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insatiable curiosity
Sep 21, 2004

Hi Dr. Bob- I am relatively new to HIV/AIDS (tested poz 04/04 after thrush) and have since devoured each line of this website. You and your collegues helped me realize realize that I am indeed in control of my destiny, and that in a civilized society, it is our duty to care for one another.

I have refrained from asking self-indulgent questions but this one is killing me. I thought you, Dr Bob, beeing the way-coolest, would be the most likely to answer. Now that I have 4 sets of #'s - is there any way to estimate how long I've been infected? These are the only unprotected encounters (anal/recieving) I ever had:

2002/ condom broke at beginning of sex episode - no ejaculation or precum noted - the guy was hyper-paraniod about HIV and I wonder.

2000-2001/ partner2 - tough to explain, enigmatic relationship. He took many pills, often right after meals- said they were vitamins. Other red flags make me think he was poz and aware. I have not called him on it cause he will certainly not tell the truth if it's so. In 2000 I had shingles (so did 2 other people where I worked) and tested neg. for HIV about 4 weeks later. Was shingles my sero-conversion illness and I tested too soon for antibodies to be present? Does this neg. rule out my previous partner or could the test have been faulty?

1993-1995/ partner1 - the only time I had ejaculate inside.

05/01/04 - cd4-44 Vl.750k+

05/28/04 - cd4-195 vl. still 750k+ after 13 days on sustiva,FTC,viread and 4 days in a psychiatric hospital.

07/01/04- cd4-335(had been taking neupogen) vl. 87k after 2 weeks reyataz,FTC/viread.

08/11/04- cd4-220 vl. 4k after 8 weeks

It blows my mind to think I've been poz almost a third of my life. If it's true I would have many people to inform. Partner 2 wants me back but I want to tell the CDC there's a sociopath in Manhattan. If I was infected 2 years ago it means I progressed to AIDS in less than 2 years! Please-I'm dying(not funny) to know.

Kudos,cartwheels and endless thanks for the folks at AHF Downtown LA as well as at The Body.com for helping me weather the eye of this storm of my life. -Hugs

Response from Dr. Frascino

Hello,

You pose a question to which there is no definitive answer, but rather several possibilities.

Based only on the information you provided, a CD4 of 44 with a viral load of 750,000+ would indicate long-standing HIV infection. A "normal" HIV poz-person (whatever that is) can be expected to loose 50-80 CD4s on average per year if they are not on anti-viral treatment. If there were no other reasons for your CD4 decline, we would estimate you had been positive for at least a decade.

The shingles episode in 2000 could have been evidence of a deteriorating immune system. Sometimes shingles in folks with immunodeficiency is more severe and not limited to just one area, as it often is in people who are able to mount a more normal immune response. Shingles limited to a single dermatome, a specific area of the body involving only one side, can also occur in people with normal immune systems. I don't know how extensive or severe your bout with shingles was, so it's difficult to speculate what exactly transpired with you.

The negative HIV test four weeks later is the real mystery in this scenario. Could it have been a false negative due to laboratory error? Do you have a copy of the report to confirm what type of test was run and the result? With only the information you have provided to go on, I would have to assume that "negative" result was in error.

The other less likely scenario is, I believe, that the bout of shingles was a red herring and the negative HIV test was indeed negative. That would mean that if your only other exposure was the 2002 failed-condom incident ("no ejaculation or precum noted"), then you must have been infected with a very aggressive strain of virus and experienced a dramatic CD4 decline during the next two-year interval. This, while possible, seems to be much more unlikely than the scenario described above, particularly because your virus appears to be responding quite nicely to routine HAART therapy.

As to which of these (or possibly other) scenarios actually occurred may indeed remain a mystery for now. In fact you may never know for sure if it was a sociopath in Manhattan or highly aggressive recently acquired viral strain. However, despite past mysteries and no matter what path you took to get to where you are today, the important thing to focus on now is present day realities and future possibilities. Your treatment has dramatically lowered your viral load and boosted your CD4 count. That means you are responding well, both virologically (decreasing viral load) and immunologically (rising CD4 count). This is excellent news indeed. I recommend you let the mysteries of the past go and keep your sights fixed clearly on today and tomorrow. Yes, you, and not the virus, are now in control of your destiny.

Finally, do you really think I'm the "way-coolest?" Thanks! (Hey, Cal Cohen, did you hear that???)

Good luck. Stay well. We're here if you need us, OK?

Dr. Bob


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