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Sep 29, 2003

Hi Dr,

First of all I understand your statement previously that it is weak to bury ones head in the sand in response ot a possible exposure ot the virus in question. Yet I think that testing is easier said than done and each person will do it on their own time. So long as they practice safe sex from NOW ON. As for me, well, I had unprotected sex with one of my undergrads in a night of passion I can only describe as Neroesque. So then three days later and I am on the floor puking with a high fever. Yep, it's viral infection. Was, I should say. I will NOT go into the history of what happened, ny experiences with the one doc I have available here on campus (internist) as well as countless professors of genetics and microbiology I have talked and listened to. Because, I have read that transmission through female-male is LESS efficient than male to female, contrary to that Ugandan study you have mentioned. Moreover, along with many other confounding variables, many of then men in Uganda are uncircumcised. While I exercised bad judgement, many have been exposed to a lethal STd, and nearly ruined my future, I am NOT a goy.

Anyway, I am curious if you think in the years to come, insteasd of HAART as a long term treatment, doctors will instead focus on treatments given to a patient, say, once a year. To supress replication without long term side effects.

GH

Response from Dr. Wohl

Sex with one of your undergrads? Isn't that illegal?

You are correct that testing is easier said than done. But testing is easier than living with the gnawing, awake-in-the-middle-of-the-night anxiety of not knowing if you are HIV negative and intolerably neurotic OR HIV positive and intolerably blind to the danger you are to yourself and others. The number of emails to this site from the very worried, but clearly very well is case in point.

You are also correct, Professor, that in the USA, Europe and Australia female to male transmission is less efficient than the other way around. I just would not bet my life on the odds being that much in my favor that I would throw (even more) caution to the wind when bedding down a co-ed.

The future? If we get new therapies that are much less toxic and simplier than the current batch we might actually start to see HIV treatment applied earlier in the course of the disease as the risk-benefit calculus of therapy tilts us back toward early vs. late treatment initiation. Other approaches such as pulse therapy - treating to get the CD4 cell count to a certain point then stopping only to restart when it gets down to an unacceptable level - may gain traction clinically. DW



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