a couple of national HIV experts and also got a consultation from a doctor. All of them are pretty sure I am HIV-negative. The doctor was a bit mad at me even. Please help me. In my country, a negative duo test at 12 weeks or after is considered conclusive and definitive.

Hi doctor,

Thanks for the fast reply. They refuse to perform an HIV RNA PCR since I had two negative combo tests, both of them beyond of the window period. It is not considered a screening test in my country. I am extremely anxious. What do you think about my symptoms? Especially, the facial waste issue? Can I move on? Am I negative indeed? What about late seroconversion? Please address my questions.

Hi doctor,

Thanks for your reply. I do not smoke but I am freaking out of huge persistent stress. I was on BZP for some time, CT did not help, refused to get SSRI. Nothing, simply nothing, can reassure me. As I mentioned earlier, I lost about 8 kg in the first month but managed to regain it since then. The doctor says it is a matter of overt AIDS which is not the case for me. Some experts think that lipoatrophy is an issue of prolonged ART, another wrote that HIV by itself can cause it. I do not really know. It is a total mess. Is it possible to get a negative combo test twice? Maybe, I developed some autoimmune or other disease causes of the huge stress? Have you ever seen a late seroconversion case and what was the reason?

Dear doctor,

Thanks again for the fast reply. Have you personally seen or heard of a fourth generation test missing twice beyond the window period in a healthy person who was not put on PEP? Is it true that it is actually much harder to get a false negative than a false positive? Is it true that test results overrule any symptoms? The funny thing is that I was pretty sure I am positive from the very beginning. I do not have any other health problems.