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Dr. Andrew Rynne

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Had unprotected vaginal exposure and groin pain due to swollen lymph. Test showing hepatitis B. Any chance of HIV?

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Dr. Roopa Hiremath

Infectious Diseases Specialist

Practicing since :2002

Answered : 877 Questions

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Posted on Wed, 11 Dec 2013 in HIV and AIDS
Question: Dear Doctor, On 30 Oct 2013, I had an unprotected vaginal exposure with a CSW. I dont know her HIV status. I am circumcised person. Two days after that i have started to have low grade fever that is continuing till date. I have groin pain may be because of lymph swelling. I had throat irritation and was treated with Augmentin. I used to take panadol (acetaminophen) to control the fever. I was really depressed and was cursing myself. I was thinking of committing suicide. There was muscle pain mainly on the back of the lower abdomen. Day before yesterday on day 17th after my exposure, I got HIV 1/2, P24 combo screening and it was non reactive with index 0.23. Further test also confirmed presence of HBsAG B (hepatitis B) as 2.04 IU/ML. Please advice doctor, is theres any chance of HIV.......i m already loosing out my battle
doctor
Answered by Dr. Roopa Hiremath 1 hour later
Brief Answer: HIV and HIV testing Detailed Answer: Hi, Welcome to health care magic. I have gone through your query and I understand your anxiety regarding this episode. Unprotected sex with a commercial sex worker definitely can be considered as potential exposure. And you have undergone the right test i.e HIV 1/2 and p24 combo which is test of choice during early infection. This test is a very specific test and usually should test positive if infection has occurred. So if this test is negative, you most probably are not infected with HIV. National AIDS Control Organization has suggested a strategy for HIV testing where any HIV test result has to be confirmed by another test just to be very sure. I suggest you undergo ELISA for HIV 1 and 2 antigens and antibodies 4 weeks from now to confirm your HIV negative status. Please remember, this test is to confirm your HIV negative status. I hope I have answered your query satisfactorily. Please get back if any more clarifications. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Roopa Hiremath 53 minutes later
Dear Dr. XXXXXXX thank you so much. It was really nice of your reply. I am having groin pain and mild fever. Although I have tested positive for Hepatitis B infection on the same day (17th day after unprotected exposure). (HBsAG =2.04, ALT 91 others are normal) In your long experience, did you ever find a case where HIV 1/2, P24 combo from Dr. Lal Path Lab went wrong. I know its very early to be conclusive. Do you think thats it is impossible for the test to identify a single P24. Lots of queries, do you think my present mild fever and groin pain may be because of Hepatitis etc. Is my hepatistis is acute or chronic. Please shed some light on this. If I am not HIV positive, I will dedicate my life to the society, the needy most. I will really serve the people if God give me this second chance. Promise to my soul and heart.
doctor
Answered by Dr. Roopa Hiremath 49 minutes later
Brief Answer: Hepatitis B infection and HIV testing Detailed Answer: Hi, Welcome back. I would like to elaborate few points about Hepatitis B infection so that you can understand better. Hepatitis B infection is spread by the following routes: 1) Parenteral transmission - means by blood transfusion, i.v drug abuse, tattooing 2) Sexual transmission - by sexual intercourse with infected person 3) Perinatal transmission - from mother to baby Hepatitis disease develops after about 2 - 6 months after infection. Here patient has weakness, fever, jaundice and most of them recover completely. Diagnosis is based on detection of certain markers which are present in Hepatitis B infection. These are listed below: 1. HBs Ag 2. anti HBc 3. Ig M anti HBc 4. anti HBs These parameters decide whether the infection is acute or chronic. In acute infection, HBs Ag, anti HBc and Ig M anti HBc are positive and anti HBs is negative. In chronic infection, HBs Ag and anti HBc are positive and Ig M anti HBc and anti HBs is negative. I have tried to simplify it as much as possible. In your case, only HBs Ag is not definitive, you get yourself tested for the other three parameters I have mentioned earlier to confirm diagnosis of Hepatitis B. Coming to HIV testing, very less chances of p24 test going wrong in adults. There is a possibility of false negative P24 test in babies born to HIV positive mothers and who are breast feeding. Moreover, HIV tests manufactured have to undergo serious quality control and maintenance as HIV reporting involves lots of moral, social and psychological issues. Please quit worrying about your HIV status but do not forget to get a confirmatory test done 4 weeks from now. I hope I have cleared all your doubts. Please do not hesitate to get back if any more queries. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Roopa Hiremath 2 days later
Dear Dr. XXXXXXX Greetings! Hope all are fine with you. Yesterday night, i was having sour throat and i took betadine for gurgle. Since the last two weeks i having fever, and today feeling bodyache and lil bit tired XXXXXXX My fever is also there, considering my Hepatitis infection what do you suggest me to take as medicine or I just continue like this till all my lab results are known to me. Do you think this could be also HIV although its non reactive at 17 day by HIV 1/2 P24 combo screening. Wish you very best and thank you in advance for your kind reply, at least i can speak with you only. With best regards,
doctor
Answered by Dr. Roopa Hiremath 13 hours later
Brief Answer: Paracetamol for fever and rest Detailed Answer: Hi, Apologies for the late reply. Welcome back. Please continue the betadine gargles which will reduce the bacterial multiplication and also reduce pain. For fever, you can take paracetamol 500 mg three times daily for two days. This medication will help reduce the body ache also. If the fever does not reduce in two days, then you get in touch with your treating doctor for a prescription of antibiotics for 5-7 days. Avoid cold foods, exposure to cold weather and rest is required till fever reduces. Drink adequate water preferably warm water. Even though acute HIV infection may present with flu like illness, I doubt it is that in your case as it is almost 20 days since exposure. Please do not worry, I do not think it is HIV infection. I hope I have cleared all your doubts. Wishing you speedy recovery. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Roopa Hiremath 14 hours later
Thank you so much Dr. XXXXXXX You are always encouraging. Yesterday night just before receiving your reply, I had sore throat and body ache specially lower back and legs. I applied volini and gurgle with betadine. Today morning, my back pain and leg pain is not there. But sometimes productive caughing occurs is there. As per your advice drinking warm water and really feeling better. Fever seems to be less now. Yes you are right, today is 22 day after exposure. I am bit worried about sore throat. As most of the HIV scute symptom says sore throat and fever are prevalance. (internet knowledge). Althogh i have negative test on day 17, but do you think that if the HIV syptom is showing on 22 day then 17th day HIV 1/2 P24 combo testing will be non reactive. Or perhaps the sore throat is because of my Hepatitis B infection. Trust me you are like an XXXXXXX to me. For your advice and suggestion. I cant speak this anyone in my surroundings and thinking-reading nearly 8 hours a day in the internet for HIV infection. Do you have any case in your experience where HIV combo test is giving negative on 17th day and positive afterwards? Althogh its does not mean that much. Every case is different. This is my only sexual exposure till date that also once only. I wore the condom but somehow it slipped during the course. When I finished, found condom inside the vagina and semen attached outside the condom. I found circumscision is reducing the chance. i am circumscised. Within a minute I put myself in dager. I put an end to my promising career just for a minute. I really felt ashamed of myself. I wont indulge anything like this in my life but please God give me a second chance,please........ Any way please dont be annoyed with me. With all respect,
doctor
Answered by Dr. Roopa Hiremath 8 hours later
Brief Answer: Please do not worry about HIV Detailed Answer: Hi, Welcome back. Please do not worry about HIV infection. I have not seen a case where pcr turns positive later. I suggest you get a confirmatory test as I had told in my previous answer. Sore throat is not because of hepatitis b. I hope I have cleared your doubts. Thanks
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Roopa Hiremath 4 minutes later
Dear Dr. XXXXXXX Sorry for bothering you. But my test was HIV 1/2 with p 24 screeing of Dr Lal Path lab, delhi and not the pcr. Do you still have the same opinion. The test was at day 17 after exposure. Yes i will be going for retest at 4 th week. With highest regards,
doctor
Answered by Dr. Roopa Hiremath 8 hours later
Brief Answer: p24 testing Detailed Answer: Hi, I apologise for the mistake. P24 also is of same specificity as PCR in early infection. Please Get the confirmatory test done. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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