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Is urticaria common in people with HIV?

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Posted on Thu, 14 May 2015
Question: Dear Doctor,

I had unprotected sex with a friend of mine. As far as i can remember I have been experiencing mild rash on my hands (mostly left hand) and both inner thighs. First appear after I drink relatively large amount of alcohol about 3 weeks ago. Now i get them every next day after my drinking session. I used to be a heavy drinker. Now only once a week. Now rash gets a a bit worst next day after I drink alcohol. It has been going on for 3 weeks. But then days after my drinking session, they sometimes disappear (after i drink lot amount of water). Then reappear mildly (occasionally), they are not itchy. I have been quite stress about HIV right even before the rash appear, because I had unprotected sex in December 2014. Next contact was around February 2014. So I took an Elisa Combo test in Siloam Hospital. It came out non reactive with 0.13 points. I think that the test taken about approximately 6-8 weeks (42-56 days) after last exposure.

My questions are:
1. Is Elisa Combo reliable? I have been googling a lot about this HIV topic,
nothing gives me a peace of mind. My stress level is escalating day by day.
2. Is Elisa Combo equals to 4th generation test?
3. Is it possible the rash is the effect of my stressful mind condition? What are the chances that the rash could be HIV symptoms?
4. Do I need to take another test? Or I can move on and enjoy my life now?

Thank you Doctor
-A paranoid guy-

doctor
Answered by Dr. Kakkar S. (24 minutes later)
Brief Answer:
HIV is ruled out; Kindly upload image of rash.

Detailed Answer:
Hello. Thank you for writing to us

I have taken note of your query and I have understood it.

Regarding testing for HIV with Combo test, it is a 4th generation test.
It is an antigen as well as antibody based HIV test i.e tests for both circulating HIV P 24 antigen as well as antibodies to HIV.
This test is highly reliable at and beyond 28 days after sexual intercourse and therefore a negative test after 6-8 weeks of your last unprotected sexual contact rules out HIV.
There is no need for further testing.

Regarding the rash I would like to have a look at it if you can upload a few Images.

You may upload images either at "Reports Section"

Or else

You may also mail me the image at YYYY@YYYY
Kindly mention the subject of this mail as Attention Dr.kakkar.

Regards
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Kakkar S. (1 hour later)
Dear Dr. Kakkar,

Many thanks for your kind and quick reply.

I will try to email you the picture. Currently the rash is in a very mild condition.
It is not very obvious. Hopefully the picture will be good enough.

Again thank you Dr. Kakkar
Following to our discussion I have attached couple of picture on my left hand.
Currently the condition is Very Mild. Nothing on my right hand and even less obvious in my both thighs.
If you do not mind, I will send you the picture when they turn bad.

These things come and goes for almost 3 weeks now.
Only sometimes I notice, when I get stressed out it gets more obvious (redish i suppose).
So i have been taking dumolit (nitrazepam) to calm my head down, it gets better, maybe.
But what do I know.

many thanks Doc

Best regards,
Tez
doctor
Answered by Dr. Kakkar S. (4 hours later)
Brief Answer:
Possibility of Urticaria; OTC oral antihistamine

Detailed Answer:
Hi.

I have reviewed the Images.
There are faintly red, raised indistinct welts on forearm.
History of evanescent recurrent rashes/ welts that come after alcohol intake and then go by themselves, is most likely urticaria/ hives.
Alcohol intake is a known precipitant of urticaria.
Itching is subjective and can be mild to severe in urticaria.

I suggest you to take an Oral antihistamine e.g cetrizine 10 mg once daily.
Topical you may use an anti-itch lotion/ cream e.g calamine lotion.

Of course, you can send more Images if and when they get worse.

Let me know the medications prescribed by your skin doctor? That would also be suggestive..

Regards
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Kakkar S. (2 hours later)
Dear Dr Kakkar,

Thank you for your quick reply.

Today i took one each of the following which my doctor gave me:
1.xyzal levocetrizine dihydrochloride, for mornings.
2.telfast od 120mg fexofenadine hcl, for nights.

Seems to get better after consumption but then reappear after few hours later. Very mildly.

Again i appologize for being too paranoid but i have red in the forum, one of the doctor said that hiv test needs to be tested in the 90th day to be conclusive. Is that correct?

How long you reckon that my condition to be resolved?
Do i need to stop drinking? I have been drinking since 2005. Used to be quite heavy. This is the first time i experience such condition.
I have been very healthy inspite of my smoking and drinking habits.
In case this still not resolved, what should i do?

Again thank you Doctor.
doctor
Answered by Dr. Kakkar S. (20 minutes later)
Brief Answer:
Avoid drinking; Your HIV status is conclusive

Detailed Answer:
Hi.

Your skin specialist too has also prescribed you oral antihistamines (i.e levocetrizine and fexofenadine) which suggests that he/ she also thinks in terms of Urticaria.
You may continue with these for a few days. Avoid alcohol as this seems to be the likely precipitating cause in your case.

HIV test, if purely an antibody based test, has a long window period of 90 days therefore it needs to be repeated at 90 days.

However, for a Combo test i.e a test based on HIV antigen (P 24) and HIV antibody, has a shortish window period i.e 11 to 28 days.

Therefore, a negative test at 1 month is conclusive for a Combo test.

As yours was a negative Combo test after 6-8 weeks of risky sexual contact therefore it is conclusive and need not be repeated.


Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Kakkar S. (10 minutes later)
Dear Dr Kakkar,

I highly appreciate your kind and detailed explanation.

My last question, what are the chances that this condition is caused by paranoia of hiv?
Honestly i have been extremly stressfull about the issue since last few months.

Again thank you.
doctor
Answered by Dr. Kakkar S. (12 hours later)
Brief Answer:
Unlikely due to stress

Detailed Answer:
Hi.

Urticaria is unlikely purely due to stress.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. (3 days later)
Dear Dr Kakkar,

Following to our discussion.

Currently the rash on hands and thighs are seem to be disappeared.

Last night i had quite hard cardio exercise since last 2 years. This morning i took levocetrizine given to me by doctor before breakfast. I noticed some res bumps appeared on chest while brushing my teeth.

Gave me scare quite a lot. I attach pictures for your review.

I called the hospital where i took the xombo test. I ask them wether any other kind of combo test. I need to clarify with them wether it is the combo 4th generation like u have explained.

My question:
1. Is there any other kind of combo test?
2. Does the red bumps similar to symptoms of hiv? Does it always accompany by other symptoms?

So far i have no other symptoms other than the anomalies on my skin. Please advise Doctor. Many thanks in advance.
doctor
Answered by Dr. Kakkar S. (15 hours later)
Brief Answer:
Acneform eruptions on chest

Detailed Answer:
Hi.

As far as my knowledge, there is no other Combo test for HIV other than the Antigen/Antibody test that you went through.
HIV may be symptomless Or may start with non-specific flu like symptoms.
Later on when immunodeficiency sets in HIV may manifest with weight loss, loose stools, opportunistic infections, malignancies etc.
The bumps that you have on your chest are actually acneform eruptions. These are not suggestive of HIV in anyway. These are fairly common in general population.
I suggest you to use a topical benzoyl peroxide twice daily and these should get fine.

Regards
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Kakkar S. (1 hour later)
Dear Dr Kakkar,

Regardless of my negative test result. Is Urticaria common in people with HIV?
What is the difference between Urticaria and Scabbies in term of symptoms and form?

My mild rash seem to reappear. Is it possible that this could be cured without medicine? They do not really bothers me. Only when I take a close look at it.
Honestly I have not really taken my given medicine regularly. 4 times levocetrizine and twice fexofenadine hcl.
Is it OK to take fexofenadine hcl with other supplements, such as Omega 3 6 9, Vitamin C 1000 and supplements for Liver and Kidney?
I have been taking those supplements for quite a while.

What could be the causes of Urticaria?
Will it be fatal if I just let them be, the rash.

Could this rash be related to symptoms of any internal organ failure?
Like liver and kidney, thinking that I used to be a quite heavy drinker and drink lesser water during my previous days.

Or diabetic? I used to love chocolate very much.

I keep wondering why I have this rash and why now.
Why after years of drinking habit it comes to appear just recently.

Please advise Doctor. Thank you.


doctor
Answered by Dr. Kakkar S. (7 hours later)
Brief Answer:
Urticaria is common; is not fatal; You should take its treatment regularly

Detailed Answer:
Hi.

Urticaria is otherwise fairly common in the general population and is not more common in HIV.

Urticaria presents as welts which may be itchy. Lesions are evanescent i.e they last for a few hours and then disappear without any tell tale sign. The lesions may reappear.

Scabies on the other hand presents as insect bite like, itchy skin lesions at various body sites like inner thighs, lower abdomen, torso, arms and legs.
The lesions are more persistent as compared to urticaria and itching is more common at night.
Other family members may also be affected with scabies.

Urticaria can be due to allergy to food Or food preservatives, drugs ( e.g antibiotics, vitamins etc) etc.
Certain drugs like aspirin, painkillers can also induce urticaria (non-allergic type) due to release of vasoactive mediators.
Alcohol is also a well known cause of urticaria.
Infections are a common cause e.g dental infections, flu i.e viral cold and fever can also induce urticaria.
Half of all cases of urticaria have no known cause i.e idiopathic in nature.

Most of the individuals in this world have had experienced urticaria at least once in there lifetime, therefore, it is common entity.
It is quite possible that one of the vitamins, supplements, alcohol could be a cause for your present urticaria.
Were these supplements started for certain deficiency Or medical conditions?
I would suggest that you discontinue with these if they are not specifically indicated and rather take a healthy nutritious diet.

Urticaria is not fatal and is neither a sign of internal organ failure nor of a deficiency.
Neither is it more common in diabetes.

Majority of cases of recent onset urticaria subside within 2 weeks of onset.
Therefore I suggest that you continue with the symptomatic treatment, regularly as advised by your doctor..

Regards
Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
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Follow up: Dr. Kakkar S. (15 hours later)
Dear Dr Kakkar,

Many thanks for your kind and detailed explanation.

I have been taking those vitamins just for the sake of being cautious. Considering i am still an active smoker and occasional drinker (once a week).

I have been taking vitamin C 1000 for years now. Helps quite a lot. I could stay healthy for a whole year without even a flu.

I used to take simvastatin to maintain my cholesterol level. Last year was at 198 Have not been checking since then.
But now i take complete omega 3-6-9 instead. Started about a month ago i suppose.

I take a herbal supplement for liver and kidney. Considering i am a drinker. Its been couple months i suppose.

Those are the supplements i take almost about once every two days. But since i got this skin issue. I take a lot lesser.

Again. Thank you Dr Kakkar.
doctor
Answered by Dr. Kakkar S. (8 hours later)
Brief Answer:
For now continue with Oral antihistamines for another week Or so.

Detailed Answer:
Hi. Thank you for the details.

I think you can take an Oral antihistamine for another week or so, as suggested by your doctor and then try stopping them.
However, if your urticaria still does'nt subside by then you need to try stop taking these supplements.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. (57 minutes later)
Dear Dr Kakkar,

Thank you for the advise.
I will finish my medication and take lot lesser supplements.

One last question;
I have a bad gastric acid problem.
When it gets bad I will experience a very bad headache. I had this couple days ago and I notice that my rash reappeared.
Is there in anyway that my gastric acid could also trigger the rash?

Only about these last 6 months I notice that when my gastric gets bad I get food allergic easily sometimes.

Again thank you for your advises Doctor.

Best regards
doctor
Answered by Dr. Kakkar S. (2 hours later)
Brief Answer:
Helicobacterium pylori could be a link.

Detailed Answer:
Hi.

A bacteria, Helicobacterium Pylori could be a link between Gastric problems and Urticaria.

The infection can be confirmed by a breath test Or by endoscopic biopsy. If confirmed, a 2 week course of an Oral antibiotics would eradicate the infection and possibly cure Urticaria.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Kakkar S.

Dermatologist

Practicing since :2002

Answered : 9382 Questions

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Is urticaria common in people with HIV?

Brief Answer: HIV is ruled out; Kindly upload image of rash. Detailed Answer: Hello. Thank you for writing to us I have taken note of your query and I have understood it. Regarding testing for HIV with Combo test, it is a 4th generation test. It is an antigen as well as antibody based HIV test i.e tests for both circulating HIV P 24 antigen as well as antibodies to HIV. This test is highly reliable at and beyond 28 days after sexual intercourse and therefore a negative test after 6-8 weeks of your last unprotected sexual contact rules out HIV. There is no need for further testing. Regarding the rash I would like to have a look at it if you can upload a few Images. You may upload images either at "Reports Section" Or else You may also mail me the image at YYYY@YYYY Kindly mention the subject of this mail as Attention Dr.kakkar. Regards