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Dr. D. Love
Dr. D. Love, Doctor
Category: HIV and AIDS
Satisfied Customers: 18664
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I would like my question answered by a board certified HIV

Customer Question

I would like my question answered by a board certified HIV doctor. if you're not then please divert my question to someone who is. I have been on Humira off and on for about 10 years. i stopped the Humira about September 2013 until March 2014. In March
2014 I took one 40mg dose of Humira. I was also on Prednisone almost that entire month as well as having 2 cortisone shots in my knee. I had a high risk exposure in April 2014. I immediately stopped taking the Humira. I started having a ton of symptoms a couple
of weeks after exposure. Lesion on penis, sore throat for a week, thrush, fungal infections, fever , lost 15 pounds, chills, C Diff, prostate infection, follicullitis, red and brown rash, fatigue, sore neck, swollen nodes all over, muscle pain and eventually
muscle atrophy. i tested antibody negative at 1,2,3,4,5,6 and 8 months. negative gen 4 at 51 days. negative RNA PCR at 5 weeks and 1 year. negative gen 4 at 16 months. I didnt take any Humira after the exposure for almost 1 year. i took a shot 2 weeks before
the 12 month RNA PCR test and i took 2 doses about 2 1/2 months prior to the 16 month test. iam actually sick now and have been for 4 weeks. swollen nodes for 3 weeks, sore throat for 4 weeks, stiff neck for 2 weeks, loss of appetite, lost 15 pounds, fever,
feel cold all the time, fatigue, red and brown rashes. Ive researched Humira and TNF alpha blockers. they say that they do affect hiv antibody production. For how long after stopping the Humira I dont know. I did take Humira again before my 12 month RNA PCR
test. i dont know if Humira could affect the Viral load. some of what ive read makes me believe that it could cause the viral load to drop. I also took Humira again months before the 16 month test. my concerns are that all of my testing has been compromised
because of the Humira. if it affects antibody production and also affects the replication of the virus then im 100% sure i have HIV. its also my understanding that Humira stays in your sytsem for a long time after stopping it. Even if my immune sytem started
to to recover, im concerned that when i took it again before my other tests that it could have caused a reduction in detectable hiv antibodies as well as the antigen or RNA. and please dont tell me Humira doesnt affect HIV antidody pruduction because i already
know it does. i just dont know for how long or to what extreme. an internal medicine dr. at MUSC said he was concerned and was going to confer with an HIV specialist about my situation. that made me very uneasy. But I either have it or I dont. i just wish
i knew now!
Submitted: 2 years ago.
Category: HIV and AIDS
Expert:  DrRussMD replied 2 years ago.


You do not have HIV based this data.

I am a double board certified doctor.

I think you must have been told this by a number of doctors.

By the way, there is no such thing as a board certified HIV specialist.

HIV is the venue of board certification in internal medicine, and an internist should have known better, and certainly would not have a reason to refer you to an "HIV" specialist.

Humira would not have affected a PCR test.

It would not affect an RNA test.

In fact, a three month elisa is so sensitive it would not effect an elisa test either.

Based on your testing, you do not have HIV.

OK, so that is an initial answer….

Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.

Customer: replied 2 years ago.
The antibody tests I took were done at labcorp. Test#083824. It's not Elisa its ICMA. The other was test#083935. It's a gen 4 enzyme immunoassay. It just appears clinically that I have it, but my labs up to this point have been negative. The doctor at MUSC is concerned because I was completely healthy, never had any of those symptoms, before the exposure. He's worried that the Humira caused false negative results. I forgot to mention that I did take prednisone a few times between my initial test and the 16 month test. It's also my understanding that not all HIV positive people with have a detectable viral load at 5 weeks and even 12 months. I was told that by 5 weeks the virus has left the blood stream aND has gone proviral making it undetectable by RNA PCR
Expert:  DrRussMD replied 2 years ago.

There is absolutely no way, none, that your battery of tests would have all been false negative.

In addition, there is no way that antibody tests would be negative from 1 to 8 matter what you were on, as they are all to sensitive.

No, you don't ave HIV, and the PCR is going to be good at 5 months and 12 month, and there is no way there would be two false negatives during this time frame.

You will not that other experts are already agreeing with me.

please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.

Customer: replied 2 years ago.
It was a 5 week RNA PCR test if that matters. So what else could be causing all of my symptoms? Right now Ive had bronchitis and upper respiratory for almost 3 weeks. Along with the other symptoms. Something is wrong. How long after an exposure is a gen 4 test considered conclusive?
Expert:  DrRussMD replied 2 years ago.

It does not matter: your testing rules out HIV.

You have actually not have typical HIV infections.

If you already have autoimmune disease, this alone can account for your situation.

please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.

Customer: replied 2 years ago.
Dr.Thomas. My fear from the start has been the possible effects of Humira on the HIV tests that I have taken. I researched TNF alpha effects on HIV. There are many, many scholarly articles on the subject. I'll quote some of what I've read, but I ask that you check it out for yourself. " TNF Alpha appears to activate HIV RNA and virus production". " Since TNF alpha enhances HIV replication in studies, researches speculate that TNF alpha blockers may have anti retro viral activity." "TNF has been associated with increased viral production. The treatment of HIV1 infected patients with TNF inhibitors reduces serum TNF levels that results in lower viral loads." Humira is a TNF alpha blocker, which means it blocks the production Of TNF alpha. So not only does it effect antibody production but it also decrease HIV viral production. Which means that not only will I not produce antibodies, I also won't have a high enough viral load to be detectable . The replication and spread of the virus is what causes antibodies to be produced as well. So the Humira is a double whammy. It screws up not only the antibody test but the antigen and RNA PCR tests as well. I urge you to Google TNF alpha effects on HIV.
1. Read the scholarly articles for TNF effect on hiv.
2. Read TNF Receptor Superfamily Members in Hiv.
I need to know your take on it seeing that this is what my question has been about from the start.
Expert:  Dr. D. Love replied 2 years ago.

Hello. The other expert has opted out.

There are no studies in the medical literature that indicates that Humira will cause consistent false negative HIV antibody tests for the length of time that you describe. Since the current generation of sensitive HIV antibody tests have been developed, there has not been a single case of someone that has had consistent HIV negative results for a year that has ultimately been found to have HIV that was missed by the tests.

It is worth noting that there are rare cases in which the viral load tests may miss an HIV infection, even in people not taking any other medicines, but the same problem is not seen with the antibody tests, and this is one of the reasons that the CDC still recommends using the antibody tests for diagnosis.

The only theoretic risk for HIV would be if a completely new type of HIV has evolved that would not be detected by the current generation of HIV tests, but this would be exceedingly rare, although the same would have been said by doctors before the first case of AIDS and before the first case of the second type of HIV. However, the indication that a new type of HIV may be present would not be suspected by the symptoms that occur with an acute HIV infection, as these symptoms can occur with many generic viral infections. The clinical information that would be suspicious for a new type of HIV would be clinical evidence of the characteristic effect on the immune system, such as a decrease in CD4 count or the development of unusual opportunistic infections.

Customer: replied 2 years ago.
Dr. David did you read my original question, as well as follow ups with Dr. Thomas? This is my concern...Humira is a TNF alpha blocker. If what I've read is true, and TNF alpha blockers inhibit Hiv replication, then there will not be a strong antibody response. Not to mention humira suppresses the immune system. So you've a situation where the viral replication is being inhibited as well as antibody suppression on top of that. If that's true then how could there be enough antibodies to be detectable? I don't know what to think.
Expert:  Dr. D. Love replied 2 years ago.

Yes I did read the original question and the responses. Your fears are not founded. Even if there is suppression of the number of antibodies that are formed, there still would be plenty of antibodies generated to cause a positive test on the current generation of sensitive antibody tests. There has never been a case in which what you fear has happened.

Customer: replied 2 years ago.
I get what your saying about the antibody tests. If you get the flu, the more the virus replicates in your body the stronger the antibody response. If TNF alpha activates HIV RNA and viral production, and humira is a TNF alpha blocker, then doesn't theoretically mean that there wouldn't be an antibody response. Isn't the spread of the virus what causes an immune response? Sure don't know what else could be wrong with me. Did you see my symptoms then as well as in the last 4 weeks? I have another question about hiv gen 4 test. How reliable is it at 4 weeks?
Expert:  Dr. D. Love replied 2 years ago.

You can postulate any theory you want - if it has never happened, then the theory is wrong.

I have already addressed the non-specific nature of your symptoms above.

The fourth generation HIV tests will detect about 80-90% of infections by 4 weeks.

Customer: replied 2 years ago.
Any ideas of what it could be based off my symptoms that started 2 weeks after my exposure in 2014? My muscle atrophy started 4/5 months after and is still getting worse. Rheumatologist and Neurologist ruled out myositis, ALS,MS. Maybe it's cancer? I don't think cancer symptoms would come and go like my other symptoms would they?
Expert:  Dr. D. Love replied 2 years ago.

As I said above, the acute symptoms could be from many different generic viral infections. Muscle atrophy is most likely related to a neurologic condition, although it could simply be disuse atrophy because of the muscle pain or from poor nutrition/oral intake.

Customer: replied 2 years ago.
your telling me that no one has ever tested negative for twelve months or longer and then tested positive. Based off no other exposures and regardless of any meds like cemo meds, powerful immunosuppressive drugs or dual infections.
Expert:  Dr. D. Love replied 2 years ago.

Correct. Not with the current generation of sensitive tests.

Customer: replied 2 years ago.
I'm very concerned about the validity of my hiv test results. The reason I'm so concerned is because of the abundant of symptoms I have and do have. I have man different kinds of skin manifestations. I have light brown spots, about the size of a pencil eraser, coming up all over my legs and arms. They are not sun or liver spots. They are flat with a grainy texture. I can actually scrap the brown off. I also have spots coming up that are a different color. They are slightly raised and are slightly reddish brown in color. I also have small red dots coming up on my skin. I've been very symptomatic for over 4 weeks. Swollen nodes, sore throat, bronchitis, chills, fever, stiff neck, headaches, etc. Iam very concerned that Iam infected with hiv and that the combination of Humira and Prednisone have caused a steady delay in antibody production and delayed my seroconversion. I'm took a humira shot, had 2 cortisone or prednisone shots for knee and ankle swelling, and also took prednisone pills the month before my exposure. I tested out to eight months with antibody tests following exposure. I had at least 2 more prednisone shots in between my 1 month and 8 month test. I also think I make have taken prednisone pills for a couple of weeks as well. I'm not gor sure. But I think I took a humira shot a month before the 8 month test. Basically I took prednisone sporadically thru my 8 months of testing. I'm concerned that it caused immunosuppression to the point where not enough antibodies were produced to be picked up on the tests. I did take a gen 4 test at 16 months, but I still took some prednisone pills, shots and a few shots of Humira leading up to that test. I'm also concerned about that test itself. When I had the blood drawn at my Dr office to be sent to Labcorp, my doctors Labtec was unable to enter the test code into the computer. She called Labcorp to get the info for the blood draw. I don't even think she used the right color test tube for the test. She had the info for the test written on a piece of paper and said she would send it with my blood sample to Labcorp. I'm very worried that that test could of been compromised. Basically I scared that my immune system was suppressed from the meds. Once the meds started to wear off and my immune system started to recover, I took more prednisone suppressing my immune system again, and repeat. That's why I'm concerned that I am infected and that it hasn't shown up on tests to this point. I have never skin manifestations like I've been having the last couple of months, and they are getting worse. I can't shake the upper respiratory infection I've had for weeks and I'm even on ab antibiotic.
Expert:  Dr. D. Love replied 2 years ago.

You can be as scared or worried as you want to be, but no case of HIV has ever been reported in the medical literature such as you describe.

Customer: replied 2 years ago.
I've read that prednisone suppresses your immune system for a good while, even after you stop taking it. That it invalidates an hiv test. Especially when your taking it right before the exposure and after the exposure during the course of testing. That is different if you took it 5/6 months after the exposure before getting tested. That the antibodies would have already formed and the prednisone would have no effect on the testing in that situation. But if I'm taking it off and on before the exposure and following the exposure during my course of testing, then how can I have enough of a response to produce enough detectable antibodies. Where are you getting your information from? It's contracting everything I've been reading about its effects on hiv testing. I just thought if I reached out to an HIV DOCTOR on this sight that he would be able to give me the facts, because he would have vast knowledge of the effects of prednisone and humira on hiv and testing.
Expert:  Dr. D. Love replied 2 years ago.

Just like the first expert, we are getting our facts from the medical literature.

Customer: replied 2 years ago.
No offense Doc, but I feel that this sight is definitely fraudulent. How would practicing doctors have time, or would even want to sit around answering questions on the net? No way your an expert on what I'm asking about. No way! You should definitely stop pulling my chain and divert me to a real HIV Doctor. That is if this sight even has one. This is nothing to play around with. Sorry....but this is how I feel.
Expert:  Dr. D. Love replied 2 years ago.

As the first doctor told you, there is no such thing as a board certified HIV specialist.

Customer: replied 2 years ago.
An infectious disease doctor is an hiv doctor.
Expert:  Dr. D. Love replied 2 years ago.

No, an infectious disease specialist is an infectious disease specialist. So you think that a primary care physician would not have time or want to sit around answering questions on the net, but an Infectious Disease specialist would.

Customer: replied 2 years ago.
You really haven't answered anything. How long does a shot of prednisone affect the immune system/ antibody production?
Expert:  Dr. D. Love replied 2 years ago.

I have answered your original question.

If you want an Infectious Disease specialist, then you would do better to post another question and specify that you want only an Infectious Disease specialist and not an Internal Medicine doctor or Family Physician.

Customer: replied 2 years ago.
I did. An infectious disease doctor is board certified and that is who specializes in diagnosing and treating hiv.
Expert:  Dr. D. Love replied 2 years ago.

No you did not. You asked for a a board certified HIV doctor, and the first expert informed you within 6 minutes that there was no such thing, and you did not ask for an Infectious Disease specialist until three days later.

And the vast majority of diagnostic testing being done for HIV is not being done by Infectious Disease specialists. Most end up seeing an Infectious Disease specialist once the diagnosis is made, but almost none are sent to Infectious Disease specialists for initial testing for the diagnosis.