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Fatigue and AnemiaFatigue and Anemia
          
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desperate fellow italian
Dec 6, 2001

Dr. Bob: I know this forum is for those who already are confirmed HIV+ but I have tried other forums with no success and truly have little options. Also I am a huuuge fan (you hear it all the time, I know) and I notice you are prone to help fellow paisans, I hope you will help me. I am 22 years old and fear I may have ruined my life and hurt someone very dear to me. On may 16th of this year I had unprotected insertive anal sex with someone I did not know; incredibly dumb I know. I was in a commited relationship at the time but things were rocky and we had a huge fight but that is no excuse. About three weeks later I was very sick: for several days I had almost no appetite (ate only a muffin), was diagnosed by my doctor with follciulitis, had bad night sweats, was achy all over, had a few mouth sores, had no energy and broke out in a rash of small red dots. Needless to say I was terrified. I had an ELISA at our local health department at 21 days post-exposure which I was fearful of because when I went back all the nurses were staring at me with a pitying look; however it was negative. I had a DNA-PCR through Specialized testing at 35 days: again, negative. At this point they told me there was no need for further testing. My partner thankfully forgave me and we moved on. Soon though I noticed more red dots and I had visibly lost muscle in my arms-- I was far from He-Man to begin with, so believe me I noticed. Unfortunately, my partner (who is a few years younger and has only ever been with me sexually) soon began to have the little red dots on arms and legs as well. He had "swollen anterior cervical nodes" in his neck for about a month as diagnosed by a physician in the small town where we attend university. They did a CBC on him and his T-cell count was low. I was horrified. At 5 1/2 months I again went to another branch of the health dept. for an ELISA test-negative. The dr. at the clinic, although nice, did no post-test counseling and rushed me out although after my questioning about symptoms did suggest I have further testing but insisted I could rule out HIV. In my paranoia I have even thought maybe the health dept. accidentally or deliberately infected me the first time, hence the pcr would have been too early to be conclusive and they wouldn't give me an honest positive result the second time and rushed me out; sounds crazy I know, but that is where my mental state is. I went to a local dr. here as I am away from home and I tested negative for diabetes (family history), lyme (tick bite in spring), and liver and kindey enzymes were normal as well as a normal thyroid count. The dr. said they would do a CBC but apparently did not--they mailed results. The test did pick up an "OLD mono infection" but since I am still feeling fatigued and having the red dots and easy bruising I doubt it could be causing this. On top of all this, I have now noticed a few very small skin groths on my arms and one on the collar bone. Everyone has assured me I can not have HIV but the duration and time frame of the sypmtoms combined with my partner's has me very worried. What should I do from here? I read several times in "ask the experts" columns a test at 5 1/2 months is as good as one at six months. Could I be the one rare person in 100,000 who does not produce antibodies, as I've always had a bad immune system? Could i have a rare strain somehow? Should I have a CBC done and maybe do a Home Access test? What do you think? I really do value your opinion, you are an amzing man. I told my partner about you and how remarkable you are. When I get very worried or depressed your wonderful cheer always helps. We are so lucky to have you. Thanks for your help, doc. I just need to get this behind me or deal with whatever is wrong. Sorry for the long question, I will be eternally grateful for your help, more so than I am even for pasta and for an italian and a college student you know how grateful that indded is! Happy holidays doc.

Response from Dr. Frascino

Hey Paisan,

Wow, you mean I rank right up there with gnocchi? Now there's a compliment I can't turn down. Sorry you didn't get a response on the other forums; sometimes the mere volume of questions that suddenly pour in can be a bit overwhelming.

First off, let me say you have not ruined your life. Even in the worst-case scenario, if you were HIV-positive (which I very strongly doubt), life is indeed a precious gift and full of great joy, wonderment, and . . . pasta. Remember, I'm positive and I can't begin to tell you how wonderful many of the aspects of my life are. Now let's look at your situation. First, a couple of facts. It's actually quite difficult to contract HIV. Second, unprotected anal insertive sex is less risky than unprotected anal receptive sex. Third, you don't know if the anonymous partner was even positive. Now the good news: ELISA negative at 21 days, DNA-PCR negative at 35 days, repeat ELISA at a different clinic negative at 5 1/2 months. These tests are quite conclusive. You are not HIV-positive! Congratulations!

OK, what about the conspiracy theory of the health department accidentally or deliberately infecting you. Not even Hollywood would buy that story line. As for shifty-eyed nurses staring at you, they were probably only admiring your wardrobe or innate ability to accessorize. Perhaps they thought you were a hotty and were hoping for a date?

So now, what about your symptoms? First, let's address your partner. Years younger than you and has only ever been with you sexually!?! You are one lucky fellow! Do guys like that really exist? Did they really do a T-cell count? It's not part of a routine CBC and it's unlikely they would have run this test without a reason. Perhaps his white blood cell count was on the low side. T cells are a subtype of white blood cells. The CD4 T cells are the ones that get into trouble when someone has HIV. If it was only his white count that was a bit low, that can be explained by lots of conditions, such as a common cold, flu, or viral (not HIV) infection. Skin rashes and swollen glands are also extremely common symptoms and not necessarily linked to HIV.

Now, what about your symptoms? Sounds like you had "something" 3 weeks after that walk on the wild side. But again, these symptoms are not exclusively related to HIV infections. In fact, they sound like some type of viral infection, perhaps that was the mono infection (another virus) that 5-1/2 months later showed up as an "old mono infection." The small skin growths are certainly a red herring and not related to HIV. Just have a dermatologist zap them off if they are cosmetically unappealing. If you are still having "red dots," show them to the dermatologist as well. As for "easy bruising," that can be evaluated with a simple blood test to see if your platelets are normal and functioning normally (bleeding time test). Regarding the loss of muscle mass in the arms, have you been slacking off on your gym work-outs or perhaps changed your activity level or diet? Again, this symptoms is not related to early HIV infection, so get back to the gym, pump some iron, and have your doctor measure your muscle mass. Exercise will also help with your fatigue and make you look more "he-man-ish" to that young buck of yours.

Fatigue? Well, that's associated with lots of medical conditions, including many types of infections, depression, anemia, hormonal imbalances, etc. A basic workup should include a hemoglobin test to check for anemia.

Now, as for your other concerns - rare strains, bad immune system, not producing antibodies, etc. - no, no, no. Your "encounter" didn't occur in Africa, did it? PCR tests do not rely on antibodies. Your immune system is not "bad."

So, what do I think? If you and your partner are still very worried, go have another test. It will be negative. With that out of the way, if you're still having some symptoms, see your family doctor or a specialist in a larger town, if your university town is just too small. Chances are you did pick up a virus that could account of all your symptoms (except the guilt-induced stress/anxiety) and these symptoms will all resolve spontaneously. If you can't stop focusing on HIV, you'll have to get help from a counselor or therapist to redirect those thoughts. I'd suggest you give that young lover of yours a hug, make some pasta, and snuggle together on the cough for a good movie.

Just as Dorothy says, "There's no place like home." And if the situation ever "arises" again, condoms are essential. Just like American Express says, "Don't leave home without it."

Happiest of Holidays to the two of you as well.

Dr. Bob


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