I was wondering, if doctors have taken to understand that low viral loads in HIV + partners, can be one of the reasons why some don't show any of the ARS symptoms that 70 - 80% of HIV + do.

Also i was wondering has their been accounts when a person recently sero converted and had none of the ARS symptoms that you tested for,

And why is insertive anal at a higher risk than insertive vaginal?

[Dr Jose]

Hello,
Thank you very much for your contribution to our forum.
There are different possible theories about why some patients do not show hardly any symptoms of acute HIV sero-conversion and others (the vast majority) show clear and more severe symptoms. Also there is a wide range of non-specific symptoms. It is still very unclear what determines the severity of the symptoms: the inoculum size (amount of virus present in the infected fluid determined by the viral load of the other person, but also the amount of infected fluid itself), HIV strain virulence, patient's immune status, etc. Symptoms always coincide with peak levels of plasma viraemia (levels of virus in blood).
Becuase of this, the answer to your second question is yes. We have certainly seen patients who tested positive and they did not experience any symptoms at all, though it is rare.
The reason why insertive anal involves a higher risk than insertive vaginal is mainly due to the fact that the lining of the head of the penis is more likely to get damaged through friction inside of the anal cavity, which is tighter than the vaginal cavity, but also the anal mucosa is more likely to bleed through anal penetration.
Best wishes,
José

a wide range of non-specific symptoms? when you say non specifc do you include coughing, or is it other symptoms, because it hasn't been proven that a cough isn't a symptom of HIV, yet, since we look for ARS symptoms but not cough symptoms in patients

[Dr Jose]

Cough is not a typical symptom. Non-specific means that they are not specific to acute retroviral syndrome, but could be symptoms of hundreds of other conditions. This is the frequency of the clinical features associated with ARS: fever (80-97%), enlarged lymph nodes (40-77%), sore throat (44-73%), skin rash (51-70%), muscle and joint pains ( 49-70%), low platelets (45-51%), low white blood cells (35-40%), diarrhoea (32-33%), headache (30-70%), abnormal liver function tests (21-23%), nausea and vomiting (20-60%), enlarged liver and spleen (14-17%), weight loss (13-32%), oral thrush (10-12%), encephalopathy (8%), neuropathy (8%). Symptoms begin 2-6 weeks after infection lasting 5-10 days, being the first four mentioned the most common ones, happening typically all at the same time.
Best wishes,
José

ok so i did the rapid antibody test 2day after my discussion with you and viral loads, and it cameback negative Sept 18 was exposure and today is october 29, almost six weeks am i out of the woods yet or should i continue getting tested

[Dr Jose]

A negative result is highly reassuring at 6 weeks. However it cannot be considered fully conclusive. From clicnical experience, I can say that it would be fully conclusive already after 8 weeks, but if you follow current guidelines, this would not be at least until 12 weeks.
Best,
José