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I know the odds but ...
Apr 28, 2003

Dear Dr. Bob, First thank you for the wonderful service you provide. Not only do you provide valuable information but also add the right amount of humor and a good dose of compassion. I am writing without a question but perhaps you will grace me with your thoughts. Honestly I feel I could answer the most of the questions posted here. Low risk exposure, don't worry about it, get tested at 3 months and be get on with your life. I have read everything about HIV. You name it. Not just general knowledge but medical literature, PUBMED and JAMA postings among many others. I agree with you that your advice applies to 99.999 of the population who come to the site. It seems many have no concept of HIV disease at all. I am also an engineer employed by the largest computer company in the world thus I have a pretty good understanding of probabilities and statistics. But I think you know and have to agree there ARE exceptions out there even though they may be very, very rare. There are people out there who don't seroconvert by 3 months. (For example, the gentleman from Utah who did not convert after 3 years even though he was diagnosed as positive via RNA PCR) Also people have received false negative PCR DNA diagnosis' usually due to non-B subtype viruses or early infection. People have been infected not due to sex or sharing needles. There are also minute numbers of people who are infected with group O and the recent group N type viruses out there. I think you will agree that ELISA testing may not pick up the group O viruses and all bets are off for the new group N virus. If you happen to be one of these people, even it 1 in a million, it just sucks to be you. Not only are you HIV infected but you may not a diagnosis until your disease has progressed to an advanced stage. So what is the point to all this you wonder? What is my story? Well on a business trip while going through a divorce I got very drunk and had unprotected sex with a prostitute. Yes insertive partner risk has lower and partner was not confirmed to be HIV positive. First she had only been doing this she said for about 3 months so potentially could have been recently infected thus having higher viral load and increased risk of transmission. Seemed she did not even consider condom. I don't know how I could have been so stupid! This was my only time I had sex with anyone besides my former wife in 12 years. I guess I was not used to safe sex as there was no need previously. So then what classis ARS a few weeks later, extreme malaise, muscle aches, truncal rash, altered taste sensation? (possible transient thrush) weight loss more than 20 pounds, strange skin problems (seborric dematitis, rosacea), small, painless genital ulceration and oral ulcer. Honestly I have tried not to diagnose myself and beleive the testing I had which included multiple ELISA for both HIV 1 and 2 out to 7 months. 2 Quantitative RNA viral load tests that were undetectable at 6 weeks and 6 months. However I know that the Amplicor version 1.0, only FDA approved test at the time, can under-detect or not detect at all non-B subtypes. I know the newer version with new primer set was not used. The same possibility also exists for the qualitative PCR test as I also got a negative result from. So why can not beleive the results. Well I gained the weight back, the possible thrush went away but I continued to have intermittent muscle aches and groin pain out to 8 months post exposure, just recently seem to be subsiding, re-occuring aphous ulcers, a entire myriad of skin problems as diagnosed by a dermatologist which continue to worsen. The list includes multiple seborric keratosis, stucco kerratosis, acne, oily skin, plantar warts, change in skin smell (floral, almost sweet smell), Spininoza (? white hair like growths coming from the pores on my nose), rash on trunk that doctor ("wasn't sure and said we will wait and see"), change in skin color and texture on neck and increased darkened pigmentations in my skin. I am 37 years old and have not ever had any of these problems except teenage acne 20 years ago. It seems highly coincidental with my episode 8 months ago. I know I contracted something and all the symptoms seem to point to HIV. What do you think? I know you won't post this as you don't want to freak out the readers who you try to re-assure on regualr basis but could you send me an email with your thoughts? This is ruining my life. It's even worse feeling 110 sure you are HIV positive but can not get diagnosed as such.

Your wary and worn out fan in Boston

Response from Dr. Frascino

Hello wary and worn out fan in Boston,

Nice try, but your logic is quite faulty. Despite your understanding of probabilities and statistics, your multiple ELISA tests out to 7 months and 2 quantitative RNA viral loads out to 6 months are absolutely conclusive. HIV is not your problem. Your symptoms are not consistent with anything but "cyberchondria". Why would I not want to post your question? Do you really think your single episode of insertive vaginal intercourse with a partner of unknown serostatus followed by a host of nonspecific symptoms and an excessive number of negative HIV tests is all that different from the thousands of other identical situations that pour in on a daily basis? Sorry pal. "Statistically" speaking, it just doesnt make sense. You are HIV-negative. You can continue to delude yourself otherwise or you can get some counseling to help you cope with your irrational fears. The choice to be sick or well is yours. HIV is not your problem. You can choose to "what if" your life away with additional unwarranted HIV tests and fears of being the exception to all the rules, but I wouldnt recommend it. Just listen to your last sentence "Its even worse feeling 110 percent sure you are HIV-positive but can not get diagnosed as such." Stop chasing an illness you dont have. Good luck.

Dr. Bob



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