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Frequently Asked Questions (II)



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What are the symptoms of HIV/AIDS?

I am making the following recommendations to persons concerned about symptomsthat they may be having.
  1. Carefully read all the information found on our web page about symptoms(http://www.thebody.com/cgi/safeans.html). It should answer the vastmajority of questions regarding symptoms.
  2. If you are having flu-like symptoms or a rash, I cannot tell you whetherthese may be due to Acute Viral Syndrome or not. Only HIV testing at 6months can determine whether a person has HIV.
  3. If you are having any symptoms that are not going away after 1 to 2weeks, or if your symptoms are very severe, see your physician, regardless ofwhat you think the cause of your symptoms may be.
  4. If you have been exposed to HIV, consider getting tested 6 months after apossible exposure to the virus. This is true whether you are having symptomsor not. This is the only way to know whether you have been infected withHIV.
  5. Remember that I cannot tell you whether your symptoms may be due to HIVor not. Because EVERY symptom associated with HIV/AIDS looks like thesymptoms of other illnesses, I cannot tell you if your personal symptoms maybe related to HIV/AIDS. Again, only HIV testing can determine that.

I have seen a lot of people convincing themselves that they may have HIV,based on their symptoms. Many people have tried to "match their symptoms" tothat of Acute Viral Syndrome and full-blown AIDS. Please do not do this! It's very easy to convince yourself you have HIV/AIDS based on symptoms,when in fact you may not even be infected. I have personally seen many caseswhere a person convinced themselves that they had HIV (based on theirsymptoms), went through major stress and anxiety (for months or even years),and then turned up HIV negative 6 months or more after the exposure that theywere concerned about. I'm trying to avoid other persons from going throughthe same unnecessary mental torment. The only thing that symptoms tell youis, if they do not go away, or if they get very severe, then you need to seea doctor. That's all they tell you. Please do not diagnose yourselves basedon symptoms!

You will also note that nobody, not yourselves, myself, nor anybody on theInternet, nor any AIDS Hotline, can tell you if your symptoms may be HIVrelated, without having laboratory tests done.

With this said, let me review with you the symptoms of HIV/AIDS in detail.

The following information compares the symptoms of both recent HIV infection,and the symptoms due to full-blown AIDS. You will note that the symptoms ofAIDS itself tend to be chronic, long-term and can recur over and over. Thisdiffers from the symptoms of recent HIV infection, which are acute, only lastfor a week or two, and do NOT recur over and over.

When we're talking about symptoms, it's important to remember that there areactually 2 periods of time when one may show symptoms.

Within the first 4-6 weeks after infection, some people with HIV (up to 70%)show symptoms due to "Acute Viral Syndrome." This occurs during your bodiesinitial response against the virus. During this time, a person may showsymptoms that look exactly like the flu (headaches, body aches, fevers,fatigue etc.). These symptoms do NOT appear as cold symptoms (coughing,sneezing, congestion, runny nose etc.) A rash is sometimes seen, primarilyin the upper portion of the body. The rash may or may not itch, and can beraised. There is no such thing as an "HIV/AIDS rash," and if a rash is seenat all, it resembles rashes seen from many other skin conditions. All of the symptoms last for a week or two, then go away by themselves. They do NOTpersist for many weeks or months. In some people with Acute Viral Syndrome,the symptoms can be very severe. In other people with HIV, these symptomsmay be very mild. In still other people with HIV, they may not show thesesymptoms at all. A person may, or may not, show positive on an HIV testduring this period of time. I must strongly emphasize here that ALL of thesymptoms of Acute Viral Syndrome look exactly like the symptoms of otherillnesses, so having flu symptoms or a rash does NOT indicate HIV infection,in of itself. It is also important to remember that not all people will getAcute Viral Syndrome, and in those that do get it, the severity can varysignificantly from person to person. Because Acute Viral Syndrome looksexactly like the symptoms of many other illnesses, NOBODY can tell youwhether or not your symptoms are due to this syndrome. Only HIV testing candetermine if a person has HIV or not.

I have had a lot of people come to me concerned about Acute Viral Syndrome,and exactly when it occurs. Can it happen in the first hour after anexposure? The first day? The first week? The first month? The first year?

Because the symptoms of Acute Viral Syndrome are so general and non-specific,it's difficult for anybody to determine the exact time that this syndromeoccurs. The fact is, nobody can give you an exact time, since it can varyfrom person to person. Also remember that during this time, a person may ormay not test positive on the test. This makes it even more difficult todetermine if symptoms are related to Acute Viral Syndrome or not. All anybodycan say is that the symptoms occur within the first month or so (that is,within the first 4-6 weeks) after infection. The symptoms usually last for aweek or two, although this, too, can vary from person to person. They do nothowever last for many weeks or months. And these symptoms do not occur in allpeople; the estimate is about 70% of people get this syndrome. That's allanybody can say.

Whenever you get any symptoms after an exposure is unimportant andirrelevant. What is important is that if you've been exposed to the virus,that you get tested, regardless of whether you have symptoms or not. And ifyour symptoms are persistent or very severe, it's important that you see aphysician, regardless of what you think the cause may be.

In regard to the symptoms related to full blown AIDS itself, they don'tusually begin until literally years after infection. Before that time, aperson can look and feel totally healthy with no symptoms at all. As for thespecific symptoms of AIDS, there are no specific symptoms you could list. This is because AIDS is actually a group of diseases, and therefore you'redealing with groups of symptoms. Because AIDS is actually a group ofdiseases, there are literally dozens and dozens of different symptoms. Noteveryone with AIDS has every disease and therefore not everyone has everysymptom. Every symptom of AIDS looks like the symptoms of other illnesses. There are no symptoms that are unique to AIDS. Symptoms can include severeweight loss, fevers, drenching night sweats, fatigue, purple-colored blotcheson the skin, severe headaches, severe diarrhea, and the list goes on and on. Generally the symptoms tend to last for many weeks or months at a time, anddo not go away by themselves (not without treatment). They can also recurover and over. Notice how this differs from the symptoms of Acute ViralSyndrome, which only lasts for a week or two, and does NOT recur over andover. AIDS symptoms are ongoing and can be very severe. AIDS relatedsymptoms do not begin until an average of 10 years after infection. You canhave HIV and even full blown AIDS and have no symptoms at all!

Generally speaking, if you have any symptoms that last for more than 1 to 2weeks and do not go away, or if you have any symptoms that are very severe,always seek medical attention, regardless of what you think the problem is. You can't assume any symptom is HIV/AIDS related until you get laboratorytests. Remember, every symptom related to HIV/AIDS looks like the symptomsof other illnesses. Therefore symptoms alone cannot determine whether aperson has HIV or not. NOBODY can tell you whether or not your symptoms aredue to HIV/AIDS, without getting tested. That's why laboratory testing is soimportant.

Also, if a person tests negative at the time that they are showing chronic,ongoing symptoms, that indicates that their symptoms are not AIDS related. Aperson first shows positive on the test (by 6 months after infection), andthen later shows chronic symptoms (an average of 10 years after infection).So if a person tests negative at the time that they're showing ongoingsymptoms, that indicates that the symptoms are not AIDS related.
















How long do I have to wait until I get tested?

In regard to the accuracy of the antibody tests:

The AVERAGE period of time that an infected person will show positive on thetest is 25 days. This is an average, so not all people will test positive bythis point in time.

The USUAL period of time that an infected person will show positive on thetest is 3 months. This means that most (but not all) infected people willshow positive on the test by this time.

The MAXIMUM period of time that an infected person will show positive on thetest is 6 months. By this point in time, more than 99% of infected personswill show positive on the test. This is as accurate as any test in medicinecould ever be.

For the most accurate test result, you must wait 6 months after your lastpossible exposure to the virus (or anytime afterward). At 6 months, thetests are more than 99% accurate. If you get tested before the 6 monthwaiting period, you could have the infection but the test won't pick it up.

Also, if a person tests negative at the time that they are showing chronic,ongoing symptoms, that indicates that their symptoms are not AIDS related. Aperson first shows positive on the test (by 6 months after infection), andthen later shows symptoms (an average of 10 years after infection). So if aperson tests negative at the time that they're showing symptoms, thatindicates that the symptoms are not AIDS related.


Approximate timeline of testing and symptoms for HIV/AIDS

Times are approximate and may vary greatly from person to person. NOT drawn to scale

Key:
AVS = Acute Viral Syndrome
A = Antigen test
PCR = Polymerase Chain Reaction test
[----] = Appears for a limited time only
----> = May continue for long periods of time
=These tests may NOT always show a positive result in an infected person! Therefore, these tests should NOT be used for the diagnosis of HIV in routine testing of adults.
= Symptoms may not always be present, and the severity of symptoms may vary greatly from person to person. The average time that the symptoms of full-blown AIDS begins is 10 years.


When taking an antibody test, what does a Negative, Positive, andIndeterminate test result mean?

Let me take this opportunity to review how HIV testing is done, and what apositive, negative, and indeterminate test result means.

When a person gets an antibody test for HIV, the first test that is done isthe ELISA test, also called the EIA. If the ELISA test is negative, this isconsidered a negative result, and confirmatory tests are not necessary. Anegative result means that no antibodies were found.

If the ELISA test is repeatedly positive, it must be confirmed with aconfirmatory test (usually a Western Blot or an IFA test). This second testcan be done from the same tube of blood. You must test positive on both theELISA test and the confirmatory test, to be considered HIV positive. If boththe ELISA test and the confirmatory test are positive, this is considered apositive result. This means that antibodies were found, and the person isinfected with HIV.

If the ELISA test is repeatedly positive but the confirmatory test isnegative, this is considered a negative result overall, and this means thatno antibodies were found.

ELISA tests are either positive or negative. Western Blot tests however, canbe positive, negative, or indeterminate. An indeterminate test means that thetest could not determine whether a person is infected or not. This can be dueto 2 things. Either a person was so recently infected that they are juststarting to produce antibodies, or something else is cross reacting on thetest. If an indeterminate test result occurs, the person is usually re-testedin about 4-6 weeks to determine whether they are infected or not.

The ELISA test is very good at picking up infections, but sometimes givesfalse positive readings (which is why confirmatory testing is always done onpositive ELISA results). The Western Blot is very good at ruling out falsepositive ELISA tests. In other words, the ELISA test is very good at giving apositive result when a person is truly positive. The Confirmatory tests, likethe Western Blot, are very good at giving a negative result when the personis truly negative. Therefore, the two tests used together are very good atdetermining whether a person is infected or not.


How accurate are the home HIV tests?

The HIV Home tests are as accurate as the antibody tests done in doctorsoffices and health departments, and they use the same ELISA/Western Blot/IFAtests. Like other antibody tests, these tests are subject to the same 6 monthwaiting period in order for the tests to be fully accurate (more than 99%accurate beyond 6 months).

There are certain pros and cons to using home testing kits.

PROS:

A person who's scared about being seen in a clinic can do the test withoutanyone knowing about it outside their home. They may feel more comfortabledoing the test alone.

These tests can be ordered by phone or here on the Internet, and can be anoption for those who do not have transportation to local clinics, or who arehome-bound due to disabilities.

The test itself is as accurate as antibody tests commonly used in clinicsaround the country.

CONS:

Getting test results over the phone can be very difficult, especially if thetest was positive. A person can just hang up and never hear all thecounseling and information they need to hear. Test counseling is best doneface-to-face, and is most effective this way.

Using home testing, if a person is positive, there is no way to do partnernotification (helping a persons sex/needle sharing partners know they've beenexposed). Partner notification is routinely done by local health departmentsaround the country for HIV and other Sexually Transmitted Diseases (STD's).Home testing would bypass this important, and proven, preventive healthmeasure.

Home testing is also more expensive. Testing through local healthdepartments, and some private agencies, are free or low cost. Home test kitshowever can cost $30-$50.

Another issue to be dealt with is confidentiality. If a person buys a hometest kit in a store, everyone in the store will know that person is taking anHIV test. The most confidential way to purchase the kit is by phone orthrough the Internet. Also, when taking a test at home, all the packaging forthe kit has to be well hidden in the garbage. If a garbageman empties yourgarbage, and sees the test kit packaging in the garbage, they'll know youtook an HIV test. If your garbage can were to open up (from animals, windetc.), all of your neighbors will know you've been tested for HIV as well. So for persons taking the home test, I say "Hide Your Garbage!"

In a home test kit, a person has a test ID card that is used to identify thespecimen. Anyone who has the number can get the test result over the phone.The person whose being tested has to make sure that nobody sees the card.Otherwise, any person who sees the card or the number can get that otherperson's test results. So it's important that a person getting tested at homedoesn't leave the ID number lying around the house, where other members ofthe household can see it.

In the United States, there is presently only 1 home test kit that has beenFDA (Food & Drug Administration) approved. It's called "Home Access." Therewas previously another FDA approved home test called "Confide," but this isno longer being sold, and has been discontinued. The Home Access Home HIVtest has been proven to be safe to use and accurate. Unfortunately, thereare also unapproved home HIV tests being sold illegally, especially over theInternet. The accuracy and safety of these unapproved tests is unknown. Therefore, if you are using a home test kit other than "Home Access," Icannot tell you whether these tests are safe or accurate. Like anything elseyou buy (especially over the Internet), as the saying goes, "Let the buyerbeware!"

I personally have tried the home testing kit by Home Access. Since I live ina rural community in the USA, I had to be very careful regardingconfidentiality, especially as it came to "hiding my garbage." Also, I cansee some people having difficulty in doing a fingerstick to draw blood forthe test. The test itself takes about an hour to do (which includes time forthe specimen to dry and to package up the sample to send to the lab). It alsoincludes a lot of reading material for the person to read through. Itherefore recommend about 2 hours to do the test at home. This includes allthe time to read the materials, and to do the actual test.

Home testing is an option for those who prefer to do the test on their ownwithout having to go through a doctor or a clinic. It is up to the public todecide which option is best for them. I chose to take the test myself, so Iwould gain a personal insight as to what it's like to take the test at home.


Should I get a PCR test or an Antigen test?

The subject of PCR tests is a very confusing one for many people. Unfortunately, these tests have needlessly been done on many people, andhave needlessly contributed to an increase in health care costs. These testshave their legitimate purposes, as described below. But they are notdesigned just to make people happy who don't want to wait 6 months for anantibody test. The inability to mentally cope with a 6 month waiting periodfor antibody tests is a mental health problem. Mental health problems arebest resolved with mental health solutions (counseling). Taking expensivetests like PCR tests, only needlessly increases our healthcare costs evenmore, thereby further limiting our already limited healthcare resources. With limited money to pay for healthcare, and to prevent healthcarerationing in the future, like it or not, we have to start looking athealthcare costs. Expensive tests (like PCR tests) should not be done justto make people happy. They should only be done if there is a legitimateclinical need for these tests.

The DNA Qualitative PCR can be used for diagnostic purposes, but there arelimitations to its use. Although it can often pick up an infection afterabout 1 month after an exposure, it will not always detect the infection. Itis NOT designed to do routine screening in adults. It is used primarily for:

  1. Research applications, where the test can be repeated multiple times torule out inaccuracies.
  2. Testing in newborns less than 18 months of age where antibody tests arenot reliable.
  3. Testing in persons with other diseases of the immune system whereantibody tests may not be reliable.
  4. Other UNUSUAL circumstances.

When we do Qualitative Diagnostic PCR's, we often do them more than once,just in case the first one did not accurately pick up the infection. We veryrarely do just 1 PCR. We usually do more than one under most circumstances(especially in babies). PCR tests are also usually done in conjunction withother tests for HIV, just to rule out inaccuracies in the test.

This test is very difficult for labs to perform, hence it's high cost. Themore difficult the test, the more the chances for innacuracies. But it's agreat test for labs that have a lot of experience with it. Usually onlyregional reference labs will do this test, but not the vast majority ofclinical labs.

Many people have requested these tests, since they don't want to wait 6months to take an antibody test. Doing these tests is clinically notnecessary in the vast majority of these cases, and only needlessly increasesour health care costs (these tests cost several hundred dollars). In the vastmajority of cases, antibody tests are all an adult needs. If a person can'tcope with the 6 month waiting period for antibody testing, counseling isoften a better option than PCR testing.

The following is a summary statement about PCR testing that was recentlypublished in a research journal. It states:

"The PCR assay is not sufficiently accurate to be used for the diagnosis ofHIV infection without confirmation. Use of PCR for the diagnosis of HIV inadults should be limited to situations in which antibody tests are known tobe insufficient. Future studies of PCR performance should be sufficientlylarge and should use adequate reference standard tests and standardizedmethods for the performance of PCR. Specimens should be evaluated by personsblinded to clinical status and to the results of other diagnostic tests forHIV infection."

The p-24 antigen test will pick up an infection an average of 6 days prior toa person testing antibody positive. The p-24 antigen tests will often showpositive 2-3 weeks after initial infection. However, not all recentlyinfected persons have detectable levels of p-24 antigen in their blood.

So a negative p-24 antigen test does not necessarily mean the person is notinfected. Once the person turns antibody positive, the p-24 antigen test willoften revert back to a negative result. So this test will only be positivefor a short period of time.

The antibody tests show positive an average of 25 days after infection.

The usual period of time that most (but not all) people will show positive onthe antibody test is 3 months. The maximal amount of time that a personstarts to show antibody positive (in more than 99% of cases) is 6 months.

So we can say that the antigen tests will pick up an infection about 6 daysbefore the antibody tests will turn positive. Let me also stress that thep-24 antigen test alone CANNOT be used to diagnose HIV infection. Remember,this test will not always pick up an infection. A p-24 antigen test (whetherpositive or negative) must always be used alongside other HIV diagnostictests, before a persons HIV status can be determined.
















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