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which tests next?
Aug 8, 2002

Dear Dr Frascino!

I want to say, that since 3 months when I am down, sometimes I go to your messageboard and read your messages. what a balm for a wounded soul!! thank you for that!! This is much more one would ever expect. I am not often smiling when i am "researching" about hiv related "fatique and anima", but you make it possible!!

WEll and I also want to apologize for this huge posting i am sending you...

I also want to say that this is the first time i am writing to you. (do I get a beginner bonus now ;-)

*** some data ****

Now to my big problem: possible exposure to HIV/HCV was twelve weeks ago (may 11/12). cunnelingus on a woman - maybe was menstrual blood involved, maybe not, i just do not know, it was dark. my oral health was also very bad (my lip bleeded in the morning) :(( The story goes on: it turned out that the woman had a very serious drug career, although she said she never used IV drugs...hhhmkay...

well and I did NOT go for a PEP!!?! (i lost a lot of self respect for that "decision". I guess i was simply not informed about the great success rates of PEP)

OK...: persistent ARS-like symptoms started at week 2. These included some enlarged lymph nodes, drenching night sweats, fatique [see, it fits your topic in some way!:-)], dry mouth, white tounge (everytime, everyday!), sometimes aches in underarms and thigh, I felt sick but went to work most of the time. These symptoms are now (at week 12) slowly fading away. in the last two weeks i also experinced some HEP-C related symptoms (?) like skin problems(itchy, vulnerable skin etc.) mild jaundice (not diagnosed by a doc), sometimes discomfort below right rips, fatiiiiiique, a few weeks ago i noticed some urin/stool discolorations - at that time i did not think about HEP-C yet)

I desperately need your advise how to get a reliable determiniation/exclusion of HIV/HCV infection, or at least of the HIV infection. i know i could wait for a few months but given all that new info about HIV-HCV-antibody interaction, and given all my mental stress, i would rather like a method where time is not such an important factor.

Here is my testing "profile" so far (started 2 wks too late and with inadauate tests)

wk.6: hiv-1 p24 test /NEG/ wk.6: hiv-1/2 antibody /NEG/ wk.9: hiv-1/2 antibody /NEG/ wk.10: hiv-1 (rns) pcr /NEG/ wk.12: hcv antibody /NEG/ wk.12: hcv pcr /TO COME/ (i know the pcrs for HEP-c need to be repeated a few times if neg)

***** my question *****

...so my question to you is focused on HIV:

~~ Which tests would you recommend to rule out (e.g. such that p<0.5 or such) HIV-infection, assuming that money for several expensive tests would be no problem ? ~~

i am thinking of another series of pcr tests. would this be a way? what do you think about that "ultrasensitive PCR test"?

I could not find enough data about accurary/sensitivity of these tests (except for the primary infection)

Thank your for reading this!! Please help me!

thanks, Joe

Response from Dr. Frascino

Hello Joe!

Thanks for your kind comments. Oral sex, cunnilingus, carries a relatively low risk of HIV transmission and many programs do not offer PEP for this type of potential exposure. Your ARS-like symptoms are most likely NOT ARS. What the heck is "vulnerable skin"?

Your lab tests out to 10 weeks, including both PCR and antibody tests, are extremely encouraging. If you want that p<0.5, all you need is an antibody (ELISA) test at 12 weeks or greater. No additional studies are really necessary, even if you do have more money than Bill Gates.

Good luck, Joe. I'm quite certain with your low risk and negative tests that you'll be WOO-HOOing very soon!

Stay well.

Dr. Bob


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