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HIV Prevention  (Expert Forum)
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High Risk HIV activity and EBV
Answered by
H. Hunter Handsfield, M.D. -
University of Washington Seattle - WA
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MedHelp Member's Question

High Risk HIV activity and EBV

by MIK67, Jun 07, 2007 12:00AM
Good Morning Doc H,  40 yr old male, heterosexual, non rug user. March 17th 2007 had unprotected sex (2 x) with a woman I met and had been talking to for about a month.  She was a "normal" person with a normal middle class job.  March 24-25 2007 weekend unprotected sex 2x.  Do not know her sexual history. March 30 req a HSV test and game back positive for IGg level of 6.4HSV-2. Symptoms were fever, lack of energy,discomfort urinating, joints aching, muscle soreness in general.  Diagnosed Bladder Inf..  No outbreaks confirmed by a doctor and none that I am aware of to this date. April 12 admitted to the ER by my GP discomfort on my rib cage, right side.  They admitted me due to the high WBC and pain, thinking it was apendicidice.  Hospital explanation was Bladder infection.  diarrhea, headaches almost daily, joint aches, muscle weakness and to date a couple of night sweats, complete lack of energy and concentration lost 15 lbs with no apetite. Another HIV test on 22 May 2007 with EBV. HIV negative but the EBV analysis indicated reactivation.  Approx 55-56 days and a negative HIV test.  But Positive EBV reactivation. IgM was not present on the EBV. Am experiencing Oral Hairy OP(spel) on the inside walls of my mouth. A:Possible I am HIV infected and this reactivated my EBV but was undetected up to these 55 days?  What is that risk factor?
B:  What is your overall risk analysis of this situation?
Thanks


Doctor's Answer

by H. Hunter Handsfield, M.D., Jun 07, 2007 12:00AM
Sorry, I cannot help very much.  I'm not an expert in EBV infection.  Although that virus often is sexually transmitted, we never test for it in STD clinics and I have little experience managing patients in your situation.  I'll just say you definitely have HSV-2, but probably going back to sometime before the sexual events you describe; your risk for HIV from those exposures was very low, probably zero; you don't have HIV; and most EBV infections resolve without significant long term health effects.

I don't have a good explanation for the acute illness you describe, but it doesn't sound like HIV or any other STD.  You'll just have to rely on your GP's evaluation and advice; or if uncertain about his or her expertise, ask for consultation by an infectious diseases specialist.

Good luck--  HHH, MD
Member Comments (9)

by gettingmymessages, Jun 07, 2007 12:00AM
To: MIK67
Hello..Mike  i had to jump in on this one as i can say.. i know what you are going through...i had an exposer with a person who was HIV positive 100%..had all the same symptoms as you identical..soaking night sweats,17pounds rapid weight lose,extreme fatigue ,white coated tongue with denuded marks on end and white ridges on side that almost resembleing OHL..i,m on treatment for fungi infection still to this day 6 months latter.well did treatment for 3 weeks it cleared up  but started again as i wasn't completely gone still isn't,anyway i was also diagnosed with HSV-2..also  5 months 1 week latter i,m HIV  negative..and i tested allot every week starting from 6 weeks to know..i spent nearly $2000.00 on test and that wasn't enough i just had my girl friend test to be sure..i know with all your symptoms its hard to believe your HIV negative but i would say you are..i think its the HSV-2 primary infection and the EBV that is causing your symptoms..anyways wish you the best and Doctor HHH just wanted you to know i,m negative still after 5 months 1 week and i know you were having your doubts..anyways thank god

by MIK67, Jun 07, 2007 12:00AM
Thanks for the comments....  Doc, How can you asses I do not have HIV?  Because of the 55 after a negative result?  Or is it because of the exopsure of female to male, unprotected vaginal sex 4 times?  This woman will not talk logically to me anymore.  She insists that she has nothing but will NOT give me any answers on the last time she was tested.

I am confused because OHL is cased by EBV, not HIV.  When EBV is reactivated it is an indication of a low immune system.  Is that enough NOT to produce the antibodies for HIV 55 days later?

I am going to a specialist whom recommends I take the P40, which shows protein for the HIV virus.  Will this be conclusive enough and what are your expectations of the outcome.

Thanks for the help as I do not feel like throwing up as much as yesterday.  I am such an idiot....

by H. Hunter Handsfield, M.D., Jun 07, 2007 12:00AM
I agree that your case is confusing.  The evidence against HIV is strong:  heterosexual with only one low-risk partner; and it is very rare to have a negative HIV test almost 8 weeks after the last possible time of infection, and even more rare to be negative after several weeks of symptoms (if those symptoms are due to HIV).  On the other hand, if you really have OHL, and given that apparently no diagnosis is yet clear, I can understand why your specialist provider is recommending special HIV tests.  But I truly expect it will be negative.

If your "such an idiot" comment refers to your sexual choices, I disagree.  Most likely whatever you have is entirely unrelated to the sexual partnership you describe.  And even if it is, I would say you are unlucky, not idiotic.  You describe nothing "idiotic" about your sexual choices.  Your story suggests she now is reacting negatively, and maybe entirely appropriately, to your insistent, possibly accusatory questions.  You should go easy on her; I truly believe you have nothing you caught from her.  Most likely you owe her an apology.

by Red Fish 88, Jun 08, 2007 12:00AM
To: MIK 67
I find your situation very interesting.  I had a hetro. exposure to a stripper in July of 06 (just oral both ways) and had many symtoms of those who go through ARS. So what I have experienced is  much of the same as you.  Tested neg with Quest at 4.5 weeks and neg. with home access at 8 weeks and 13 weeks which I thought was conclusive, but pos. for EBV  from Quest lab test.  I have been experiencing bouts with oral thrush or some other oral infection for 9 months ( I had a biopsy done on it on Monday to be 100% of what infection is) and I have an unexplained weight loss of 20 lbs over the last 11 months as well.  

I went to GP yesterday to find root cause of the oral thrush / oral out breaks and weight loss and GP wanted to do another HIV test.  So... I'm a little nervious, even though I keep telling myself I have nothing to worrie about.  I get my results back on Tues. or Wed.

Keep your post up to date I would like to see how things turn out.

Best of luck.

Red

by MIK67, Jun 08, 2007 12:00AM
To: red fish
and everyone else....  Thanks for the support and advice.  PLEASE let me know how it comes out.  I am having difficulty getting the specific test the doctor is ordering P42??  My PCP has not come back yet, but she ran another antibody test this past Tuesday (approx 72 days) and it was negative.  I thank Jesus Christ every moment for that.  She also confirmed today that it is NOT OHL in the corners of my mouth or thrush!!!  I am not sure if she was just saying that because I am visibly upset and worried???  What else can that be in the corners of my mouth??  It looks like the photo's I have seen, so ???  Help???

Anyone else have any input?

by shiblee101, Jun 11, 2007 12:00AM
I'm in a similar situation.  Negative elisa and RNA PCR@ 3 months, but positive EBV reactivation @ 3 months.  Lingering symptoms (rash, lethargy, myalgia--more pronounced over last week.  I'm worried that the EBV infection