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Negative HIV antibody test 10 months after exposure to a HIV positive contact

Question: 

Dear doctors,
This is my story. I had sex with a HIV infected partner, and he revealed to me his HIV positive status only when I started to have acute symptoms 3 months later after exposure when I texted him with a question, what's the matter with me, it looks like HIV and if it is, it is certainly from you and he answered me, yes I have HIV. Up to that 3 months period I had not suspected and not thought at all about any HIV. But after his confession I started to remember the prehistory. All that previous time I had an exhausted look though I didnt feel very tired. I also had some rare small night sweat outbreaks. After about 2,5 months I started to have some very small pain in the throat which after 3 months grew to a terribly full-blown flu-like episode with my pharynx hot-red and so painful, though fever grew slowly and did not rise above 38. All that time I had painful neck under the chin, which continues to this day and has not gone anywhere. This flue-like episode lasted about a week. But temperature about 37.2-37.5 lasted 2 months. Now too from time to time it rises to 37-37.2. Now often when I get up in the morning my temperature is 36.2 but the moment I leave my house for work it is often 37.2. I felt terribly tired about 1-1.5 months, I could hardly prevent myself from falling flat on earth any moment. But after 1-1.5 it disappeared almost completely. I also lost about 7 kg within a month, after that I gained back my weight quickly and even over my usual weight. From that time on my bowel gradually behaved worse, although before I have never had any problem with it. My stool about 1 month after an acute episode started to be more and more liquid. Now about about 1-2 times a week I have a perfect diarroea and this keeps going on already for more than 8 months. During the acute period my two very small hardly visible warts on the head became bloody and now they are quite bigger in size. During the acute period I started to have a coated tongue, which does not improve and continues to this day. I had HIV tests after 3,5, 6, 8, 10 months after exposure, all are negative. I have had some tender small spots in the lymphatic region in the neck and about the armpits on the chest from that period up to this time. So you can see I still have symptoms which I have never had before: sore throat with coughing (continues to this day), coated tongue, rises in body temperature, liquid stools with diarrhoea, some tiredness and weakness bringing me definitely some level down (though generally I am satisfactory). My exposure details are such. Anal sex was protected (I am on the active side), but my skin on the penis easily breaks even after small rubbing with some blood showing due to chronic fungal dermatitis. We had a lot of kisses, and there are papillomas in my throat which delay swallowing. I should explain about my fungal condition. It is chronic but spread all over the body and it is dormant. But if I rub my skin any anywhere just very little it breaks and becomes an injure. My doctor was very surprised that my fungus on the body did not disappear after many treatments with antifungals and became chronic though inactive, he said he has never seen such a case in his life. As for me I can attribute my new continuing symptoms to nothing else but HIV. Also it seems my immunity (although good enough in itself for living) is somewhat special and abnormal and can explain somewhat strange reaction of my body to HIV. Also I should say I cannot pay for PCR test, I must tell my name if I want it free, but I am terribly afraid of being disclosed. I will greatly appreciate your responses to my question what can you tell me about my case and what should I do? Can I do RNA test in your laboratory? Regards.

Answer: 

Hello,

Thank you for your inquiry. From what we gather from the question, you were asking about various symptoms you have experienced after engaging in protected anal sex. From the information given, this scenario is determined to be Low Risk (Evidence of transmission occurs through these activities when certain conditions are met).

The scenario mentioned above could meet the three components of the Transmission Equation if the condom broke during intercourse, which could then allow a bodily fluid containing HIV direct access to your bloodstream. This risk could also be heightened due to your fungal infection, which could increase the risk of acquisition if open wounds are created during sex.

The symptoms you have experienced are very likely not due to an HIV infection. A chronic fungal infection could be indicative of a weakened immune system, making you more likely to get other infections more easily and in cases of severe fungal infections, the symptoms you are experiencing could be due to the fungal infection itself (1). Often, taking anti-fungal medications for an extended period of time or trying a different medication could be beneficial to eliminate the fungus if it is resistant to treatment (2). With this in mind, your chronic fungal infection is still unlikely to cause a completely different immune response to HIV as your immune system should still create antibodies that would be detectable as early as 4-6 weeks post-exposure if an HIV infection were present. The negative HIV tests that you had at 3, 5, 6, 8, and 10 months after exposure are all completely conclusive (3). The result of an HIV antibody test after 3 months is considered completely conclusive.

Recommendation: Refer to a physician for other health related questions and to further inquire on treatment for fungal infection.

Regards,

AIDS Vancouver Helpline/Online, Marie