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London calling - help needed
Sep 3, 2006

Dear Dr Bob

We have 24 here but I'm more of a Sopranos fan.

Please help! I wrote to you a while back but I need further help desperately.

I took PEP (Combivir) for 28 days after a high risk exposure. Elisa negative at 5 weeks and P24 duo negative at 6 weeks. At 7 weeks I was in desperate need of an answer and I got a PCR RNA test done which came back undetectable. I know you advise waiting and testing at 3 and 6 months only but my anxiety levels are at ridiculous levels. Mainly due to continued swollen tonsils and a painful tongue.

My questiona are as follow - 1) how do I interprete this result? You talk about needing an expert to do this. Please interprete it. For background, I first got 'symptoms' 3 weeks after exposure. 2) Is there typically a spike in viral load followed by a fall in viral load? 3) If there is a fall in viral load, is this often below detectable levels at this point?

Thank you so much Dr Bob.

John

Response from Dr. Frascino

Hi,

Sopranos, Six Feet Under, Sex and the City reign supreme, but 24 is indeed fun. Ever wonder how Jack Bauer's cell phone, no matter when, no matter where, is always fully charged and ready for Chloe to download the bad guys' exact coordinates so Jack can shoot their kneecaps off? I think we should send Jack to take out Osama.

OK, on to your questions:

1. Your results to date are "encouraging." An HIV expert would advise you to follow the post-PEP testing guidelines, as that is how we can be more definitive about your status. If your "anxiety levels are at ridiculous levels," you need to treat your "anxiety levels," and that is not done by getting non-recommended tests that can not give definitive answers. An HIV specialist would have explained this to you.

2. Yes, this would be the natural history of HIV disease.

3. No.

John, go watch some Sopranos reruns and stop driving yourself 'round the bend, worrying about things you have no control over. You took your PEP. Now you have to wait for definitive confirmation of what I strongly suspect will be your conclusive HIV-negative status.

If your anxiety levels are still out of control, you'll need to see a Melfi-equivalent.

Good luck.

Dr. Bob



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