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Dermographism and early HIV infection?

Hello Dr., I am a 38 yo MSM. Two months ago I had one single unsafe sexual contact with another man with unknown HIV status. I engaged in receptive anal sex for about 10 minutes without ejaculation.
I have done 2 HIV tests, the first at 28 and the second at 46 days. Both were combi tests Ag P24+Ab and negative. Other STD at 28 days also tested negative. So, theoretically I should be fine, but I am not !
About three weeks after my exposure I had a few days a soar throat (very mild though), and the week thereafter some loose stools (but apparently only after exposure to some specific foods like ice cream) but no fever or swollen lymph nodes or a rash. But I am suffering for a month now from a general itchiness and red stripes on my back when scratched. My dermatologist diagnosed it as 'dermographism'. He did not see something like the typical HIV rash (maculopapular). I am on anti-histamine therapy for two weeks now because it could be an allergy and it works relatively well.

But could this not be a reaction of my body to HIV. But why would neither of the two HIV tests picked it up?

1. Because I am a later convertor?
2. Because there is a second window period between the detectibility of P24 antigen and antibodies and I have been tested in that window?
3. Because the sensitivity for P24 antigen in those DUO tests is not high (about 80%?) and therefore the test could have missed out on me?

What also spooks into my mind is that dermographism and itchiness is caused by the release of histamine through own mast cells as a reaction to an allergen (could be an antigen?). Histamine release has a fucntion in the activation of the immune system. By now taking anti-histamines would that not impair my immune response to a possible HIV infection, making things even worse?
  
I am planning to retest at 3 months (one month to go) again but in the meantime, I would really appreciate your opinion on the above.
3 Responses
936016 tn?1332765604
MEDICAL PROFESSIONAL
Hello

Thanks for the post which I have further condensed to:-

But could this not be a reaction of my body to HIV. But why would neither of the two HIV tests picked it up?

Because you are HIV negative and what you have described is not an HIV illness.

1. Because I am a later convertor?

No. You are HIV negative. Two negative DUO's at the intervals described establish that you are HIV negative.

2. Because there is a second window period between the detectibility of P24 antigen and antibodies and I have been tested in that window?

No - this is false. P24 remains through the course of the illness. The detectability of the p24 will depend on how much is produced but certainly during the acute phase - which if you were HIV positive you are still in - you will have huge amounts of p24. In any event the majority of people will form antibodies by 4 to 5 weeks and 99% by 6 weeks.

3. Because the sensitivity for P24 antigen in those DUO tests is not high (about 80%?) and therefore the test could have missed out on me?

Again - false. The snesitivity is high, the combination is an excellent one and we regularly identify newly infected HIV positive patients between weeks 2 and 3 using a DUO and interestingly modern third generation tests.

I really do not believe you are HIV positive, even if you were exposed to HIV, which we're not certain about.

best wishes, Sean
Avatar universal
Dear Dr. Cummings,

Thank your for yout clear answers. What you say has been confirmed by an HIV expert here in Belgium I visited today to receive my 10 weeks confirmation test today and I am HIV-.
It is time that the gray zone around the window period will finally be resolved. The HIV expert at the university center highly specialised in HIV confirmed to me he has never seen a person tested with combitests Ab/Ag negative after 6 weeks turning positive after 6 weeks after more than 5 years using the combi tests. And neither have his colleagues. There was only one exception described, a person who had taken PEP and he converted after 8 weeks. But that was really that very unusal exception that may be the 1% or less that is exceptional. A combitest at 6 weeks is like you and the other medical experts say here on this forum 99% conclusive, at least.

So I hope, now that the combitest has been approved in the US (only since this year while in Europe it has been used for many years, which is such a pity), the US experts will adapt their guidelines soon. It will make a huge difference in reassuring people.

I also hope people like TEAK from the public forum who so firmly stick to the 3 months window will open their eyes and accept the new reality and be more reasuring to the worried people here. Really, 6 weeks is it !

Thanks a lot for your advice,


Avatar universal
Dear Dr. Sean,

Despite all the reassuring test results (tested 4 times: after 4 - 6.5 - 10 and 13 weeks with duo tests), would you consider that there is still a possibilty that I was infected with HIV, given my skin problems (dermographism, chronic urticaria, acne, folliculitus) that started about 3 weeks after the sexual risk contact. I have been tested for all other kinds of STD, together with general blood tests and allergy tests, there is nothing to find.

I am still scared about HIV because of these skin problems that do not go away. Please tell me if there is a chance that I could be an exceptional case, one of those people that would test negative even at 3 months.

The specialist doctor I visited told me statistically I can be 99% confident. But 1% is still 1 out of 100 cases. What could I do to receive 100% reassurance. It seems like noone wants to 'guarantee' me that I am HIV negative.

Thanks,

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