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Marked Weight Loss during ARS
Oct 13, 2002

Thank you in advance for helping me sort out my dilemma. I had receptive oral sex with a man of unknown HIV status mid-May 2002, no ejaculation but possible pre-ejaculate. Since about four weeks after that possible exposure, Ive had a constellation of symptoms that point directly to everything Ive read about HIV. I tested ELISA negative at 6 weeks, 14 weeks, and 17 weeks. I tested PCR RNA undetectable at 14 weeks, PCR DNA negative at 17 weeks. I just tested antibody HIV 1/2 and type O negative using the Discreet test from Canada (I did two of these in an attempt to rule out false negatives.) at 18 weeks. My problem is that I am having prolonged and troubling symptoms that my Drs. are attributing to stress/anxiety. Note During these past months I have been on various strong (Cipro, Tequin, Levaquin) antibiotics for a GI infection that was present before my exposure. Im experiencing joint/muscle pain, lymph node soreness under jaw/in neck/armpits/behind knees, peripheral neuropathy (burning feet, icy hot tingles in legs and arms, arms/hands fall asleep to the point of waking me up hourly at night), burning mouth, hairy tongue with what looks like the beginnings of OHL on the sides (Drs. briefly glance at it and say no whereas I examine it closely in mirror and think yes), some small Molluscum C. eruptions on my face, minor petechiae (4 or 5), dry/flaky skin on face, intermittent diarrhea, loss of appetite, nausea which has finally cleared, weight loss of 20 lbs., fatigue, at one point my total lymphocytes dropped to 870 (they are now back to over 2000), prostate infection, difficulty swallowing, and the clincher an endoscopy revealed esophagus plaques which were biopsied negative for monilia but were most likely negative due to antifungal medications the Dr. had me on for possible thrush on my tongue (however I know it was not thrush because it is hairy and will not come off). All my Drs. state that I am completely clear of HIV based on my tests, but I find it hard to believe. Ive tested negative for other STDs and CMV, EBV, Mono, HTLV1/2, even Cat Scratch, you name it. Questions: 1) Do you agree with my Drs. that this constellation of symptoms could all be stress/antibiotic use related? I know Im still in the 6-month window period, but I thought that the PCRs in concert with the ELISAs would be conclusive after 4 months, and my Drs. seem to feel the same. I want to catch any HIV infection early so I can get better. 2) Is it customary during the HIV diagnostic process for Drs. to deny HIV even though they may really strongly suspect it in order to keep a patient somewhat emotionally stable until the tests turn positive? In other words, do Drs. typically hold back bad news until they can show proof positive and prescribe treatment options? So far, none have suggested future testing. 3) Am I a psychotic in need of institutionalization if Im doing this to my body with my mind? Drs. have prescribed 5 mg. Valium 3/day and 25 mg. Paxil 1/day. Please give me some advice. Thank you for any help or light you can shed on my dilemma.

Response from Dr. Little

Based upon your test results, I would agree with your doctors that it is very unlikely that you are HIV infected. I would suggest only a follow-up HIV antibody at 6 months, but otherwise no further laboratory testing. Regarding your second question - no, I don't think most doctors withhold information (even if it a possible bad diagnosis) from their patients while awaiting test results. This however, is a matter of personal opinion - and I cannot speak to your situation. Third - I am not a psychiatrist so cannot tell you how many of your symptoms may be anxiety, but based upon the amount of concern you have and the emotionally disabling nature of the complaints you have, I think it might not be unreasonble to see a specialist and at least discuss this possibility.


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