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Re- Canker Sores
May 28, 2010

Hello Dr, this is in regards to the earlier question you have replied to for me. I was just wondering if PEP of combivir and keletra could suppress virus for longer than 6 months I did not mention in my post that I took it 5 hrs post exposure. I have heard of the health care worker that have taken longer than 6 months but were positive by 12. What factors does one need to take in to account to consider himself negative conclusively(ie how long to test post exposure). Is it at all possible to have HIV and never make antibodies like I have read is sometimes possible with Hepatitis C?

Finally how did I get Herpes Simplex and the Canker sores if I used to get them before I started having sex.

Thank you in advance, the work you do truly does matter and I don't know if medical professionals believe in god but I am sure he will reward you.

The reason I ask so many questions is that I know different places have different guidelines 6 weeks with antigen duo in Australia, 3 months in others, 6 months in others. Different countries I'm sure set different standards because of bureaucratic reason. My life however is isn't a policy and I cannot approach it as that I have to approach it with the best care possible in order for me to be happy. I need your help in short.

Response from Dr. McGowan

Thanks for your post, and I understand your apprehension.

99% of people who test positive for HIV will do so by 3 months. Many people feel that this can be the final test. The CDC in the US and New York State (where I practice) recommend a final test at 6 months in case there is a delayed conversion. The very rare delayed cases you have described had been seen (2 out of 3) when hepatitis C had also been spread at the same time. This can be tested for separately.

The lack of antibody in some people with hepatitis C and HIV dual infection is likely due to the fact that they have had HIV first, had a weakened immune response and failed to make an antibody to hep C since they already had low CD4 counts. This would not be the case with a new infection with HIV since the immune system is working normally at the time of exposure.

The herpes that causes canker sores comes from person to person contact, but not necessarily sexual contact. A parent can spread it to a child or a sibling, etc. Kids can spread it through rough and tumble play, etc.

Best, Joe



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