Patient's Query
Hello doctor,
I have had a few unprotected high-risk exposures in my life so far. I had a concern and checked my status of HIV (human immunodeficiency virus) through an ELFA test (enzyme-linked immunosorbent assay) three months after the last encounter. I did another ELFA test after six months, and both were non-reactive. I did not have any exposure in between the tests. My condom broke after the six-month test, so I did a fourth-generation HIV test, syphilis, chlamydia, HSV-1, and HSV-2 six weeks after my last exposure, and they were all non-reactive. I also got an ELFA test three months after my last exposure, which was also non-reactive. I had a qualitative EDTA plasma HIV-1 RNA PCR test four months after my last exposure with a minimum assay range of 35 copies per ml. I have gotten recurrent and persistent rashes like hives on my arms, back, and legs for a year. I also have had a persistent sore throat for a few months and painless muscle twitching now and then for a month. I have been panicked and restless for six months now, and I had a recent episode of anal fissure following a couple of days of constipation, which healed without any medication.
Are ELFA and HIV DUO tests conclusive at three and six months post my last exposure, irrespective of previous exposures? Can there be any point where both antibodies and p24 antigen are not detectable in an HIV-infected patient? If there is a seroconversion stage now, will no antibodies be detected till now? If I had acquired HIV, would my immune system go so weak? Having said everything, am I HIV-negative? I am currently taking tablets Allegra, Xyzal, Goutnil, Glace X, and Symbicort Accuhaler.
Please help.
Hi,
I am glad you chose iCliniq for your medical-related queries.
I understand your concern and will try to help you with it.
Your last screening test for HIV (human immunodeficiency virus), that is, the fourth-generation p24 antigen and anti-HIV antibody screening test, is conclusive for all previous exposures. A negative antibody screening test further substantiates this after three months of your last exposure. Antibodies cannot be detected very early after infection, that is, in the first seven to 10 days. After that, the p24 antigen appears until its levels start falling after three to four weeks of infection, by which point antibodies would become detectable. Seroconversion happens during two to three weeks after infection when the antibodies start appearing against the virus. If you were infected, then by this time, you would have already been seroconverted, and the screening tests would have been positive. Usually, the T cells get depleted in HIV, which is cell-mediated immunity. B cells are antibody-producing cells, and they are not depleted in HIV. Therefore, the antibody screening test is reliable throughout the course of infection. You are not HIV positive, and your screening tests are conclusive with respect to your history of sexual exposures.
Thank you for consulting me.
You can always reach me at icliniq.com.
Patient's Query
Hi doctor,
Thanks for your reply.
It has brought a smile to my face after almost a year now. I have one other confusion. I have been known asthmatic since childhood. I was given Wysolone for a course of several months when I was in school, and I had been using Budecort and Seretide inhalers for years. I also use Symbicort now. I remember being given Cortisone injections during asthmatic attacks in my adolescence, too. Last year, I had a shot of Decadron from a local physician for severe wheezing. Would all these have had any effect on me and made me immunosuppressive? Considering these factors, are my negative test results reliable? And should I start living my life normally? Kindly help.
Hi,
Welcome back to icliniq.com.
I read and understand your concern.
Intermittent use of oral steroids or injectable steroids does not cause immunosuppression. Moreover, the intake of steroids, even though it may theoretically delay antibody response to HIV (human immunodeficiency virus), would have no effect on HIV antigen detection and HIV PCR (polymerase chain reaction) RNA test. Since you tested negative for PCR RNA and HIV p24 antigen at four months and six months, respectively, there is no need to worry. PCR RNA has a short window period of nine to 13 days, whereas HIV p24 antigen has a window period of one to two weeks. Beyond the window period, the results of these tests are reliable and conclusive, and even if we presume that you were infected with HIV, then steroids would not have interfered with these tests, and in fact, they would have aided viral multiplication.
Looking forward to your response in order to help you.
Thank you.
Patient's Query
Hi doctor,
Thanks for your reply.
I did another HIV DUO test the day before yesterday, and it was non-reactive as well. Should I take any other test to reassure, or should I seek medical help for my symptoms of rashes and random muscle twitching, concluding my HIV status as negative? Please advise.
Hi,
Welcome back to icliniq.com.
I read and understand your concern.
Your HIV screening tests are conclusive. There is no need to undergo any further tests for reassurance. For your other medical concerns, you may contact an appropriate specialist.
Looking forward to your response in order to help you.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
One last question out of concern is whether EBV (Epstein–Barr virus) or CMV (cytomegalovirus) interfere with HIV results or delay seroconversion beyond so many months.
Hi,
Welcome back to icliniq.com.
I read and understand your concern.
No, these are common viral infections, and the majority of the common population is infected with CMV (cytomegalovirus) and EBV (Epstein-Barr virus). They do not cause any health problems in healthy individuals unless there is an underlying immunosuppression, for example, HIV or AIDS patients. These infections do not delay HIV seroconversion.
Looking forward to your response in order to help you.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
I need one other clarification from your expertise. Does MS delay the detection of HIV or interfere with seroconversion by any chance? This is because I have random muscle twitches. I am very anxious.
Please help.
Hi,
Welcome back to icliniq.com.
I read and understand your concern.
Multiple sclerosis does not delay the detection of HIV or interfere with seroconversion. Multiple sclerosis has no effect on antibody formation against the virus.
Looking forward to your response in order to help you.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
If my exposure five years ago had exposed me to HIV and if it had transformed into AIDS (acquired immunodeficiency syndrome), would my negative HIV Duo test still be conclusive? Would my antibodies have been depleted?
Please help.
Hi,
Welcome back to icliniq.com.
I read and understand your concern.
I have viewed the images as well as the test reports (attachments removed to protect the patient's identity). The neck lump is perhaps a swollen lymph gland, which may have been caused by the recent sore throat. It is not something to be worried about. The rashes that you have are urticaria, that is, hives. Hives are more common in patients who have a history of asthma and allergic rhinitis. I suggest you take a tablet of Montelukast and Fexofenadine (Allegra) 120 mg once daily for three weeks. Topically, you may use soothing lotions like zinc oxide and 0.5 % iron oxide (Calamine) lotion. Again, I would like to reassure you that your screening tests are fine, and your symptoms are not related to HIV infection.
Looking forward to your response in order to help you.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
I have rashes on my palms on and off too. I have tested for VDRL thrice and the results are attached. My dermatologist says it is dermatography and an allergic manifestation. Should I be more proactive and do more tests? Please help.
Hi,
Welcome back to icliniq.com.
I read and understand your concern.
Dermographism is a type of physical urticaria. It is a type of chronic urticaria. Unfortunately, I have not received the image or attached file. I request you to kindly upload again.
Looking forward to your response in order to help you.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
I am hereby attaching the pictures of the rashes on my palms and the VDRL test (venereal disease) reports. One is on the 46th day of my last exposure (about four and a half months after my last exposure), and another one is at six months. VDRL alone is negative (not attached). The rashes are itchy as well. It gets controlled upon taking Allegra. Should I do any other specific tests? I am so confused and losing my life. Please advise.
Hi,
Welcome back to icliniq.com.
I read and understand your concern.
I have gone through the attachments (attachments removed to protect the patient's identity). All your tests are normal and conclusive. As far as the itchy rashes are concerned, they are hives, that is, urticaria. Urticaria can be due to allergies to food or food preservatives, infections (viral, bacterial, fungal, dental), drugs or medications, autoimmune diseases, and so on. However, a vast majority of chronic urticaria is idiopathic; that is, there is no identifiable cause. You may do a few more blood tests like CBC (complete blood count), ESR (erythrocyte sedimentation rate), thyroid profile, comprehensive allergy panel test, chest X-ray, urine routine, stool for ova or cyst, ANA (antinuclear antibody) in quest of identifying the cause. They may guide future treatment. Till then, you may continue taking a tablet of Montelukast and Fexofenadine (Allegra) 120 mg daily.
Looking forward to your response in order to help you.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
Should I be worried about elite controllers or suppressors or slow progressors in my case related to HIV? I am asking because I feel my armpits to be tender since morning. I feel worried. Please help.
Hi,
Welcome back to icliniq.com.
I read and understand your concern.
Elite controllers and long-term non-progressors constitute a very low percentage of HIV-infected individuals who are able to maintain an undetectable or low viral load and higher CD4+ cell counts as compared to the majority of HIV-infected individuals who display a gradually progressive decline in CD4+ cell counts. In these very few individuals, even though HIV RNA PCR may yield a false negative result because of a check on viral multiplication, the antibody response to HIV is elicited as expected, and therefore, HIV DUO Ag (antigen) or Ab (antibody) test and HIV ELFA Ab tests would be positive and reliable. Tenderness in armpits may be due to a local cause like bacterial folliculitis or intertrigo.
Looking forward to your response in order to help you.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
With the amount of test results showing negative results, can I allay my fears of HIV? Please help.
Hi,
Welcome back to icliniq.com.
I read and understand your concern.
Yes, absolutely. Your tests are conclusive.
Looking forward to your response in order to help you.
Thank you.
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Answered byDr. Kakkar
Medically reviewed byiCliniq medical review team
Same symptoms don't mean you have the same problem. Consult a doctor now!
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