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Acute HIV Oral Symptoms, CBC Irregularities

Question: 

Hi, 
 
I want to thank you from the bottom of my heart for providing this service. I’m a 30 year old drug-free heterosexual male. 6 weeks ago I began showing ARS like symptoms. Night sweats, fever, and oral ulcers (very large canker sores, thrush, inflamed papules on the tip of my tongue, and recurring geographic tongue). After 3 weeks my night sweats mostly disappeared, as did the canker sores, and thrush, but the inflamed papules and geographic tongue persisted and fatigue and general weakness and heart palpitations set in. Also, five weeks after symptoms began I began noticing recurring blood red spots (dark red/purple) that come and go on the inside of my mouth cheeks. I’ve never had more than 3 at once. They’re 1mm or less in diameter and can appear suddenly within an hour and usually fade and disappear within a day or two. 
 
I was tested for Hep A,B,C, HIV and other STDS. All negative. My most recent HIV test, a rapid antibody test, was taken 33 days (4.5 weeks) after symptoms began (a little over 5 weeks after my most recent unprotected sexual exposure). The result of the 4.5 week HIV test was negative.
 
Finally I had a CBC about 3 weeks after symptoms began and again about 5 weeks after symptoms began. The first CBC (after 3 weeks of symptoms) came back with no irregularities.  The second CBC (after 5 weeks of symptoms) showed:
 
LOW Counts:
 
LKCS (White blood count) of 4.1 (normal=4.8-10.8)
ERCS (Red blood count) of 4.63 (normal=4.7-6.1)
Lymphocyte of 1.4 (normal 1.5-4.0)
 
High Counts:
MPV of 10.5 (normal=7.4-10.3)
 
Low end of normal counts:
Neutrophyl of 2.3 (normal 2.0-7.5)
 
My risks for HIV were about 5 incidents of unprotected vaginal sex with 4 women (none of whom are known to have HIV), over the last 4 months (the most recent being just 5 days prior to falling ill with symptoms). 
 
I'm terrified with fear about HIV. 
 
1. How reliable (trustworthy) is my most recent test (after 4.5 weeks of symptoms)?
 
2. My symptoms have persisted for an unusually long time for ARS. Do oral symptoms of Acute HIV have a tendency to persist longer than other symptoms? 
 
3. Do CBC irregularities caused by Acute HIV tend to show up during the initial weeks of symptoms, or do they generally appear later, in the weeks following the disappearance of symptoms? 
 
4. Are my CBC irregularities and symptoms atypical for HIV? How concerned should I be about HIV at this point?
 
I greatly appreciate any insight you can share with me. 

Answer: 

Hi there and thank you for using AIDS Vancouver as your source of HIV/AIDS related information.
First off, it is great to know that you have been tested for both HIV and other STIs as it is the only way to know your status. But considering that we here at the AV Helpline are by no means medical professionals or physicians, I will be unable to make an accurate diagnosis of your symptoms. Though, I will try my best to answer your questions and provide you with the necessary information.
Also, it is important to note that HIV symptoms or ARS (acute retroviral symptoms) often mirror the symptoms of other viral infections (e.g. flu, mono, etc), so attempting to determine one's HIV status through symptoms is difficult and often times not favorable as it can lead to anxiety. Again, the only way to know your status is by receiving an HIV test.
 
1) How reliable (trustworthy) is my most recent test (after 4.5 weeks of symptoms)?
With a rapid (or "point-of-care") test, it detects for antibodies and the window period for antibody detection is between 4-12 weeks. So, seeing that your last unprotected sexual encounter was 5 weeks, without measuring the time since your symptoms, your results are considered reliable but not conclusive. Up to 95% of HIV infections are detectable within 4-6 weeks. But still, it is a good indicator of your status. As suggested by international HIV guidelines and most HIV specialists, an HIV retest should be received again at or after 12 weeks for your results to be considered conclusive. However, here at the AV helpline, we have never seen a negative result change to a positive one.
2) My symptoms have persisted for an unusually long time for ARS. Do oral symptoms of Acute HIV have a tendency to persist longer than other symptoms?
Like I stated previously, HIV symptoms usually mirror other viral infections which means they could vary, be more or less severe, or may in fact not occur at all. But if they do happen to occur, they usually only occur 2-6 weeks after infection and typically only last a few days, if at all. Seeing as you have already received a negative HIV test result and have been tested negative for other STIs, the only thing I can advise you to do would be to consult your doctor or a healthcare professional as they are able to accurately diagnose your symptoms.
3) Do CBC irregularities caused by Acute HIV tend to show up during the initial weeks of symptoms, or do they generally appear later, in the weeks following the disappearance of symptoms?
Your CBC (complete blood count) results cannot be used to determine your HIV status at all. Generally, in the way HIV infection progresses, there would be a slight decline in your CD4 count during the initial weeks but usually spikes back up before gradually declining again if one is not receiving medication. But your CBC is not an accurate or reliable way to determine an HIV status as underlying causes may be the result of CBC irregularities. It must be remembered that our bodies are always fighting off infections so white blood cells in particular may fluctuate from day to day or week to week. 
4) Are my CBC irregularities and symptoms atypical for HIV? How concerned should I be about HIV at this point?
Again, I am not a medical doctor so I am unable to read you CBC, but from what I can gather, I do not think you should be concerned as you have already received a negative HIV test result which is definitely a good predictor of your status. But, I would advise that you receive another HIV test at or after 12 weeks if this still concerns you as it will provide you with a conclusive result.
 
Please feel free to email or call us if you have any further questions.
In Health,
DarrienAIDS Vancouver Helpline VolunteerE-mail: helpline@aidsvancouver.orgPhone (Mon-Fri 9-4pm): (604) 696-4666Web: www.aidsvancouver.org/helpline