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Shingles Coinfection and Seroconversion
Apr 7, 2010

Dr. Frascino - many thanks for all you do.

Background: 24 Y/o male - developed a shingles infection on my right side while visiting Thailand. At the peak of my shingles episode, I had unprotected vaginal insertive sex with a sex worker. -5 days later: Bleeding gums, fever, chills, night sweats. These symptoms lasted around 9 days. Diarrhea developed around this time and lasted 19 days. -17 days post-exposure: tender swollen lymph nodes in arm pit, neck, and under ear lobe (all subsided in a week) -21 Days post-exposure: Spleen becomes uncomfortably enlarged (and has remained so for the past 8 weeks)

Over the course of the following weeks I had more night sweats, sore throat, hives, transient rashes, lymph nodes swell in my face and on the back of my neck, painful lesions, and capillaries become visible in a belt under my sternum. I still have an uncomfortable mass under my left rib, which I believe is my spleen. It tends to become more enlarged as the day progresses and has been enlarged now for 8 weeks. Although, my splenomegaly does seem to be leveling off at this point. My shingles disappeared at about the time of 6 weeks post-exposure. Possibly the most supportive symptom of a HIV diagnosis - I have oral thrush and I am developing candida on the sides of my tongue. One doctor was particularly worried by this.

I have seen 4 GP's. 3 Immediately ordered HIV testing and 1 believed it was EBV. Monospot was negative at 10 weeks. No satisfactory diagnosis has been made.

Test history: 19 Days RAPID:Negative 1 Month Gen 1 ELISA: Negative 8 Weeks Red Cross Administered: Negative 73 Days: Negative

I just submitted my 88 day test and will have results next week.

The question: If my results happen to be negative again, does my situation warrant additional testing? (16 weeks/24 weeks)

I worry that my seroconversion may be delayed by a possible co-infection with herpes zoster and the acyclovir I was taking for it at the time. Also, the timing and presentation of my symptoms seems to be supported heavily by a HIV infection as the culprit.

I'm past the point of worrying as I do believe I have HIV. I would like to go forward with my life - I have to make a lot of work and life decisions based on my test result.

Response from Dr. Frascino

Hello,

Neither herpes zoster nor acyclovir would delay HIV seroconversion.

Having sex "at the peak" of a shingles outbreak is certainly not wise and probably was fairly uncomfortable.

Your repeatedly negative HIV tests out to 73 days are encouraging. If your doctor has concerns about the accuracy of your HIV test, he could consider getting a qualitative HIV PCR proviral DNA test. It's not routinely recommended for HIV screening, but it can be helpful if the results of the antibody tests are in question.

Good luck.

Dr. Bob



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