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Been asking for weeks, I need your expertise
Sep 12, 2013

I am a 21 year old male who engaged in unprotected anal and oral with another male of unknown status. Two weeks after the encounter I experienced classic ARS symptoms including fatigue, loss of appetite, weight loss, fever, swollen lymph nodes, stiff neck and diffuse joint pain.

I have been ordering my tests through stdtestexpress.com and requestatest.com. All my testing has been performed at Labcorp.

See results below:

Negative with HIV 1/O/2 Abs-ICMA at 3, 4, 5, 6, 8 months. 1) Does this test look for all the subtypes of HIV?

Negative with HIV-1 DNA, PCR at 3 weeks and 5 months.

Negative HIV-1 RNA at 6 months

The ARS symptoms lasted for about a week, then subsided, but ever since the encounter I have been displaying oral and epidermal signs of HIV infection. I have experienced wide-spread and systemic form of what appears to be xerostomia, indicated by enlarged papillae all over and under my tongue, including the floor of my mouth. Also, I show hyperkeratinization, aconthosis, and fordyce granules on the mucosa of my gums and inner cheeks. It basically looks like hyperplastic candida. In addition, I have what appears to be a candida-like coating on my tongue due to the chronic dry mouth.

I also developed keratosis pilaris the backs of my upper arms simultaneously with the oral manifestations.

The oral and skin conditions both onset after I recovered from my ARS-like sickness, and have been present for over nine months. I have been reasonably healthy my entire life up until this point, so the sudden onset of these symptoms are clearly related and cause for legitimate alarm.

I have read that HIV commonly affects the salivary system, which would likely explain my oral and skin conditions.

2) From a clinical standpoint, have conclusively exhausted all my testing options? Would you recommend a different form of testing given my symptoms?

The CDC recommends that an individual keep testing as long as he/she is experiencing suspect symptoms. 3) In 2013, can we ever get to the point where one can definitively state that an individual is HIV negative regardless of the displayed symptoms? I read a case where an individual didn't seroconvert until four years after exposure.

At this point all I can say is, I engaged in high risk sexual activity, I subsequently acquired a viral infection, which has caused morphological changes to my body. These changes seemingly scream HIV infection. 4) How else can I explain these kinds of real long-term symptoms in an otherwise healthy 21 year old? 5) Could HPV or a form of herpes cause these kinds of symptoms?

Please advise me how I should proceed, I can't stop focusing on HIV.

Response from Dr. Wohl

Your tests are conclusive and you do not need to keep testing. The CDC does not recommend testing forever. RNA testing obviates any concern regarding some weird, rare late conversion of antibodies.

I have never seen persistent symptoms following ARS. I suspect you may be over-diagnosising the normal topography of your mouth (once we start looking in there for stuff, we find it). I am reluctant to mention it but think you will be unconvinced, so another idea is to get a CD4 cell count. When that comes back stone cold normal, I hope you will agree that HIV is not your issue and will look for alternative causes of your symptoms.

DW



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