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Had Unprotected Sex. Tested Negative For HIV. Getting Diarrhoea, Night Sweats And Fungal Infection In Mouth. What's Wrong?
Question: I am a 37 year old man from Norway. 6-8 years ago I had two incidents of sexual contact with West-African prostitutes in Oslo (Ghana/Nigeria). In one of the incidents I had fresh wounds on my fingers (I often bite my fingers and in this case I was bleeding right before the incident). My fingers were in contact with the girls vagina. I remember I was looking at my fingers right after the incident and I was thinking "Now I might have been infected with something". Then it never crossed my mind again until October 2011. I also have a memory of a flu-like illness with swollen lymph glands that I had several years ago, and that my wife did not get it. I had no knowledge og HIV symptoms at that time, so I didn't connect that disease with my sexual incidents. I am not sure if there were any connection.
In September 2011 I got diarrhea that lasted for 3 months (still have it on and off). 2-3 week after the diarrhea startet I got a fever-like feeling in my head (no fever), lasted for 8-9 weeks. At the same time I also got extreme night sweats. That lasted for months, I still have it on and off, but I sleep with only a thin blanket to reduce it. During this period of about 3 months I also experienced extreme fatigue, extreme sound sensivity (physical pain when exposed to sound), very high resting heart rate (80-90) for several months, one incident of fungal infection in my mouth, excess mucus in my lungs, 10% weight loss, rarely fever (except when I had Streptococcus in my throat, cured with Clarithromycin, didn't disappear with Apocillin), CRP was 15-60 for weeks, body aches, dry mouth, muscle twitches, sore throat. I was tested for "everything", and the only thing that was found was "recent or active" Mycoplasma pneumoniae in addition to Streptococcus. Three negative HIV-tests during these months.
I was diagnosed as depressed/delusional in December and startet on medications to treat that. That did not reduce my physical ailments. I have now stopped taking both types of medications (anti-psychotics and anti-depressants), and I am feeling fine mentally. I still experience varying degrees of tiredness/nightsweats/diarrhea/body aches and the fever-like feeling in my head is back since beginning of September. Despite negative HIV-tests I have persuaded three different doctors to check my CD4/CD8-levels.
January: 603/558 (ratio=1.08)
April: 753/1084 (ratio=0.69)
August: 704/937 (ratio=0.75)
So what I get from this is that I have a slightly lowered CD4 count, and a very high CD8 count on the two latest tests. Also it seems like I have an unusual low CD4/CD8 ratio (normal is between 1 and 2 I have read, and HIV negatives rarely have a ratio below 1). A CD8 count of 1084 is also outside the reference intervals (200-1000). All this; symptoms, blood values and sexual incidents, makes me suspicious regarding HIV. "Problem" is that HIV-testing is telling me I am negative. That confuses my mind. I also had an ELISA-test in April which turned out positive (outside the reference limit values). I have tested for syphilis and Borrelia, negative.
It is physically painful to live this way. Is there anything I can do? Any suggestion what can be wrong with my body? Is the HIV antibody test reliable also for HIV-2? I try to excercise on my best days, and I eat healthy.
In September 2011 I got diarrhea that lasted for 3 months (still have it on and off). 2-3 week after the diarrhea startet I got a fever-like feeling in my head (no fever), lasted for 8-9 weeks. At the same time I also got extreme night sweats. That lasted for months, I still have it on and off, but I sleep with only a thin blanket to reduce it. During this period of about 3 months I also experienced extreme fatigue, extreme sound sensivity (physical pain when exposed to sound), very high resting heart rate (80-90) for several months, one incident of fungal infection in my mouth, excess mucus in my lungs, 10% weight loss, rarely fever (except when I had Streptococcus in my throat, cured with Clarithromycin, didn't disappear with Apocillin), CRP was 15-60 for weeks, body aches, dry mouth, muscle twitches, sore throat. I was tested for "everything", and the only thing that was found was "recent or active" Mycoplasma pneumoniae in addition to Streptococcus. Three negative HIV-tests during these months.
I was diagnosed as depressed/delusional in December and startet on medications to treat that. That did not reduce my physical ailments. I have now stopped taking both types of medications (anti-psychotics and anti-depressants), and I am feeling fine mentally. I still experience varying degrees of tiredness/nightsweats/diarrhea/body aches and the fever-like feeling in my head is back since beginning of September. Despite negative HIV-tests I have persuaded three different doctors to check my CD4/CD8-levels.
January: 603/558 (ratio=1.08)
April: 753/1084 (ratio=0.69)
August: 704/937 (ratio=0.75)
So what I get from this is that I have a slightly lowered CD4 count, and a very high CD8 count on the two latest tests. Also it seems like I have an unusual low CD4/CD8 ratio (normal is between 1 and 2 I have read, and HIV negatives rarely have a ratio below 1). A CD8 count of 1084 is also outside the reference intervals (200-1000). All this; symptoms, blood values and sexual incidents, makes me suspicious regarding HIV. "Problem" is that HIV-testing is telling me I am negative. That confuses my mind. I also had an ELISA-test in April which turned out positive (outside the reference limit values). I have tested for syphilis and Borrelia, negative.
It is physically painful to live this way. Is there anything I can do? Any suggestion what can be wrong with my body? Is the HIV antibody test reliable also for HIV-2? I try to excercise on my best days, and I eat healthy.
Hi,
Thanks for writing in.
I understand your concern and will give you best possible professional advise.
As you already know CD4/CD8 values are not used to diagnose HIV infection however they are used to monitor HIV positive patients for anti retroviral treatment.
Unless you have an HIV test positive the values of CD4/CD8 ratio do not indicate anything.
You have mentioned that you have tested negative 3 times for HIV.I would like to know details of these tests.Were these test ELISA or antibody tests or other tests?
Antibody based tests like ELISA are usually dependable when done after 3 months of suspected exposure to HIV.If ELISA shows negative results after 3 months it is highly suggestive that you are free from virus.
Your physical complaints can be from other disease rather than HIV /AIDS.They can be due to depressive illness or other bodily illness.
My advise to you would be to undergo a HIV RNA PCR test.This test is very reliable and it can detect even minute amount of HIV in body.If this test is negative you can be 100% free of HIV.Once you are confirmed that you dont have HIV we can go for other causes for your illness.
To reassure you I dont think you have got HIV.because of your sexual history and symptoms I would suggest that you should undergo HIV RNA PCR.
Hope this helps.
I will be available for follow up.If you need any further clarification feel free to ask them to me.
Regards
DrSudarshan
HIV & STD specialist.
Thanks for writing in.
I understand your concern and will give you best possible professional advise.
As you already know CD4/CD8 values are not used to diagnose HIV infection however they are used to monitor HIV positive patients for anti retroviral treatment.
Unless you have an HIV test positive the values of CD4/CD8 ratio do not indicate anything.
You have mentioned that you have tested negative 3 times for HIV.I would like to know details of these tests.Were these test ELISA or antibody tests or other tests?
Antibody based tests like ELISA are usually dependable when done after 3 months of suspected exposure to HIV.If ELISA shows negative results after 3 months it is highly suggestive that you are free from virus.
Your physical complaints can be from other disease rather than HIV /AIDS.They can be due to depressive illness or other bodily illness.
My advise to you would be to undergo a HIV RNA PCR test.This test is very reliable and it can detect even minute amount of HIV in body.If this test is negative you can be 100% free of HIV.Once you are confirmed that you dont have HIV we can go for other causes for your illness.
To reassure you I dont think you have got HIV.because of your sexual history and symptoms I would suggest that you should undergo HIV RNA PCR.
Hope this helps.
I will be available for follow up.If you need any further clarification feel free to ask them to me.
Regards
DrSudarshan
HIV & STD specialist.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I have taken 5-6 HIV tests the past 12 months. They are Combo test for HIV1/2 antibody/antigen.
As I told you my ELISA-test from April was positive, which makes me even more suspicious. There must be some kind of antibodies in my body since that test is positive.
What I did not tell you is that I took a blood test four weeks ago to perform an HIV PCR test. Two days later my doctor got the results for a standard antibody HIV test, negative. I thought this was a misunderstanding and went to take another blood test for PCR HIV. Then I called the lab and asked about this, and they said they didn't perform PCR tests unless my HIV test was positive. They confirmed that tey hadn't performed the PCR test, but still my doctor had gotten the results for HIV RNA PCR which was negative. Now they have changed their statement and they claim that they actually did perform PCR test for HIV1 (not for HiV2). This is a public hospital. I cannot really trust them when they say the have taken the test since they first said they hadn't and they don't do it unless antibody test is positive. Either way they have not performed PCR for HIV2 which makes me still wonder about this (HIV is common in West-Africa I have hear).
Should I really go abroad to get these PCR tests do you think? There are no private labs in Norway performing these tests.
As I told you my ELISA-test from April was positive, which makes me even more suspicious. There must be some kind of antibodies in my body since that test is positive.
What I did not tell you is that I took a blood test four weeks ago to perform an HIV PCR test. Two days later my doctor got the results for a standard antibody HIV test, negative. I thought this was a misunderstanding and went to take another blood test for PCR HIV. Then I called the lab and asked about this, and they said they didn't perform PCR tests unless my HIV test was positive. They confirmed that tey hadn't performed the PCR test, but still my doctor had gotten the results for HIV RNA PCR which was negative. Now they have changed their statement and they claim that they actually did perform PCR test for HIV1 (not for HiV2). This is a public hospital. I cannot really trust them when they say the have taken the test since they first said they hadn't and they don't do it unless antibody test is positive. Either way they have not performed PCR for HIV2 which makes me still wonder about this (HIV is common in West-Africa I have hear).
Should I really go abroad to get these PCR tests do you think? There are no private labs in Norway performing these tests.
Hi again,
It seems hospital people have goofed up with reports.
My suggestion would be to repeat HIV rNA PCR one more time.They can do it even if ELISA is negative.
Also if test is not possible there it should be done where it is done.Blood can be sent to other countries or you should visit abroad and get it done in a reputed lab.It is the only way to clear the confusion.
Hope this helps.
Regards.
DrSudarshan
It seems hospital people have goofed up with reports.
My suggestion would be to repeat HIV rNA PCR one more time.They can do it even if ELISA is negative.
Also if test is not possible there it should be done where it is done.Blood can be sent to other countries or you should visit abroad and get it done in a reputed lab.It is the only way to clear the confusion.
Hope this helps.
Regards.
DrSudarshan
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi again,
One ELISA test positive can be due to other diseses.It can occur in autoimmune diseases and XXXXXXX fungal infection.More likely possibility is lab error or false positive test.
Elisa is a screening test .It can give false positive test.
It should be confirmed by other test.
HIV2 is detected simultaneously by RNA PCR.It detects both HIV1 and 2.
If ELISA is only test available then it should be done 3 times.If all the test are positive then patient is positive for HIV.If the test give one or two positive then it cannot be considered definite result and should be confirmed by either WESTERN BLOT TEST or RNA PCR test.
Hope this helps.
Regards
DrSudarshan
MD
One ELISA test positive can be due to other diseses.It can occur in autoimmune diseases and XXXXXXX fungal infection.More likely possibility is lab error or false positive test.
Elisa is a screening test .It can give false positive test.
It should be confirmed by other test.
HIV2 is detected simultaneously by RNA PCR.It detects both HIV1 and 2.
If ELISA is only test available then it should be done 3 times.If all the test are positive then patient is positive for HIV.If the test give one or two positive then it cannot be considered definite result and should be confirmed by either WESTERN BLOT TEST or RNA PCR test.
Hope this helps.
Regards
DrSudarshan
MD
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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