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HIV & Chronic Fatigue Syndrome
Aug 15, 2005

Dear Dr. Bob: You continue to inspire me and many, many others. Thank you so much! Firstly, I appologize that my questions are in 3 parts, are somewhat long, and that some of what I'm asking is periphery to this forum. The thing is you are the only doctor that I feel like I can trust right now and I REALLY value your advice. I was the one who wrote last month (Stressed in Asia) saying that I had suddenly realized that I was sometimes fumbling with the condom. That is, I would finger the woman then try to put on the condom, squeezing the tip as you're supposed to. Then I'd realize I was putting on the condom upside down, flip the condom over and put it on right. I realized that sometimes secretions from the women may have ended up on the inside of the condom. Time from removing my finger from the women to the time I had the condom on right was usually about 30 seconds up to a minute. I think twice there may have been blood on my fingers. And, I deep-kissed about 3 women last year. Here are my questions: 1) In your reply to me last month you said my risk was "minimal to non-existent". If the virus "dies" or denatures within a fraction (or a couple of seconds?) of a second of exposure to air, under these conditions, then why is there even "minimal" risk? Should it be totally non-existent?

2) I was diagnosed with CFS back in 1991. I've seen you say in your forum that you think CFS is over-diagnosed and that you often think there are more psychological causes. For me, I can pin-point the date in November, 1988 when I had a mono-like illness, then felt fatigue, brain fog, sore lymph nodes, etc. ever since. If you still think its unlikely that I have CFS then what else can it be? If you think it may, indeed, be CFS can you recommend resources (websites, books, doctors, etc.) that can help me treat my condition? Note that it isn't too debilitating for me. I generally need about 9 hours sleep a night, feel very groggy in the morning until my 2nd cup of coffee, get hit by flus pretty often and severely, and still feel some brain fog. Otherwise, I can function pretty well - work, play sports, etc.

3) You said in one place that the "vast majority" of people will seroconvert within 3-6 weeks of infection and then in another place you said 6-8 weeks. Approximately what percentage will seroconvert within 8 weeks - 90%, 95%, 99%? I had a negative Rapid Immuno-chromatographic Test at 7 weeks and then a negative ELISA test at 9 weeks after the last possible condom fumbling incident. Is it possible that having CFS and herpes will suppress my immune system to the point that it would delay making anti-bodies for HIV? That is, do I need to test again after the 12 week point?

Again, sorry about the long, 3 part question. I just don't know who else to pose these questions to. One doctor I spoke with here in this Asian country said that you can get HIV from saliva!! So, I'm afraid to ask them anymore questions. Thanks so much for helping me to work through some of this! By the way, even with my snails-pace internet connection here, I was able to make a donation with my credit card through your website. If you answer this, another will be on the way. :-) Still Stressed in Asia

Response from Dr. Frascino

Hello again Still Stressed,

1. Your risk remains "minimal to nonexistent." How quickly HIV is destroyed outside the body depends on many factors viral load, quantity and type of infected fluid, ambient environmental conditions, etc.

2. Yes, CFS is over-diagnosed. There is a very specific set of criteria that must be met for CSF. From your description, I very strongly doubt you have CFS. I would recommend you discuss your fatigue concerns with your doctor. If a physiological cause can not be identified, I suggest you consider a psychological cause. Stress, anxiety and depression are all associated with fatigue.

3. Percentages, such as the one's you request, are not available. The best we can say is that antibody tests taken prior to three months are not considered definitive or conclusive. CFS and herpes will not affect your body's ability to produce anti-HIV antibodies, alter the "window period" duration or affect HIV test results. Your seven- and nine-week negative tests are very encouraging. A 12-week test would be definitive.

Thank you for your donation (www.concertedeffort.org)!

Now it's time to begin your stress-reduction program. Remember stressed spelled backwards is desserts! Why not go have something sweet and put your fears to rest? O.K.?

Dr. Bob



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