Would HSV-2 Lower CD4 Count

[byeoldtimes]

I'm gay. I'm tested HSV-2 IgM Positive 1.5 months ago and Negative now. I'm HIV negative.

But my CD4 recently dropped and I've suffering from a long term low grade fever since HSV-2 infection (about 7 weeks and feel better since last week).

My CD4 dropped to 420 and CD8-HLA is activated(42%).

So my problems are:

1. Would HSV-2 lower CD4? If it would, how long does it take to recover?
2. I didn't have any symptoms of breakout during the infection. (Not on my genital nor mouth) So how possible would I transmit it to my partner through oral sex(both receive or give) 1 month after tested negative.
3. I've infected CMV. Some researches show that it's possible that the test confused HSV-2 IgM and CMV IgM (and some other virus in the same family). Is it true? And How could I possibly know that if I'm infected or not? Should I go for a HSV-1/2 IgG Test or something?
4. I still feel fatigue sometime even 1.5 months after the infection ( if it existed), is it reasonable? ( One of the best doctors here said that from my CD4 and CD8 test results, she made a conclusion that I'm currently NOT infected by any bacteria nor virus. I just need time to adjust my emotion and have more rest.)

Thank you.

[Terri Warren, RN, Adult Nurse Practitioner]

A positive HSV 1 IgM followed by a negative HSV 2 IgM means absolutely nothing whatsoever.  You need an IgG test, not an IgM test.  There are many false positives on the IgM test.  Why did you have the test done in the first place?  You report no herpes symptoms right?  Be certain the test that you get is type specific - that is, can differentiate between HSV 1 and HSV 2 IgG accurately.  I thinking that you might not live in the US so I'm not sure what tests are available to you?  IgM tests should Never EVER be used to diagnose adults with heres.

Also, why were you tested for CD4 and CD8 is you are HIV negative?

Terri

Terri

[Terri Warren, RN, Adult Nurse Practitioner]

1,  HSV 2 would not lower your CD4 count, no.
2.  Answered in my post above.  
3.  Answered in my post above.
4.  It is my understanding that CD4 an CD 8 cells vary a lot, so I'm not cler that you are immunocompromised at all.

When someone goes to several different doctors and most of them tell them nothing is wrong, I believe that nothing is wrong.

Please stop taking antiviral medicine and get an IgG HSV antibody test.

Terri

[byeoldtimes]

Sorry, let me describe my situation in detail.

Medical History
1. I'm gay and tested HIV negative this May.
2. I'm infected by CMV this May (IgM Positive and turned Negative after treatment)
3. I gave/received oral sex with a man 7 weeks ago, about 3 days after then I have 1~2 herpes inside my mouth ( I'm not sure whether they were herpes), and none on my genital.
4. I had a consistent low grade fever in the past 7 weeks (even now), usually 37.2~37.3 c. And I measured my temperature after sleep and it should be 36.5 c. Though my temperature varies within 1 degree, but when my temperature rises to 37.2/3 I feel fatigue and unwell. I also have reduplicated sore throat.
5. I tested HIV antibody and p24 4 weeks after my last sex(7 weeks ago), I also had quick oral 6 weeks after that. My doctor said HIV isn't something I should worried about, My exposure is at very low risk.
6. I've tested EBV, Gonorrhea, Syphilis, flu, hepatitis B, hepatitis C negative. I also tested CMV IgM and copies, both negative.
7. The doctor ordered a HSV1/2 IgM type-specified test, turned out HSV-1 IgM Negative, HSV-2 IgM Positive. But the test result has no cut-off value. The doctor gave me acyclovir and I've taken it from week 4 to week 6 (3 weeks) and I still feel fatigue sometime and my temperature could rise to 37.3 sometime.
7. When staying at home and sleep well, my temperature tend to be normal (37 or under 37), but when I get back to work or go outside my temperature rises and feel unwell.
8. So in week 6, I went for another doctor. She's an infectious disease specialist. She doubted the HSV-2 IgM test. Her reasons are as follows: 1) the test result didn't gave cut-off, it could be a false positive. 2) I have no symptoms on genital, and I'm not sure whether I have symptoms in my mouth. 3) even if I'm HSV-2 infected orally, symptoms should more likely appeared on my lips, not on mucosa inside my mouth. So I asked her to order another HSV-1 and HSV-2 IgM test and the result turns out that HSV-1 IgM Negative, HSV-2 IgM Negative.
9. This still doesn't explained why I had consistently low grade fever in the past 7 weeks. The doctor said that I might be over-anxious, and ordered an Lymphocyte subsets test. The result will tell us whether I'm infected by any bacteria or virus.
10. The result:

white blood cell 7000/ul
lymphocytes% 23.9% (27.9 ~ 37.3) LOW
lymphocytes   1673  (1752~2708) LOW
B-lymphocytes CD19%    5.3%   (8.5 ~ 14.5) LOW
B-lymphocytes CD19     89/ul   (180~324) LOW
CD16/56% 27.8% (9.5 ~ 23.5%) HIGH
CD16/56   465/ul (175~567)
T-lymphocytes CD3%   66%   (62.6 ~ 76.8)
T-lymphocytes CD3   1104   (1185~1901) LOW
CD4+T-lymphocytes%   25.5%   (30.0 ~ 46.0) LOW
CD4+T-lymphocytes    427/ul   (561~1137) LOW
CD8+T-lymphocytes%   24.7  (19.2~33.6)
CD8+T-lymphocytes   413/ul   (404 ~ 754)
CD4+CD28+/CD4+%  86.8%   (85 ~ 100)
CD4+CD28+    370   (520 ~ 1050)  LOW
CD8+CD28+/CD8+%   43.6%  (37.2 ~ 60.4)
CD8+CD28+   180  (190 ~ 392) LOW
CD8+DR+/CD8+%   46.5%   (6.3 ~ 23.8) HIGH
CD8+DR+   192 (20 ~ 178) HIGH
CD8+CD38+/CD8+%    45.4% (32.4~57.4)
CD8+CD38+    188/ul   (157 ~ 385)
CD4/CD8     1.03   (0.95 ~ 2.13)

11. My (2nd) doctor thought that I'm not infected by neither bacteria (my white blood cell isn't high) nor virus (CD8+DR+/CD8+% is higher than expected but still not high enough). She said that if I'm infected by virus, it should be as high as 80%, if infected by HIV it should even as high as 90%)

12. The 2nd doctor and 3rd doctor (another infectious disease specialist) both made the conclusion that I'm not infected, however, my immunity situation is quite poor right at this moment. The 3rd doctor gave me thymic peptide to boost my immunity system.

13. I've taken thymic peptide for 3 weeks, I felt better this week. But still got low grade fever sometime (frequency becomes lower)

So, my questions are :

1. Would HSV-2 lower CD4? If it would, how long does it take to recover?
2. Am I infected by HSV-2 or not based on the description above? I learnt that 2/3 of HSV infection has no symptoms at all.(So the IgM Positive in the 1st test could be possible?). But the doctor also told me that it usually takes a long period for IgM positive turn to negative (about 2~3 months?). So I'm not sure whether I'm not infected, or I was infected but cured?
3. What further tests should I take? I would discuss with my doctor next week.
4. Though they thought I'm not infected by virus, my consistent low grade fever is consequence of poor immunity situation. I'm still worried, because drop in CD4 and CD8+DR+% shows that my immunity system is activated,right?

[byeoldtimes]

Sorry, let me describe my situation in detail.

Medical History
1. I'm gay and tested HIV negative this May.
2. I'm infected by CMV this May (IgM Positive and turned Negative after treatment)
3. I gave/received oral sex with a man 7 weeks ago, about 3 days after then I have 1~2 herpes inside my mouth ( I'm not sure whether they were herpes), and none on my genital.
4. I had a consistent low grade fever in the past 7 weeks (even now), usually 37.2~37.3 c. And I measured my temperature after sleep and it should be 36.5 c. Though my temperature varies within 1 degree, but when my temperature rises to 37.2/3 I feel fatigue and unwell. I also have reduplicated sore throat.
5. I tested HIV antibody and p24 4 weeks after my last sex(7 weeks ago), I also had quick oral 6 weeks after that. My doctor said HIV isn't something I should worried about, My exposure is at very low risk.
6. I've tested EBV, Gonorrhea, Syphilis, flu, hepatitis B, hepatitis C negative. I also tested CMV IgM and copies, both negative.
7. The doctor ordered a HSV1/2 IgM type-specified test, turned out HSV-1 IgM Negative, HSV-2 IgM Positive. But the test result has no cut-off value. The doctor gave me acyclovir and I've taken it from week 4 to week 6 (3 weeks) and I still feel fatigue sometime and my temperature could rise to 37.3 sometime.
7. When staying at home and sleep well, my temperature tend to be normal (37 or under 37), but when I get back to work or go outside my temperature rises and feel unwell.
8. So in week 6, I went for another doctor. She's an infectious disease specialist. She doubted the HSV-2 IgM test. Her reasons are as follows: 1) the test result didn't gave cut-off, it could be a false positive. 2) I have no symptoms on genital, and I'm not sure whether I have symptoms in my mouth. 3) even if I'm HSV-2 infected orally, symptoms should more likely appeared on my lips, not on mucosa inside my mouth. So I asked her to order another HSV-1 and HSV-2 IgM test and the result turns out that HSV-1 IgM Negative, HSV-2 IgM Negative.
9. This still doesn't explained why I had consistently low grade fever in the past 7 weeks. The doctor said that I might be over-anxious, and ordered an Lymphocyte subsets test. The result will tell us whether I'm infected by any bacteria or virus.
10. The result:

white blood cell 7000/ul
lymphocytes% 23.9% (27.9 ~ 37.3) LOW
lymphocytes   1673  (1752~2708) LOW
B-lymphocytes CD19%    5.3%   (8.5 ~ 14.5) LOW
B-lymphocytes CD19     89/ul   (180~324) LOW
CD16/56% 27.8% (9.5 ~ 23.5%) HIGH
CD16/56   465/ul (175~567)
T-lymphocytes CD3%   66%   (62.6 ~ 76.8)
T-lymphocytes CD3   1104   (1185~1901) LOW
CD4+T-lymphocytes%   25.5%   (30.0 ~ 46.0) LOW
CD4+T-lymphocytes    427/ul   (561~1137) LOW
CD8+T-lymphocytes%   24.7  (19.2~33.6)
CD8+T-lymphocytes   413/ul   (404 ~ 754)
CD4+CD28+/CD4+%  86.8%   (85 ~ 100)
CD4+CD28+    370   (520 ~ 1050)  LOW
CD8+CD28+/CD8+%   43.6%  (37.2 ~ 60.4)
CD8+CD28+   180  (190 ~ 392) LOW
CD8+DR+/CD8+%   46.5%   (6.3 ~ 23.8) HIGH
CD8+DR+   192 (20 ~ 178) HIGH
CD8+CD38+/CD8+%    45.4% (32.4~57.4)
CD8+CD38+    188/ul   (157 ~ 385)
CD4/CD8     1.03   (0.95 ~ 2.13)

11. My (2nd) doctor thought that I'm not infected by neither bacteria (my white blood cell isn't high) nor virus (CD8+DR+/CD8+% is higher than expected but still not high enough). She said that if I'm infected by virus, it should be as high as 80%, if infected by HIV it should even as high as 90%)

12. The 2nd doctor and 3rd doctor (another infectious disease specialist) both made the conclusion that I'm not infected, however, my immunity situation is quite poor right at this moment. The 3rd doctor gave me thymic peptide to boost my immunity system.

13. I've taken thymic peptide for 3 weeks, I felt better this week. But still got low grade fever sometime (frequency becomes lower)

So, my questions are :

1. Would HSV-2 lower CD4? If it would, how long does it take to recover?
2. Am I infected by HSV-2 or not based on the description above? I learnt that 2/3 of HSV infection has no symptoms at all.(So the IgM Positive in the 1st test could be possible?). But the doctor also told me that it usually takes a long period for IgM positive turn to negative (about 2~3 months?). So I'm not sure whether I'm not infected, or I was infected but cured?
3. What further tests should I take? I would discuss with my doctor next week.
4. Though they thought I'm not infected by virus, my consistent low grade fever is consequence of poor immunity situation. I'm still worried, because drop in CD4 and CD8+DR+% shows that my immunity system is activated,right?