Still worried after all this time...

Question

Dr Bob.

Hello. I have been wanting to write you for a while, but being in Iraq, a computer terminal is pretty hard to get access to. Here is my story. In late June of 2003, I had an unprotected sexual encounter with a girl I met in Florida. Later I found out that she was a cocaine user, and that scared me because I figured that she probably had sex with a lot of men when she was using drugs (an assumption that I can't verify). Anyway, the panic set in and I noticed the usual symptoms that people report in your forum, specifically mouth sores and a white tongue, as well as painful joints. I did what everybody else does and started reading online and discovered that my symptoms were consistent with HIV. So, then the wait began for my three month test. Finally, on September 9th, I went to the lab and asked for an HIV test. Then, after what seemed like forever, I got my negative result back. This was at about 85 days post-exposure. For some reason, I was still convinced that the test was wrong, and continued to worry. Finally, October 28th, four months post-exposure, I tested again with the same result, negative. Now, I have a couple questions. First, will people generally test positive before or after symptoms first appear. I mean, if I am experiencing HIV symptoms, does that mean that my body has already seroconverted and antibodies have already been produced and my test would be positive? Second, are three month tests now considered definitive? I think that with a three month negative that is considered definitive, my four month negative test will help me to put this behind me once and for all. Incidentally, I am a Marine stationed in Iraq and can not wait to cast my vote for John Kerry in November. Bush certainly has not impressed me, and has had me away from my family and friends for long enough. I cant tell you how much your response will mean to me Dr. Bob and I certainly hope to hear from you soon. With Highest Regards, SSgt B

Answer

Hey SSgt B,

I've written rather extensively lately about HIV testing recommendations as well as the limitations associated with this testing. So I'll refer you to the archives for all the background information, and just cut to the chase.

I don't know what everyone is reading online that makes them so convinced that vague symptoms, like mouth sores or painful joints, would have to be HIV related. I can assure you they aren't reading it here! HIV symptoms are notoriously unreliable in predicting HIV disease. The reason to get tested is not the presence of symptoms, but rather the placing of oneself at risk for HIV (or other STDs). Immunologically speaking, yes, it would make sense that if the symptoms were related to HIV seroconversion, that anti-HIV antibodies would be produced at that time as well. However, the take-home message is that symptoms are unreliable and never to be used in place of HIV testing.

For your exposure, I would consider your three-month test conclusive. Your four-month negative result just corroborates what we already knew at three months. You can read up on the three-month versus six-month window period debate in the archives.

Finally, on behalf of all readers in this forum, please accept my thanks for being in Iraq. Bush is just too stubborn to realize how wrong he's been about Iraq, despite no WMDs, no Al Qaeda-Saddam link, no eminent threat to the U.S., the findings of the 9/11 commission, etc., etc., etc. You are one of many members of our armed services who have written in and advised how they feel they have been mislead by Bush's poor judgment. Kerry's acceptance speech at the Democratic National Convention last night was a breath of fresh air filled with hope, honesty, wisdom, and leadership all the things we are sorely lacking with the current administration!

Please come home safe and sound. I'm glad to at least take this one worry off your shoulders.

With my highest respect and deepest thanks for your service to our country,

Dr. Bob