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Lymphadenitis, Adenopathy, Lymphadenopathy, oh my!
Aug 9, 2010

Hey Dr. Bob,

Sorry to bother you on a Sunday. Hopefully, you are having a better weekend than those of us posting terrified questions.

I previously asked you a question about fatigue and rash in relation to ARS. http://www.thebody.com/Forums/AIDS/SafeSex/Archive/Infected/Q210037.html Your answers were extremely helpful and really helped calm me down. I started to feel pretty good about being tested.

But, shortly thereafter, I developed a single, slightly swollen cervical node over the last 5 days (Day 40-45) in the right side of my neck. I have looked at possible local causes of the swelling and none seem to be apparent. A swollen cervical node without explanation seems really bad. I feel like I am down to cancer or HIV.

1. Would it be possible to develop fatigue at Day 26 and then a single, swollen cervical node 2 weeks later and have it all be consistent with ARS? Would they be connected? Or would it have to be one or the other (i.e. symptoms usually onset together so it's either fatigue as your ARS symptom or a late onset represented by the node)?

2) I noticed you cited a list of symptoms and their relative percentages where swollen nodes are not listed. How common are swollen nodes with ARS? Is there a reason why some respected medical sites list swollen nodes as a symptom and some do not?

3) I have no other symptoms outside of slight malaise and a lack of appetite (no weight loss), which could be attributed to anxiety. Obviously, it's impossible to predict with ARS but is this a good sign? Or is it strange because it's not indicative of a conventional illness as an alternative explanation to ARS?

4. Have you ever read of ARS cases involving just the swelling of a single node? The "google" consensus seems to be "no". But, could it not be possible that some of the deeper nodes are swollen and are not easily detected? Can I expect more nodes to become swollen if it is indeed ARS or would all the swelling come together?

5. When lymph nodes are inflamed due to ARS are they usually very inflamed or can they be more subtle? Do they tend to come swift and prominent?

6. In your experience, do partners tend to inform if they have tested positive? My acquaintance seems to have dropped off the map since she said that she was considering getting tested for "peace of mind", and it is scaring me to death (perhaps you can also judge how annoying my questions are and we can figure out that she is just tired of my worry)

7. I have been reading the "positive I am positive" section all day. I just want to go into the test thinking that I have a 50/50 shot of maybe not being infected. Taking it all together, do I at least have a coin flip here?

Thanks again Dr. Bob. I am wordy but now lack the words on how much your answers mean to me (be they good or bad).

Response from Dr. Frascino

Hello,

I'll be brief, as I've responded to many similar questions in the past and this information is readily averrable in the archives. Have a look!

1. Based on the information provided, I do not believe your fatigue or swollen cervical node are HIV related.

2. The medical term for swollen nodes is adenopathy. Adenopathy occurs in 74% of cases of HIV ARS. The information I posted was from the Department of Health and Human Services [DHHS] Guidelines which were published in the Annals of Internal Medicine 2002;137: 381.

3. I agree your problem is anxiety.

4. No. The swollen nodes associated with ARS are generalized throughout multiple locations in the body.

5. They are generally non-painful and their appearance varies from case to case.

6. I have no doubt she's tired of your overwhelming anxiety.

7. Yes.

I would suggest you reread my response to your initial question below, review the informant in the archives and then get a single HIV-antibody test at the three-month mark. If you continue to be an anxious wreck during the window period, contact your doctor for anti-anxiety medication or a referral for counseling. The statistical odds are all in your favor that you did not contract HIV from this lapse in judgment. I also certainly hope you've learned from this entire anxiety-provoking incident that unprotected sex is not worth the potential catastrophic consequences.

Dr. Bob

A little more clarity to the always unclear ARS Jul 31, 2010

Hi Dr. Bob,

It has been a real pleasure (albeit under a difficult circumstance) to learn about your work and foundation. And, I will be making a donation - not to elicit a response - but because of how immediately tangible HIV becomes when one considers themselves at risk.

36 days ago I had unprotected vaginal sex with a friend of mine. To my knowledge, she does not seem particularly high risk. I have looked at your previous answers and have not been able to find the precise answers to my questions. I hope they are not repetitive and could be helpful to others.

1. Does tiredness in the legs equate to myalgia? Or, is myalgia generally thought to be an aching pain when present?

2. Where does fatigue fit in on the spectrum of ARS symptoms? Is it thought to be a by-product of other symptoms or is it able to occur on its own as a sole symptom?

3. Is an ARS rash almost always maculopapular and bilateral when it presents? As in, is it one of those things that you would know when you see it? Or, can it be more subtle (e.g. a small patch of redness, white bumps, etc.)

4. I have read that most people who present symptoms will have a fever (96%). Is this figure accepted within the medical community or simply the result of one study?

5. My current situation notwithstanding, what would be the likelihood of a person contracting HIV 15 years ago without showing any signs or taking medication? Fortunately, I always used condoms before this latest exposure but this long-past incident now has me wondering.

6. Finally, do you know any research studies off-hand that might be helpful to those looking for information on ARS?

Thanks for all your great work

Response from Dr. Frascino

Hi,

1. Nope. Myalgia refers to pain, not "tiredness."

2. Fatigue is very nonspecific. It can be associated with HIV (see the Fatigue and Anemia expert forum) or with many other conditions, ranging from anemia to anxiety/depression.

3. Yes. Yes. No.

4. Fever is very common with HIV ARS. It's accepted within the medical community and has been verified in clinical studies.

5. Extremely unlikely. Your worries are unwarranted and could be put permanently to rest with a simple rapid HIV test. You would be WOO-HOO-ing in as few as 20 minutes. Testing is not medically warranted, but might help for psychological peace of mind.

6. Not really. We already know what we need to know about ARS. Symptoms are notoriously unreliable, as ARS symptoms are not specific for HIV disease. The bottom line is that if you've placed yourself at risk for HIV, get HIV tested outside the window period, whether or not you have any symptoms. It really is just that straightforward.

Thanks for your donation to The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's warmly appreciated and urgently needed.

Be well. Stay well.

Dr. Bob



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