Hello Dr. McGowan,

I have had this problem for over one year now. Over one year ago I have had a high risk situation concerning hiv. I have been sick for the last year with ars symptoms especially swollen nodes in neck and groin region, still lasting. Symptoms started 2-3 weeks after risk. All my HIV test out to one year were negative (ELISA and rna-pcr).

I don't know, doctors can not help to find the cause. And I am really really bothered by this. hiv fears coming and going...

Thanks for your opinion.

HIV antibody tests (ELISA) will usually be reactive (positive) by 3 months after exposure to the virus (in 99.5% of cases). All positive ELISA tests are confirmed with a second antibody test called a Western Blot. Falsely negative screening tests are, therefore extremely rare. Using HIV RNA (or a "viral load" test) to diagnose HIV is not generally recommended, but can be done if someone has very recently been exposed and may have symptoms of acute HIV infection. They may be in the "window period" in the first weeks after infection when the body may not have had time to develop antibodies to HIV. The HIV viral load test may be done in cases, such as pregnant women, when it is very important to know right away that a person is infected so that decisions about treatment to prevent transmission from mother to child would be critical. Usually the viral load is very high in the earliest weeks of the infection. Since you have had both negative antibody and viral load tests this is reassuring. The antibody tests currently used are designed to detect HIV type 1 and most will also detect HIV type 2. It would be important to check with your medical provider to be sure you were also screened for HIV type 2. HIV-2 would not be detected by the viral load tests. The ELISA tests are very sensitive for detecting antibody against HIV type 1, Group M, which accounts for the vast majority of all infections in the United States. The tests may not be able to detect antibody against HIV that is in Group O or N, which are usually seen only in western Africa. Long-term (chronic) lymph node swelling can be due to many conditions. Bacterial infections (such as tuberculosis), viral infections (such as EBV), parasitic infections (toxoplasmosis), fungal infections (histoplasmosis), tumors/cancers (lymphoma) among many others can cause prolonged lymph node swelling. The location of the swollen glands is also important since the lymph nodes drain from different parts of the body, so an infection in the teeth, for example, will cause swollen lymph nodes under the jaw or on the side of the neck. It would be very important for you to have a general check up so that your health care provider can look into all the possible causes of your condition.

Best,

Joe