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Follow up on "recently diagnosed, best friend stopped talking"
Aug 8, 2008

Hi Dr. Bob I am the med student from NYC who sent you a message recently about my recent diagnosis, panic and also frustration over rejection by my best friend. You got back to me immediately. You say you are here for me/us and let's go through this together. I accept the impossibilty of you remembering and keeping track of each one of us but I wanted to tell you that this was one of the sweetest and most comforting things I heard in the past several months. Being in the medical field myself, I supposed I adjusted pretty quicky to this recent change in my life, I have a doctor that I trust, I am doing my best to go on with my life and still make plans for my future, I started exercising and eating healthy again after a period of depression and discussed the issue with my best friend as you recommended. We talk again just like in the old times and this made it clear to both of us how indispensable we are for each other and I'm grateful for having him back in my life and his support as well as yours. As for my health, it's been so so, my cd4 has declined very rapidly to my surprise. I was hoping to go on without meds for several years but my last cd4 came back 360, gradually dropped to this point over the past 8 months since I got infected. So I am due starting treatment in a few months, after less than one year of living with HIV. But numbers are numbers, I guess I'm just one of the few unlucky fast progressors. I just wanted to take this opportunity to update you on my status and tell you how much it means to have you here. I am aiming for a career in HIV research in the future (provided that I will respond to therapy well and be healthy) and I will send you regular updates. A big hug to you.

Response from Dr. Frascino

Hi,

I may not remember every crazed victim of lap-dance-o-phobia, but I certainly remember you! I'll reprint your initial post below for the benefit of our readers.

I'm delighted you've found an HIV specialist you can trust and that you've given up your "alien" behaviors and returned to healthy habits, including good nutrition and an exercise regimen. BRAVO! I'm particularly pleased you've reconnected with your best friend. True friends are difficult to find and really are a treasure to be cherished and nurtured.

Regarding your CD4-cell decline, you may not be an "unlucky fast progressor." If indeed you were infected relatively recently, your body's immune system could still be adjusting to the infection and not yet fully "kicked in." It's quite common following primary HIV infection for the CD4 cells to dip significantly. Then, over the course of a matter of months, as the body's anti-HIV immune response develops, it tamps down viral replication and in so doing allows for some CD4 reconstitution. Ultimately, most HIVers will reach a "viral set point." It's a kind of equilibrium between the virus's ability to replicate and the body's immune system response working to stop that replication. Without treatment, the virus would eventually win this battle. But in most HIVers, this viral set point "equilibrium" persists for a number of years with relatively gradual decline of CD4s (about 100 per year or so). I certainly wouldn't be surprised if your CD4 count trended upward on your next determination. Let me know when you get your next laboratory results.

Finally, I'm delighted you are aiming for a career in HIV research and I'm very much looking forward to your becoming a professional colleague. In the interim, you can count on me as a friend. We will get through this together. I really am here if you need me.

Be well.

Dr. Bob

just diagnosed-best friend stopped talking Apr 26, 2008

29 yo male from NYC, got infected only a few months ago, still trying to come to terms with it. I am in medical school, finding it extremely hard to concentrate lately, my profs think I act like an alien, not knowing what's happening to me. There are many unknowns, will I keep my sanity and get out of school successfully, will I respond to treatment, will I eventually develop a fatal cancer ? The worst is my best friend stopped talking to me. We had the best time of our lives ever since we met in a downtown gay club 4 years ago, we shared everything, moved in together, emailed and texted each other 100 times everyday, I did so many things for him, always been there for him. We were going to move to California together eventually. He told me he would always be there for me when I told him about my infection but over time he started talking less and less to me. When I ask hi what's up, he just says he is busy. He has never been this busy in the last 4 years, he has not called or emailed me for the past 3 weeks almost. before we would talk everyday. If of all the people he does this to me, how can I expect to be in an intimate relationship ever with somebody else let alone have a boyfriend? Thanks for being there Dr. Bob. There is nothing you can do but at least I know you read it and you understand what I am going through.

Response from Dr. Frascino

Hi,

It's time for a heart-to-heart talk with your best friend. Maybe he really has just been busy (doubtful). Maybe he's mad at you for getting infected, but is unable or unwilling to share that feeling with you. (This happens more often than you might realize.) Maybe he just can't handle the fact you are HIV positive. There are many reasons people may suddenly distance themselves from someone else once HIV enters the equation. Since this friendship obviously means a lot to you, I think it's worth trying to find out what's going on. Hell, maybe you really are acting like an alien. Also, maybe this guy really isn't "best friend" material after all. Why not show him this post and my response and just ask him to level with you? But, be prepared. If for whatever reason he can't handle your being "virally enhanced," realize that he is rejecting the virus, not you!

I also think you need to widen your support network considerably. How about confiding in close family members or other friends? An HIV-positive support group may also be worthwhile.

Getting an HIV-positive diagnosis is a shock. A period of adjustment to your new reality is to be expected. Your medical training should be beneficial in helping you put your HIV disease into perspective. Start by getting more informed. Read the information in the chapter "Just Diagnosed" that can be easily accessed on The Body's homepage under Quick Links. Then expand your knowledge base by perusing the wealth of information on this site, its archives and its related links. From there you can review the information in your medical school textbooks and maybe even consider doing some of your rotations on an HIV/AIDS ward or outpatient clinic.

I don't know if you know this or not, but I've been HIV positive since January 1991. Let's get through this together, OK? I'm here if you need me. Good luck.

Dr. Bob


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