You are an inspiration
Sep 18, 2003
Dr. Bob, I had no clue that you were positive. Without sounding ignorant, it helps to see someone so strong in a who is faced with something similar as I. I am married and have recently tested Pos. My wife is neg and will retest every 3 months until we hit that 6 month. We are doing fine. I had one incident with another woman, oral, and tested pos 2 weeks later. My ID Dr. took my counts 5 weeks later and they came back CD4 1237 @ 52 and VL of 56,000...yikes! He basically said that he isn't sure when I contracted "IT", but my counts look like it was recent and he wants to talk about HAART treatment for one year then a break. My wife and I are sceptical of this. He took more blood work to see if the results support this....I guess to see if VL went up even more. But he also said that the exposure I had was the least likely to infect me. The only other earliest I could have been infected before that would have been 3 years earlier. Anyway, I guess we're confused as to whether to start meds now or wait until the CD4's show signs of slowing down. We also want to know if it's possible for me to father a child safely. Any thoughts? Sorry for the unbearable email. I'm not freaking out, just looking for some educated advice as it looks like I have to make this decision, not my Dr. He's made that very clear.
Response from Dr. Frascino
Thanks for your comments! I'm sorry to hear about your recent positive test. I agree with your ID doctor that testing positive 2 weeks after oral sex would be extremely unlikely. Could it have been that contact 3 years earlier? Yes, you could still have high T-cells 3 years after becoming infected. Your doctor can determine this by running what's called a "detuned ELISA" test. It distinguishes between a very recent infection and one that that has been established for months to years. That should give you your answer about the oral sex episode 2 weeks before testing positive.
Should you start HAART? I agree with your doctor: Only you can make that decision. My advice however, is dependant on how recently you were infected. If indeed you are undergoing acute seroconversion with rising viral loads and a detuned ELISA test confirms very recent infection, then there is strong reason to consider HAART. It may preserve your immune function. Clinical trials are presently underway to confirm this, but preliminary data do suggest it could indeed be helpful. If, on the other hand, your detuned ELISA indicates your HIV infection is more chronic or established, then current recommendations would suggest holding off on HAART treatment to avoid medication-induced toxicities.
Is it possible for you to father a child safely? The final verdict is still out, but several medical centers around the world have reported very promising results using a technique involving sperm washing and in vitro fertilization techniques. Should you and your wife decide to consider this option, I would strongly suggest doing so only under the close supervision of your HIV specialist and an obstetrician/gynecologist experienced in these techniques.
Last, your e-mail was not at all unbearable. I'm delighted you are taking the time and effort to become educated and involved in your health. We'll all be sending good karma your way in hopes that your wife continues to test negative, that you continue to stay healthy, and that you will one day soon be celebrating "Father's Day" with a new addition! Good luck.
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