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Dr. Andrew Rynne

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What are the symptoms of HIV?

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Dr. S. Murugan

HIV AIDS Specialist

Practicing since :1974

Answered : 2726 Questions

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Posted on Sat, 30 Aug 2014 in HIV and AIDS
Question: Hi,

I just would like to know regarding HIV ARS Symtoms:

1. If in case Espongitis Candida occurs during ARS / Seroconversion time, would that go away on its own like other symptoms go away or considering its severity, one would need fungal treatment for that ?

2. I know HIV test is the Gold Standard. But, would a person's CBC / FBC / Blood work report show any abnormalities during "ARS / Seroconversion time" ?

3. Will only one ARS symptom last for more than 1 month, while other ARS Symptoms had gone in 10 days or so ? (If it was ARS at all!). In other words, will one ARS symptom would last for more than 20 days since the other symptoms had gone ?

My personal issue was:
I accidentally (Yes, really accidentally) "RECEIVED ORAL SEX" (Insertive oral sex) from a Russian Sex worker (Probably a high-class escort, but you never know their status!). No kisses or any other sexual activities were there. Just receiving oral sex (Her mouth to my genitals and it lasted for about 40 minutes!). I did not see any blood there. I saw only saliva, but honestly can not be sure at all. After 24 days of this incident, I felt something got stuck in my throat. Went to the Dr and he said it's GERD issue and gave me pills. The problem reduced the other day. However, I have never had a GERD problem in my life so far. I had no cough, cold, throat clearing etc etc.

Then I felt dizziness (I don't know whether it's due to the GERD pills he gave me). Then he prescribed Domperidon to control the dizziness. Further I saw my throat was severely red (a sore throat) and developed very low grade fever for about 2 days. Tongue was white in color which some people say tongue's reaction to the acid.

In 2-3 days dizziness gone. In 2 days the fever had gone. But, it took around 10 days for the "feeling something stuck in throat" feeling to go away slowly & slowly. Around 7-8 days for the tongue to come to normal color and feel tastes. Appetite also came back to normal after 10 days or so. BUT - STILL the 32nd day after these issues, still the red throat is there. I took an HIV Antibody Test (2 tests using the same blood) an Strip test and an ELISA test 33 DAYS AFTER the exposure and 7 DAYS AFTER the onset of these issues. Both tests came back negative. My FBC work showed normal.

Finally went to an ENT Dr and he inspected my throat by observation (no tests) and said it's called Laryngopharyngeal Reflux (LPR) which is called as "Silent Reflux" as well. That's why I did not have any heart burning effect. The acid had come up and that's why throat is damaged / burnt. Although his explanations made sense to me due to the following reasons:

1. I had a lump feeling in my throat and it got reduced the other day for GERD pills. If it was due to ARS HIV Candida etc, it's unlikely it get controls for GERD pills.

2. If it was ARS, then sore throat can not stay this long, while other symptoms had gone.

But, I am still clueless because, if it was Laryngopharyngeal Reflux (LPR), then why I had a low-grade fever for 2 days ?? Did dizziness really a side effect of GERD pills ?

Thus, I need an opinion of an HIV Specialist regarding my issue. Please be kind enough to provide your expert view on this.
doctor
Answered by Dr. S. Murugan 5 hours later
Brief Answer:
Test become conclusive after 12 weeks.

Detailed Answer:
Hi,
Welcome once again.

ARS is different from that of acute infection otherwise called as Primary infection or Sero-conversion illness. AIDS related syndrome is not accepted in the recent days. ARS in the past refers to non-specific vague symptoms occur in the course of HIV disease after 5-7 years.

1. Candial esophagitis needs specific treatment with high dose of antifungal antibiotics. Spontaneous remission is unusual unless there is a marked improvement of CD4 count more than 500. Endoscopy can confirm the same. Usually associated with oral candidiasis. Symptoms of Dysphagia is more behind chest rather than throat. Your problem, as your ENT surgeon pointed out was more towards larynx and not with esophagus. An experienced surgeon can pinpoint the the diagnosis without help of any instrument.
2. In acute infection all symptoms would wean simultaneously within a week or two following the gain in CD4 count and with antibody formation.
3. Laryngitis can well associated with fever. There is no doubt.
4. CBC would reflect abnormalities during Acute infection
5. ELISA and the Strip test on 33 days have to be repeated after 12 weeks to get more conclusive results.
GERD pills can cause Dizziness.
Don't get confused with thinking odd possibilities. Oral insertive sex carries a very low risk as far as HIV is concerned.
DR S.Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S. Murugan 12 hours later
Dear sir,

Loads of thanks that your answer relieved me a lot. Yes I was referring to Seroconversion illness.

My sore throat is still there (30+ days) while the other problems (Feeling in the throat, short-time Dizziness, short-time very mild fever, Loss of appetite and White coated tongue) had all gone away 3 weeks before. Based on this (that Seroconversion illness symptoms would go all at once, once the antibodies been formed), may I assume my problem might not be seroconversion illness sir ? (As sore throat still remains)

Further, may I also assume that, the feeling in throat was there only for one day in its severe format and the next day (after taking GERD pills), it got reduced. Then gradually it got reduced. Sir, could I assume, if in case this was Candial esophagitis, this is very short time period (a day or two) for the CD4 cells to rise and control Candial esophagitis ? So this might not be Candial esophagitis, Is this correct ?

I took the antibody test ELISA on the 7th day after the onset of these issues. If in case this was seroconversion illness, are there any chances the antibodies been detected in the ELISA and/or Strip test on this time sir ?

Again, many thanks for your time and special advice. In fact, I'm from your neighbour country and my mother tongue is Tamil. I feel glad to meet such a knowledgeable doctor here, as it's somewhat hard to find doctors in my country who have up to date knowledge about HIV. Your explanations make me feel comfortable. Thank you for that sir.
doctor
Answered by Dr. S. Murugan 4 hours later
Brief Answer:
Dysphagia not due to Candidal esophagitis.

Detailed Answer:
Hi,

Welcome to HCM.

You had understood everything in the right manner

1. If your symptoms were due to Acute infection, the sore throat alone would not persist for such a long time. The change of better antibiotics would help you in this regard.

2. Candidal esophagitis would not respond to GERD drugs. As you rightly pointed out that any increase in CD4 count will take not less than 3-6 months, not in days. So your difficulty in swallowing could not be due to candidal esophagitis.

3. Sero-conversion would likely to start by 6 weeks on-wards, but at very low titres ELISA and rapid test can not pick up the same. Considerable amount of antibodies must be there for these tests to be show positive. Certain tests can pick up earlier, some identify the same after few weeks later. Similarly some individuals immune system will be able to produce antibodies a little earlier whereas others after a period of delay. So the test done after 12 weeks would be more conclusive without any doubt.

I am very happy to know that I am chatting with a fellow Tamil man from Srilanka. Wish you a very bright future.
DR S XXXXXXX


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S. Murugan 16 minutes later
Thank you again for your comprehensive answer.

Sir, I was earlier prescribed Augmentin for sore throat, but it did not respond. The ENT Dr says the throat is burnt by the acid and that's why it's red in color. Is it acceptable sir ?

My heartiest thanks for your time. Feel comfortable to listen to you.
doctor
Answered by Dr. S. Murugan 6 hours later
Brief Answer:
Better choice of antibiotics other than augmentin

Detailed Answer:
Hi,
Welcome once again.

Many a time Augmentin did not work well. Azithromycin or Roxithromycin can be tried. Cephelexin group also is good for sore throat. Otherwise a throat swab is taken and send it for culture and sensitivity. According to the outcome of the test result, appropriate antibiotics can be given. That will heal your sore throat beyond doubt. Your ENT doctor's word regarding the burn due to acid is just to calm you from further questions.
Get well soon.
DR S.Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S. Murugan 32 hours later
Dearest sir,

Thanks again for your patience and kind explanation. Satisfactory and understandable. Sir, may I ask only very few questions and then hopefully I would get satisfied.

1. Have you seen, read in medical literature or heard from your colleagues that someone infected with HIV through receiving oral sex once, but for about 40 minutes ?

2. Have you seen, read in medical literature or heard from your colleagues that a 5 week Antibody HIV NEGATIVE test result changed into Positive later on ?

3. My Full blood count done 33 days after the exposure was: WBC, Platelet count, Total Lymphocyte count and all were within the normal range except Eosinophils which my physician simply said it would increase if I had any allergies). Sir, If in case I had infected with HIV, would my this blood work done AFTER 33 DAYS of the exposure be normal ?

Kindly enlighten me on this sir. Thanks again for your patience. Very much of a help indeed.
doctor
Answered by Dr. S. Murugan 50 minutes later
Brief Answer:
A normal hemogram at the time of HIV diagnosis is also possible

Detailed Answer:
Hi,
Welcome once again.

1. Most of the occasions the individuals would not restrict with only oral sex activity alone. They usually have bisexual or other types of sexual activity. So it is very difficult to say that how many cases acquired HIV through oral sex alone. In my practice I had one case who had oral sex with multiple partners and also married and had heterosexual relationship also. There are very few documented cases HIV through oral sex alone. The duration of oral sex is immaterial.

2. Yes we had seen cases negative at 5 weeks with antibody tests became positive subsequently in repeating the test by 12 weeks.

3. A blood count within normal range initially is also possible.
But these do not mean that your risk is high.
Still the risk through oral sex is low.

Dr S.Murugan
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. S. Murugan 2 days later
Thank you for your answers sir.

Today I had an Strip rapid test (I think it should be 2nd Gen) and it came negative. I have requested an ELISA test of the same same sample again.

As per Dr. Hunter Handsfield - an award winning professor in STDs attached to the University of XXXXXXX as well as Dr. XXXXXXX Hook - "Best Doctors in the USA 2002 - 2006" awarded professor in STD attached to the XXXXXXX XXXXXXX Department of Medicine, USA which is one of the world's leading HIV/AIDS researching institutes, an "8 week antibody test (regardless of generation) is CONCLUSIVE & FINAL". In this manner, considering my low risk exposure and 9 week NEGATIVE Antibody Test, I rule out HIV. I believe, I should continue to work my ENT Doctor on any possible LPR Acidic reflux problems which keeps my throat red for more than a month now.

I believe you might have valuable things to add to this my view. Thank you for your time with me.
doctor
Answered by Dr. S. Murugan 16 hours later
Brief Answer:
Appropriate specialist's guidance would hold good.

Detailed Answer:
Hi,
Welcome back.

Dr Hunter, USA must be more experienced. You can follow his advice as well with regards to your test result. The test is fine.

Similarly follow the advice of the ENT Surgeon with regards to your throat problem.

Hope this answers your query. If you have no further clarifications for me, you can close and rate the conversation.
Dr S.Murugan
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. S. Murugan 9 hours later
Dear Sir,

If you are happy with my views in the light of your highly experienced expertise, I would follow up with my ENT doctor for my throat issue and hopefully ruling out HIV. As I speak Tamil, I felt really comfortable with you and you were the main doctor I discussed my issues. You helped me a lot in the past month or so where I was really scared to death. I had never been this much afraid in my life. I was really mentally disturbed. You helped me a lot ease my anxiety giving your valuable views that my issues can not be HIV related. Specially, when I was down thinking my problem might be Candiasis, you scientifically proved it was not so - easing my mind. Thank you very much sir for all your assistance and helping in my hard time. I can not forget you. Following are quoted from Dr. XXXXXXX Hook. Thank you again sir.

I am pleased to hear that, as we expected, the test was negative. Any test obtained more than 8 weeks following a potential exposure to HIV provides definitive results. There is no need for further testing- the results you have are definitive. EWH XXXXXXX W Hook, MD,BS,Member of XXXXXXX STD Association, Member of XXXXXXX College of Physicians
Professor of Medicine and Epidemiology, Medical Director - STD Control Program, 2002-2006 - Best Doctors in XXXXXXX Infectious Diseases
doctor
Answered by Dr. S. Murugan 5 hours later
Brief Answer:
You are welcome, get well soon.

Detailed Answer:
Hi XXXX
Welcome once again.

You knew more eminent people in my field than me and had more authorized quoting. So you need not have any fear about the possibility of HIV. Relax and carry on your routine without any worry. Have a nice day and your throat problem will settle soon, If you don't have any more questions, you can close this conversation.
DR S.Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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with reflexes
HIV 1/2 EIA AB screen non-Reactive non reactive


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Hard copy to follow



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