Second opinion

[D_123]

Dear Dr. Cummings:

I posted a question earlier this year, which was answered by Dr.  Gonzalez-Garcia.

http://www.medhelp.org/posts/STDs---International/Severe-symptoms-but-non-reactive-test-result/show/1684788

My exposure was the ingestion of breast milk from a Dominican prostitute, which was followed by a raft of severe ARS symptoms.  They were so severe that I was initially bedridden for about two weeks. While most have subsided, I am still suffering from digestion problems and loose stools.

I am concerned about this exposure for a number of reasons not least because I was experiencing a bad case of GERD at the time, having run out of my normal medication, Pantoloc.  

I tested HIV negative at 3,4,6,12, and 27 weeks by 4th Generation Ab/Ag assay, but I still cannot reconcile my test results with my symptoms.  

Delayed seroconversion in healthy individuals has been known to occur, yet when I mention my ongoing concern to health care professionals (GP, STD clinic nurse, etc.) they tell me that I could not possibly be infected because my testing would have returned a positive result by now.  Dr. Gonzalez-Garcia hares this opinion.  

It is not my intention to second-guess the advice I have been given, but ultimately I believe that I am anything but in the clear.  

What has been your own experience with regard to patients who have presented with severe ARS vs. their time to seroconversion?  

Have you experienced cases where the p24 Ag test returns a positive result when the antibody test is negative?

Any additional advice or insight would be welcomed.

Thank you.

[D_123]

Thank you for your reply.  This was my only risky encounter, and I have not had any sexual contact since.  The situation caught me off guard and I really wish I had taken PEP.  To rephrase my first question: is someone who suffers very severe ARS symptoms any more prone to delayed seroconversion than someone who suffers only mild symptoms?  Obviously I am concerned that I could still be HIV positive despite having tested multiple times with negative Ag/ Ab results.  As you say a PCR would be the next test to consider.  I will probably have one done but I am terrified of the results.  

[Mukkies]

I had unprotected gay anal sex with a known HIV positive man( me being the HIV negative top),I met this guy online and he really liked me and we planned to meet at his house. In fact he already told me,he was taking his meds( on treatment) when were chatting on msn. We started using condoms and then in the heat of the moment we it went all LOSE
How risky it is? Have I contracted HIV already HELP ME PLEASE ITS killing me
Thanks

[Dr Sean Cummings]

Good Morning,

Thanks for the post. I've re-read the original and the reply.

You are not HIV positive from the event you are concerned about - I understand your concerns but I don't agree with your conclusion.

You have asked:-

What has been your own experience with regard to patients who have presented with severe ARS vs. their time to seroconversion?  

I don't understand this question.


Have you experienced cases where the p24 Ag test returns a positive result when the antibody test is negative?

Yes of course - thats the whole point of the combined test - the p24 element allows for earlier detection of early HIV.

Any additional advice or insight would be welcomed.

You've had five sequential negative HIV tests over a period of 27 weeks. This means that you are HIV negative. If you wish to test further then a PCR would be the next test. It would though be unnecessary. You did not become HIV positive from the event described.

best wishes, Sean