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Can I get a WOOHOO??!! / Thanks
Nov 12, 2002

Dr. Bob,

I want to thank you for all the fine work you have done on this board. You have the ability to make the worried well take that step back and think logically about the situation they are in and realize that more often than not there is nothing to worry about.

Anyways, I just got my negative result today (89 days after very low risk exposure of insertive oral, fingering and having my rectum fingered by an escort). Like many of the worried well, I would freak out at times and my work and relationships w/ my girlfriend and friends suffered. However I am ready to put this experience behind me and chalk it up to experience.

I have a few questions though that have bothered me during my ordeal and I'd love to hear (or rather read) your insight on them:

1) If scientific studies have shown that the average window period using 3rd generation ELISAs is 25 days and that the 95 confidence interval is 9 to 41 days, why don't you encourage more people to get tested at the 6 week point? If you test negative at six weeks then you can be 97.5 sure that you're negative right? This would also help many of the worried well quell their fears. I understand that from a public health perspective the CDC would want every HIV case caught and that's why they recommend the 3-month window period, but sometimes a little bit of mental reassurance helps.

2) This is my cynical business school side talking, but wouldn't you think that the pharmaceutical/medical device industry would lobby for more frequent testing and earlier testing after an exposure? More frequent testing results in greater sales of testing kits while earlier detection would result in greater sales of anti-HIV drugs for these huge pharmas.

3) I got my negative result today at Columbia University's GHAP program, which is run by Mr. Kull. I found it a bit ironic that I was told by the counselors there that 90 of all seroconversions occur within 4 weeks and that ARS occurs within a week or two after exposure. Don't get me wrong, the counselors there helped calm me down and were of a great service, but was there message wrong or are the messages on The Body of the utmost conservative nature?

By the way, I plan on giving your foundation a donation. After learning about this disease and the way it changes people's lives, I want to do whatever I can to help.

I plan on signing off from The Body for good (after reading every single post at least 3 times!) so don't take this the wrong way, but I never want to see your face again =)

Response from Dr. Frascino

Hi,

Congratulations and WOO-HOO on your 3-month negative test! I'll try answer your questions, but remember, this forum is for HIV+ folks with fatigue and anemia questions so this will have to be brief.

1. The ELISA tests are improving. The confidence intervals are based on population studies. "A little bit of mental reassurance" may indeed help, but testing prior to 3 months statistically still leaves too much room for doubt. The consequences of missing a positive test are too great to recommend 6-week testing as conclusive at this time. 2. Pharmaceutical companies would indeed like to sell as many kits as possible, but that doesn't change the predictive value or statistics of when these test kits should be used. When and if to intervene with antiviral medication is a whole other story. 3. I can't speak for all the experts on The Body, but let's just assume the statistic you heard - "90 percent" of people seroconvert within 4 weeks is accurate. That still leaves 10% (1 in 10) as not seroconverting in that period. That's a significant number.

So, you can probably see why we can't tell folks to WOO-HOO after just 4 weeks. Is that being conservative? No, just honest. I'm very much an optimist, but having witnessed this illness from both sides of the examination table, I'm also very much a realist.

Congratulations again! And many thanks for your donation to The Foundation. Tax-deductible contributions can be sent to:

The Robert James Frascino AIDS Foundation 779 Altos Oaks Drive, Suite 200 Los Altos, CA 94024

Stay well. We'll miss you :)

Dr. Bob


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