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Q. My HIV tests are negative, but I have lymphadenopathy. Should I be concerned?

Answered by
Dr. Parth R Goswami
and medically reviewed by Dr. Preetha J
This is a premium question & answer published on May 06, 2021 and last reviewed on: Nov 08, 2021

Hi doctor,

I had unprotected oral sex with a commercial sex worker five months before. Since then, I have had fleeting lymphadenopathy till now. I did my HIV TRI-DOT test (rapid HIV antibody test) and HIV ELISA test three months before, which were negative. I did an HIV-1 RNA PCR test, HIV-2 RNA PCR, western blot, HIV duo tests two months before, which were all negative. One month before, I repeated the western blot test, which was negative. Should I be worried about HIV? Should I test again? I currently have palpable lymph nodes in the submental and submandibular regions.

#

Hi,

Welcome to icliniq.com.

HIV (human immunodeficiency virus) testing should be done at the sixth week and then three months after unprotected sexual exposure. You had done many different method investigations for HIV, and you have also done ELISA (enzyme-linked immunosorbent assay) testing for HIV after three months of exposure as well. So you do not need to worry. There is no need to repeat HIV testing. In your CBC (complete blood count) report (attachments removed to protect the patient's identity), neutrophil count high. So enlarged nodes could be due to infection. If enlarged nodes persist after an antibiotic course, then FNAC (fine needle aspiration cytology) of the enlarged lymph node can be done for further workup. I hope I have answered your question. Let me know if I can assist you further. Best regards.

Thanks for the reply, doctor,

If I do, FNAC test, will it point out the presence of HIV as all the test results are negative? What are all the causes for generalized lymphadenopathy?

#

Hi,

Welcome back to icliniq.com.

FNAC will not rule out HIV. So you do not need to worry about HIV. FNAC of lymph node will be helpful to rule out the nature of the lesion, whether it is an infective lymph node or some other cause. There many causes of enlarged lymph nodes like infective Rosai-Dorfman disease, lymphoma, reactive enlarged nodes, etc. So FNAC or biopsy of enlarged lymph node will be useful to diagnose and decide the further management of enlarged lymph node. I hope I have answered your question. Let me know if I can assist you further. Best regards.

Thanks for the reply, doctor,

It is reactive lymphadenopathy, according to the FNAC report. I again tested negative for HIV-1, HIV-2 RNA PCR qualitative test. p24 antigen is also negative, but still, I have lymphadenopathy. I also checked with another lab for antibody it is also negative. I am worried.

#

Hi,

Welcome back to icliniq.com.

You have done many tests for HIV, including the confirmatory western blot as well. Western blot rules out HIV conclusively. So, if you do not have further exposure, then do not worry about HIV. If your FNAC report suggests reactive node enlarged, then it does not mean due to HIV. Some ongoing inflammation could be possible for node enlargement. Kindly attach your FNAC report and USG (ultrasonography) of the neck report so that I can check and further comment. Meanwhile, do not worry about HIV. Your HIV test is negative as per history and our previous conversation. I hope I have answered your questions. Let me know if I can assist you further. Best regards.

Hi,

Thanks for the reply doctor.

The western blot and HIV duo test at 6.5 months are negative.

#

Hello,

Welcome back to icliniq.com.

Following is my opinion for your asked question.

Your HIV Duo and Western blot negative after 6 month. So it rules out HIV exclusively. Now do not worry about HIV. Any test can effectively exclude HIV maximum after three months of exposure.

I hope I have answered your question. Let me know if I can assist you further.

Best regards.

Hi doctor,

Thanks for the reply.

I have tested again. Till now, all tests are negative, including 1) At seven months - western blot and HIV duo negative and ICTC (counseled and tested for HIV) combaid kit negative. 2) At eight months, HIV 1 qualitative and quantitative tests are negative (target not found), HIV 2 qualitative negative. HIV p24 not detected. HIV duo negative with titer 0.16. 3) I have done my CBC (complete blood count) too. The value after the exposure was between 12000 and 14000. But it has come down to 9700 as per the latest count done in the 8th month. I have done my CD counts too. To my knowledge, it seems to be normal. 4) Issues that concern me now are I have swollen lymph nodes in the submental and submandibular regions. Nearly 6 to 7 tingling sensations in the area mentioned above. 5) My doubts are - am I a late seroconverter. Is there any protocol for testing if the patient has symptoms tested negative other than the asymptomatic ones? Is that I am suffering from some other variant of HIV that cannot be detected? I had no other risky behavior or potential exposure after that incident. Thanking you, mam, kindly find the attachment of my reports (attachment removed to protect patient identity). And sir, I had intercourse too, along with oral sex in the same day with the same client but with a condom (not sure about its integrity and whether slippage has happened or not).

#

Hello,

Welcome back to icliniq.com.

Following is my further opinion on your case.

I have seen attached reports (attachment removed to protect the patient's identity).

Your all HIV test is negative.

Additionally, ELISA (enzyme-linked immunosorbent assay) HIV test detects both HIV 1 & 2.

So, you can consider your tests reliable to exclude HIV.

You are not a late sero conversation patient.

HIV can be ruled out effectively, maximum after three months of exposure.

So, do not worry about HIV if you do not have any other risk exposure after that day.

For an enlarged node in the neck area, investigate further with FNAC to rule out the cause of elevated node like inflammatory or infection, etc.

I hope your concern is solved.

Let me know if I can assist you further.

Best regards.

Hi doctor,

Thank you for your reply.

I have done my USG neck since I had complaints of white tongue and ulcers at the edges of my tongue. Kindly go through the reports (attachment removed to protect the patient's identity). Is the bilateral swollen submandibular lymph nodes are due to viral infection or HIV sialadenitis?

#

Hello,

Welcome back to icliniq.com.

Following is my opinion on your asked questions.

The USG test cannot rule out HIV. You have already done many tests in the past for HIV.

So, it does not seem to be HIV.

In the USG report, submandibular gland inflammation is present. It could be by a viral infection temporarily.

Your both side lymph nodes enlarged, for which FNAC investigation can be done as suggested in my previous answer for further workup.

I hope I have answered your asked questions.

Let me know if I can assist you further.

Best regards.

Hi doctor,

Thank you for your reply.

Have you seen anyone turning HIV reactive after six months with similar complaints of mine? I got my CMV (cytomegalovirus) IgG (Immunoglobulin G) tested too, which showed a high titer with great affinity. The recent USG scan showed salivary gland swelling subsided, but subcentrimetric lymphadenitis was still present in the neck. I have a burning mouth that is on and off, a white appearance of the tongue, small ulcers, and sometimes small pimples on the tongue. My last HIV duo was two months back, which was negative too. But I am still worried.

#

Hello,

Welcome back to icliniq.com.

Following is my opinion on your asked questions.

No, I have not heard or seen a patient positive for HIV after six months of exposure.

High IgG titer for CMV could be due to past infection with CMV virus. It does not rule out recent infections. To rule out recent CMV infection, investigate with IgM for CMV or molecular testing.

For lymphadenitis in the neck, you can be prescribed antibiotics and anti-inflammatory drugs. I suggest you visit an Otorhinolaryngologist for your physical examination, FNAC investigation, and for getting a prescription.

Ulcer in the mouth and burning mouth all could be due to vitamin B12 deficiency. I suggest you take Mbson Sl (Methylcobalamin) or Becosule like Multivitamin tablet for that. You can visit an otorhinolaryngologist, and the doctor will give you a prescription.

As per our previous discussion, your HIV report was negative after six months of exposure. So do not worry about HIV.

I hope I have answered all your questions.

Let me know if I can assist you further.

Best regards.

Thank you doctor,

But I forgot to say that I have often had swollen lymph nodes coming and going off in the axilla and groin. Currently, I am having one in the axilla.

#

Hello,

Welcome back to icliniq.com.

Following is my further opinion for your asked question.

The enlarged node could be reactive due to inflammation or infection. However, an enlarged node does not mean it is HIV. You can investigate further with biopsy or FNAC investigation of the enlarged node to rule out the exact cause of that. It would help if you visited a nearby surgeon for examination and further investigation of the enlarged node.

I hope this will help you.

Let me know if you have more questions in mind.

Regards.


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