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Still worried

Dec 8, 1998

Dear Dr. Holodniy, Thanks for the great service you provide. I need your help. In Dec 1997 I had a brief encounter (vaginal intercourse) with a woman I met while on a business trip in Malawai in Africa. I was devastated that I could have been so stupid. I have been tested (Abbott Recombinant HIV-1/2 and Serodia PA test which uses viral lysate based antigens) on weeks 6,9,12, 19, 25 in a major teaching hospital in the UK-all negative. My doctor told me to get on with my life - I was happy to do so but still a bit anxious.On week 33 I felt unwell and had a mild headache and stiff neck which passed after a few days. On week 36 in August I came down with a HUGE constant generalised headache and feeling of extreme fatigue and I still have the constant headache(which feels like severe pressure in my head) but not the fatigue nearly 4 months later. My doctor retested me for HIV on week 39 and I also got tested on week 42 in a different Reference Laboratory (Murex HIV-1/2 incorporating group O antigen and Serodia PA). These tests were negative. My doctor is happy these tests can pick up any subtypes I could have been exposed to. She referred me to a neurologist who ordered CT and MR scans - these were normal. I was also bitten by a deer tick in early July (it hasn't been a good year!) but my blood tested negative for Lyme by ELISA in start of Oct. Incidentally, I was negative for all other STDs tested. My doctor feels my chronic headache was induced by stress and it is certainly true that I have been deeply distressed by what happened, she thinks I have what she calls a psychosomatic conversion reaction/disorder. I hope she is right - she is an infectious disease specialist and trained in the US for many years and is a really decent person. She has recommended counselling for my headache and worry and I have begun this but I am still very worried. What do you think? Have you seen people come down with severe psychosomatic headaches before? Could HIV cause such a severe headache so soon? Should I do further testing? Thanks so much for your help.

Response from Dr. Holodniy

I think you have definitively ruled out HIV infection. I would not get any more tests. Although HIV can cause headaches during acute infection, that is not what is going on with you. I assume that the neurologist has ruled out tesion/musculoskeletal headaches and migraine. And that your blood pressure/pulse are not high. The scans were negative which is very good and means that there is no obvious lesions in the brain. If a medical reason cannot be found, then the diagnosis focuses on psychosomatic illness. MH



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