Question: Hello Doctor,

I am a sexually active 32 years male. I have had multiple sexual encounters with multiple women since 2006. I always used condom in all my sexual encounters.

Back in May 2007, I was having sex with a sex worker and the condom broke. I do not know the HIV status of the women I had sex with. I did not have nay HIV symptoms at that time and did not take any post exposure medication.

My last exposure was on 5th November 2011 and I used condom this time too.

In January 2012, I developed severe back pain, indigestion and blood test and urine test. Following are the test results:

     i) My CBC (complete blood count) was found to be normal
     ii) I was found to be severly deficient in Vitamin D
     iii) I was found to be deficient in Vitamin B12
     iv) There was blood trace found in the Urine (RBCs were found in the urine)

The doctor gave me vitmain B12 injection and 0000IU Vitamin D tablets. Also for the Urinary Tract Infection the doctor gave me a course of Bactrim Ds tablets for 7 days starting 26th January 2012. I was very much concerned if I have HIV infection and went to a HIV testing centre.

On 29th January 2012, the doctors at the HIV testing centre tested me for HIV 1,2 antibodies using a Rapid HIV Test. Please note that I was taking bactrim twice a day (in the morning and evening) while they ran the HIV Rapid test. To be exact, I was on the 4th day of the 7 day Bactrim DS course when the ran the HIV Rapid test. The HIV rapid test result came out Negative. On the same day, I was tested for all other STDs and the results came out Negative.


A month after giving the HIV rapid test, On 29th February 2012, I was give hydrocortisone injection on my back (along the spinal cord) for my back pain. The pain did not go away after the injection. Then the doctors checked the spinal cord using the MRI scan and everything came out normal. The doctors then said like probably I was having muscular pain and nothing was wrong with my spinal cord to give me back pain.

Then again on 29th March 2012 ( 4 months since my last expsoure, two months after taking the bactrim ds tablets, a month after taking the hydrocortisone steroid injection) I went for HIV ELISA antibody test for HIV 1, 2 antibodies. The HIV test result came back Negative with the following measurements:

     Test OD - 0.017
     Cutoff OD - 0.180

The doctor said like, I was most likely to be HIV negative as the last serious exposure was in May 2007 and the results came back negative.

Since then, I have developed a fungal infection (candidis) on my penis and an ear infection too. The doctor said like the fungal infection is common and the ear infection was probably because I used somebody else's headphone or earphone.

But I am really concerned if the Bactrim DS tablets or the Hydrocortisone injection could have affected my HIV test results (both Rapid and the ELISA)?

I am really worried and going thru depression. Please advice if my previous HIV test results were invalid and If I need to go for further testing. If so when should I go for the next HIV test and what kind of test shuould I go for (ELISA, Western Blot, RNA PCR). Also let me know which is the best place for these tests in Bangalore, India.

Thanks,
XXXXXXX

Hello Doctor,

Thank you so much for you informative reply. I have few questions:

1. I do have severe fatigue, knee pain, pain in the feet. I become tired very easily. I have heard that people who have HIV has these symptoms. Or could these symptoms be because of other illness?

2. Also, I seem to have completely lost my appetite. Could this be because of any HIV or STD infection? Or is this because of the vitamin B12, Vitamin D deficiencies I have?

3. I have very poor appetite. I hardly eat two meals a day. How do I get my appetite back? Is there any specific disease I should be tested for my poor appetite? I have already been tested for Hepatitis and lever related diseases.

4. How do I get back my vitamin B12 to normal levels. I have been taking the 1000mcg per day vitamin b12 tablets as my doctor advised. But there seem to be no effect at all. I feel very tired and anemic. Should I ask for Vitamin B12 injection instead of tablets?

5. My doctor told me that my vitamin D deficiency should improve if I get enough sunlight. But it hasn't improved yet despite me spending couple of hours in sunlight everyday for the last 7 months. Do you think any other medical condition could lead to poor vitamin D absorption?

6. My backpain is chronic and is always along the spinal column. I would say it is more inflammatory than acute pain. I head HIV patients have back pain complaints. Do you think something else could be a reason for this back pain?

7. I do hear my own heart-beat while I am about to sleep or whenever I am trying to lay down calm. Is this a HIV symptom?

Sorry I might have asked stupid question. I request your kind understanding. I am very concerned and scared because of my current health condition.

You have been really helpful. Thanks a log.

Best Regards,
XXXXXXX