HIV Symptoms and Testing: What You Need to Know

HIV-related issues

1.
Ten days ago, I had unprotected sexual intercourse, and three days after the encounter, I developed a fever of 38.5 degrees Celsius.
After seeing a doctor and receiving an injection, my fever subsided, but I continued to experience diarrhea for the following week (without fever).
Some people online say that symptoms within seven days cannot be caused by HIV, while others claim that acute infection symptoms can appear as early as three days.
I would like to ask the doctor if the symptoms that appeared three days after unprotected intercourse could be indicative of acute HIV infection?
2.
If I go to a testing center and the HIV RT-PCR test comes back positive, will I be required to undergo confirmatory testing using the Western blot method at a hospital? Or will a positive RT-PCR result be reported directly? I am currently not mentally prepared for being reported to the health department.

Niming, 20~29 year old female. Ask Date: 2022/08/22

Dr. Liao Zhongxin reply Internal Medicine

According to the Centers for Disease Control (CDC) data, the transmission routes of the Human Immunodeficiency Virus (HIV) are as follows:
1.
Sexual Transmission: Engaging in oral, anal, or vaginal intercourse with an HIV-infected individual or exchanging other bodily fluids carries a risk of infection.

2.
Blood Transmission:
- (1) Receiving or coming into contact with blood or blood products contaminated with HIV.
- (2) Sharing needles, syringes, or diluents with individuals who inject drugs and are HIV-positive.
- (3) Receiving an organ transplant from an HIV-infected donor.
3.
Vertical Transmission: Infants can acquire HIV from their infected mothers during pregnancy, childbirth, or breastfeeding.
Incubation Period: There are two interpretations of the incubation period following HIV infection:
1.
Symptoms resembling a cold may appear approximately 2-6 weeks after infection.
2.
The period from HIV infection to the appearance of clinical symptoms generally ranges from 5-10 years (currently referred to as the asymptomatic phase or subclinical phase).
However, the progression of HIV infection can vary significantly among individuals.
During the window period or asymptomatic phase, many patients may not exhibit symptoms, which can lead to risky behaviors and create gaps in HIV prevention efforts.
Symptoms of Disease: The symptoms of Acquired Immunodeficiency Syndrome (AIDS) can vary widely depending on the individual's immune status, the type of bacteria involved, and the site of infection.
For example, Pneumocystis pneumonia can cause pneumonia-like symptoms, while Mycobacterium tuberculosis can lead to tuberculosis symptoms, and oral candidiasis can result in thrush.
Prevention Methods:
1.
Safe Sex Practices: Maintain a single, monogamous sexual partner, avoid sex work, casual encounters, and ensure proper use of condoms throughout sexual activity.
If lubrication is needed, use water-based lubricants and avoid oil-based substances (such as baby oil or petroleum jelly) to prevent condom breakage.

2.
Avoid sharing needles, syringes, or diluents.

3.
Individuals with sexually transmitted infections should seek medical attention promptly and get tested for HIV.

4.
Pregnant women should undergo HIV testing.
If the mother is confirmed to be HIV-positive, preventive medication should begin during pregnancy, and a cesarean section may be recommended, along with avoiding breastfeeding.
Window Period: After HIV infection, there is a period during which HIV antigens or antibodies may not be detectable in the blood (serum).
This period, during which an individual is infected but cannot be tested positive, is known as the window period.
Generally, the window period lasts about 3-12 weeks, depending on the testing method used.
For specific testing options, individuals should consult their testing facilities.
During the window period, the virus is present in the body, and the individual is infectious.
If someone engages in unsafe sexual practices and later tests negative, but still suspects they may be infected, they should retest after the window period while avoiding unsafe sexual practices in the meantime.
Regardless of mental preparedness, early testing and treatment are the best options.
Currently, many healthcare facilities offer Combo tests, with results available within three days, which should be utilized effectively.

Reply Date: 2022/08/22

More Info

Understanding HIV symptoms and testing is crucial for anyone who has engaged in high-risk behaviors. Let’s break down your questions and provide a comprehensive overview.

1. Symptoms After Unsafe Sexual Behavior
You mentioned experiencing a fever of 38.5 degrees Celsius three days after engaging in unprotected sex, followed by a week of diarrhea. The timeline of symptoms is important when considering HIV infection.
HIV acute infection, also known as primary HIV infection, can present with flu-like symptoms, including fever, fatigue, and gastrointestinal issues. However, these symptoms typically appear 2 to 4 weeks after exposure, not just three days. While some individuals may experience symptoms sooner, it is relatively uncommon. The symptoms you are experiencing could be attributed to various other infections or conditions, especially since they occurred shortly after a high-risk encounter.

The general consensus among health professionals is that while some people may exhibit symptoms as early as three days post-exposure, it is more typical for symptoms to manifest within 2 to 6 weeks. Therefore, while it is theoretically possible for your symptoms to be related to HIV, it is more likely that they are due to another cause, especially given the short time frame.

2. Testing and Reporting Procedures
If you were to undergo an HIV test, such as the RT-PCR (which detects the virus directly), and it returned positive, the next steps would depend on local health regulations and the specific practices of the testing facility.
In many jurisdictions, a positive RT-PCR result would typically lead to confirmatory testing, often using a method like the Western blot test or an HIV antigen/antibody test. This is to ensure that the initial result is accurate, as false positives can occur with certain tests.
Regarding reporting, many countries have laws that require healthcare providers to report positive HIV tests to public health authorities. This is done to help monitor and control the spread of HIV. While this may seem daunting, it is important to understand that these measures are in place to protect public health and provide support for individuals diagnosed with HIV.

Additional Considerations
- Window Period: After potential exposure to HIV, there is a window period during which standard tests may not detect the virus. For most antibody tests, this period is about 3 to 12 weeks. However, RT-PCR can detect the virus much earlier, typically within 10 days of exposure.

- Symptoms vs. Diagnosis: It is crucial to remember that symptoms alone cannot confirm HIV infection. Many conditions can mimic the symptoms of acute HIV infection. Therefore, testing is the only way to confirm or rule out HIV.

- Mental Health: The anxiety surrounding potential HIV infection can be overwhelming. It is advisable to seek support from healthcare professionals or counseling services to help manage this stress.

- Prevention: Moving forward, consider adopting safer sex practices, such as using condoms consistently and correctly, to reduce the risk of HIV and other sexually transmitted infections (STIs).

In conclusion, while your symptoms may raise concerns about HIV, they are more likely related to another cause given the timeline. If you are worried about HIV, it is essential to get tested. If you receive a positive result, follow up with confirmatory testing and seek support from healthcare providers. Remember, early detection and treatment can significantly improve health outcomes for those living with HIV.

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