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Dr Bob, Personal Question...
Nov 13, 2004

Hi Dr Bob,

I dont need to tell you again how well respected and loved you are. Single handedly, you have helped millions of infected and negative people around the world. I wanted to ask you a personal question, and obviously respect it fully if you choose not to answer. I believe you had acquired a needle stick injury and started PEP within an hour or so. What are you views on why it didnt work? I do realise it doesnt work in every instance. At the time did you only take one drug, as thats all that was available or do you believe it was a resistant strain of virus. Was the individual you acquired it from sick with a high virus load? Also do you recall when you serconverted, as in do you recall having symptoms of acute retroviral syndrome within a month or so after the incident eventhough you were on PEP. The reason I am asking is that I started PEP (Combivir) within 24 hours of a high risk vaginal insertive incident. Hypothetically, if I was infected, and the PEP didnt work, would the medication in all probability keep virus levels too low within the first month for any symptoms to occur. Would they only occur, if they did occur at all once the pep was stopped and the virus was able to begin replicating again. I do realise that symptoms do in no way mean HIV infected, but I was very interested to know what you went through.

Remain as strong as you are, you keep us all going and give us hope.

JJ South Africa

Response from Dr. Frascino

Hello South African JJ,

First off, it is impossible to extrapolate one person's seroconversion experience to anyone else's, because there are an extraordinary number of variables that would need to be taken into account different viral strains and different immune responses, for example.

The virus found me in January 1991. At the time of my occupational exposure, very few HIV drugs were available and only AZT was even considered as a potential post-exposure therapy. The patient I was performing the procedure on had advanced-stage AIDS and was most likely already resistant to AZT. There was no way of knowing this at the time. It was long before we had resistance tests or even viral load tests, for that matter. So, I took AZT, as it was really the only option. Yes, I do recall my ARS seroconversion reaction. It fit the classical description and was not subtle.

Moving on to your situation, hypothetically, if "PEP didn't work," there would be no effect on ARS symptoms.

Good luck with your PEP therapy. We'll all send you are best karma!

Dr. Bob


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