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Cry for help from africa - will new drugs reduce resistance?
Nov 22, 2002

Hi Doctor

First let me point out that i am writing from africa and therefore i can not spare too much money for tests at this stage AND there is very limited expertise on HIV treatment and thus what i get here will most likely be more authoritative than what i am likely to get from the most expensive hospital in my country.

about 2 weeks ago, i got drunk due to problems at work and slept with a woman without a condom. Having a history of no alcohol and safe sex, i did not expect the lady i went with would remove my condom. but she did. i didn't know this lady and she does not seem to take hiv seriously.

anyway, naturally i am very worried. i had read about acute viral infection on this site and was watching out for it. now two weeks later, i have now had a painful lymph node in my left armpit for 3 days, though the pain seems to be reducing now, i have also had a mild sore throat which i don't feel unless i am swallowing but otherwise do not feel (been on for 2 days now). no fever, no rash, no fatigue, no night sweats, yet. i realised the lady had removed my condom after about a 1 minute. i am not sure if i inserted the bare penis but i know i did not ejaculate. i will eventually go for a test, but i want to know the following before i go:-

1. What are the chances that i could be infected? are the symptoms indicative of high risk or what? what is likely happening in my body? 2. If it is likely that i am sero converting, is it true that if i took drugs now, it could improve my ability to fight the disease for a long time, more than if i took later? 3. If i should take drugs, which are the least toxic even though still effective cocktails? 4. I have read on this forum about fusion & integrase inhibitors. are these drugs better than the earlier combinations? are they available on the market? if not, how can one join the clinical trials? if yes, how much do they cost?

Response from Dr. Little

I cannot even guess what the chances of HIV infection would be after your exposure. I can only tell you that there is nothing about the acute HIV infection syndrome that makes it readily recognized based upon symptoms alone - even by physicians who are looking for it.

It is also hard to even discuss therapy when you do not know if you are HIV positive - I would get the test. If you are positive - I do not know what treatment options you have available to you. All are expensive. There are however, several good, fairly well tolerated treatment regimens that will control viral replication. But, there is not even a consensus in the U.S. about whether someone with acute HIV should receive potent antiretroviral therapy. In some circumstances, it might be better to save treatment options until the infected person will more clearly benefit (this depends completely upon what resources are available to you). Sorry I cannot be of more help.

What VL level to test?
change my medication

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