Q. My last HIV risk exposure was three to four years back. Am I safe now?

Hello doctor,

I am a 65-year-old white male who tested negative for HIV 1 and 2 in a one-time test three to four years ago. I am not sure if it was a third or fourth-generation test. I tested negative with a fourth-generation test four months back because I thought I might have some symptoms. And I remembered the flu-like illness about six months after exposure.

I weighed 204 kg three months back, and now I weigh 191 kg. I have worried a lot (pacing the floor, sleep loss) for the past five months, took Paxil, and realized my worry could account for some weight loss. Shortly after the test, I had the following symptoms:

1. I started having a small patch of 8 to 10 pinpoint-sized pink-light red dots under the skin of my left wrist that had been there for two to three weeks.
2. I also had a smooth, flat spot about 3/8 inch in diameter that appeared on the back of my right hand about a week ago that has now faded to a pinkish brown. I have read about Kaposi sarcoma being a definer of AIDS, but I do not understand how that could happen with a non-reactive fourth-generation test four months back.
3. Three months back, I had sinus-type headaches multiple times that would sometimes be severe. After three rounds of antibiotics and a CT scan two months back that showed shadowing in a sinus, my ENT doctor just told me this week that there is something in my sphenoid sinus. He is treating it with a rinse for inflammation for three weeks before I see him again. I have had blood in the mucous from my nose for the past three months. It dries out in my nose and causes blood almost every time I pick at it. The ENT doctor said that the lining of my nose had been worn down from this, but did not seem concerned about it. I do mess with it a lot and blow my nose a lot.
4. My PSA elevated quickly in the last six months, going from 1.2 to 3.5. A biopsy two months back showed early cancer in one of the 12 regions biopsied.
5. I had lithotripsy on an 8 mm kidney stone this month, and I am still passing dark urine. I was told that I do have several small stones still in each kidney. I have had multiple stones over the years.
6. I have a swelling sensation all the way around my waist down into my groin at times that has been there for about two months, but no noticeable swelling. Several doctors have felt in my abdomen and detected nothing abnormal. A CT scan with no contrast ten days ago showed no abnormalities other than a little swelling in the right kidney where the 8 mm stone was blocking the passage into the ureter. A CT with contrast five months back was normal except for showing stones. But I have had microscopic blood in my urine since then.

My vital signs have consistently been normal for the past five months, including temperature, BP, and oxygen. I know I am getting old, and some of these symptoms happen with age. But it is driving me crazy that so much has happened since my negative fourth-generation test, which is supposed to detect antibodies, may not be conclusive after three to four years of exposure. I had Zoloft 100 mg daily earlier, but I am currently on Paxil 40 mg and Propranolol 60 mg daily.

After nearly four years of exposure and a negative antibody test four months back, would that test have detected antibodies if I were in a stage of HIV or AIDS? Do you think it was conclusive? Or is there another test I should have done? I have read about an HIV RNA test, but it says early detection. I understand that it detects more than antibodies. What are your thoughts on my next step?

Thank you doctor,

I meant to say that my exposure was three to four years ago, not for three to four consecutive years. Does that make any difference in your answer?