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Follow Up and More Concerns
Feb 7, 2007

Dr. Bob,

First of all, I would like to thank you for your response on January 4, 2007. My original question was posted under "Give it to Me Straight." Your kind words were definitely reassuring. But, I have recently had another huge scare that has me sick with fear.

Before discussing my recent scare, I would like to give you my testing updates. Yes, Ms. Cleo should move over because you were correct about the HIV-2 and Hep C tests. They were both negative at 90 days. I also had HIV-1 antibody and PCR tests done at the same time. They too were negative. So, I used those results and your words of reassurance to move on.

But, here's my recent experience that has me paralyzed with fear. At day 113 post potential exposure, I got a rash on the back of both my arms. It kind of resembled a diaper rash with tiny red pimple like bumps scattered about. It didn't really itch, but I did get a burning sensation in it every so often. At the same time, I got a burning and flushing feeling on the back of my neck and lower back. I didn't notice any rash on my back though. I went to see my PCP two days after the rash started. He kind of seemed to brush me off, and stated that it looked like some type of ezcema. I'm no rocket scientist, but I think that it resembled a maculopapular rash (reddened/pinkish areas with small pimple like bumps). The same day that I saw my PCP (2 days after the rash started), I also developed a low grade fever in the low to mid 99s. It seemed to last for most of the day. The next day, I still had the same mild fever, but it seemed to drop into the 98s more frequently. I also started to get an aching feeling in my knees and an overall crappy/sick feeling in my body. I still had the burning feeling on my back. The mild fever broke for good on the third day, my knees stopped aching, and my back pretty much stopped burning.

I am extremely scared that I am seroconverting at the four month mark. I recently took another Home Access HIV-1 test at 116 days (3 days after the rash started). It was negative.

I was also taking a few medications when the rash started (amitryptylin and lyrica). A few days before the rash started, I stopped taking vicodin.

So Dr. Bob, does it sound like I'm going through seroconversion?

If I am seroconverting, do you think that the Home Access test would have at least been indeterminable three days after the rash started?

Do you think that the PCR test at 90 days would have detected something if I do have HIV?

Another donation following your response will be on its way.

Thanks Dr. Bob!

Response from Dr. Frascino

Hello,

Exactly which part of "HIV negative" don't you understand?

You are not seroconverting. You are HIV negative. HIV is not your problem. No way. No how. Period. End of story.

If you can't accept the wonderful news that you are HIV negative, you should seek psychological help, not more HIV tests!

Dr. Bob

Give it to Me Straight Jan 4, 2007

Dr. Bob,

I knew that header would catch your attention. I chose you to pose my questions, because, given your situation, you seem to have an amazing outlook on life. Plus, you crack me up. Here's my situation. I had unprotected/insertive vaginal sex three months ago. Yeah I know. You were probably hoping for a story about some hunky dude. Sorry to disappoint!

Anyhow, a little less than a week after the encounter, I became extremely fatigued. Around the same time, I started to get generalized itching w/o any apparent rash. About 2 1/2 weeks after the encounter, my submandibular glands became slightly swollen (PCP not concerned). Then, the diarrhea began. I had diarrhea on and off for about 5 or 6 weeks. It intially lasted about a week, got a little better, came back, got a little better, then eventually went away. During the diarrhea, I had a lot of abdominal pain. About 3 1/2 weeks after the encounter, I started to get a lot of pain and weakness in my legs. I also started having some back pain.

My PCP ran several blood tests, including an HIV-1 antibody and p24 antigen test at 17 days post exposure. Of all the blood tests, the only thing out of whack was my WBC count. It was around 11.8. So, my PCP sent me to an infectious disease specialist, hematologist/oncologist, and gastroenterologist. The infectious disease specialist didn't think it was HIV because I had no apparent fever and/or rash. Also, I told her that the woman that I was with had a negative HIV antibody test around 4 weeks after our encounter. The ID specialist said that I couldn't possibly have HIV if the woman had a negative test. I'm not sure if she could have been in her window period or not. The girl told me that her last unprotected encounter was in June. But, I've caught her in a few lies about her sexual background. So, I don't know whether to believe that or not.

Anyhow, all the other docs ran more blood tests. I was also sent for an untrasound and CAT scan of my abdomen. Everything once again came back normal. About two months after the encounter, my WBC count was back down to around 9.8. So, they send me for a colonoscopy. All it showed was diverticulosis.

Where am I at today? I'm a freaking mess. The diarrhea has been gone for about a month. I recently had an EMG test that showed mild radiculopathy (another ARS symptom). That explains the lower back and leg pain/weakness. The diarrhea was chalked up to IBS. The fatigue has pretty much subsided, w/o any explanation for it. As of this moment, I just have the leg pain/weakness.

Since the original HIV-1 antibody and p24 antigen tests at 17 days, I have obsessively taken around 10 Home Access tests. All of them have come back negative, with the most recent one at 88 days. I am going to my PCP today to have another HIV-1 test done, along with an HIV-2 test and Hep. C test. All other STD tests were negative.

So Dr. Bob, I guess that I should get to my questions.

Can I get any Woo-Hoos based on any of this information?

Do you believe that this is HIV? What are the chances that this might be HIV-2?

I'm confused about how the p24 antigen test works. I've heard that it's useful during the first 2-3 weeks after infection. But, I've also read that it's only useful about a week before antibodies are detectable. Can you help me to better understand this test?

Do submandibular glands tend to swell during ARS?

Lastly, could you please give me the address as to where I can send a donation to your organization?

Thanks Dr. Bob!

Response from Dr. Frascino

Hello,

Don't worry about the boring unprotected-insertive, straight vaginal sex story. I always add in some hunky spunky dudes as I'm reading and imagining the scenario for my own amusement. And speaking of amusement, in my version of your mattress mambo sexcapade, you were having the best time, you stud you! OK, back to reality.

So you've had PCPs, infectious disease docs, hematologists/oncologists, gastroenterologists, CAT scans, EMGs and a dozen or so HIV tests . . . . Hmmm . . . seems all that's lacking is a partridge in a pear tree.

I'll answer your specific questions first:

1. Yes, of course. WOOOO-de-frickin-HOOOO. A negative 88-day antibody test is definitive and conclusive!

2. Dude, I just WOOO-HOOOed for you. Would I have done that if I believed you had HIV???? Frevinsakes! It was a WOOOO-HOOOO, not a BOOO-HOOO!!!

As for your chances of this being HIV-2, so remote, I would say, as to be nonexistent. I'm willing to bet you the HIV-2 (and hep C) tests both came back negative, right???? Amazing, eh? (Miss Cleo, move over. I'm taking over the psychic hotline!)

3. P-24 antigen is a core protein of an HIV viral particle that surrounds the viral RNA. P-24 antigen production is kicked into gear when HIV is replicating. So the more HIV replication, the more P-24 antigen produced. Hence, this is a fairly good marker for acute HIV infection when there's an amazing amount of HIV replication taking place. (HIV can self-replicate to the tune of 10 billion times per day!) The P-24 antigen (protein) begins to appear in the blood within a few days of the high viral replication process. However, it then disappears within a couple of weeks as "P-24 antibodies" begin to develop as part of the body's immune defense. Today, P-24 antigen tests are sometimes used as an alternative to HIV RNA tests to detect acute HIV infection, due to their reduced cost. It is also used in fourth generation HIV screening tests that combine a third generation format ("antigen-sandwich" format) for anti-HIV antibody detection with the ability to simultaneously detect HIV P-24 antigen using ELISA techniques. These combination assays allow for earlier viral detection in those with primary HIV infection. This may be more information than you wanted to know, but hey, you asked!

4. The lymph gland swelling seen during ARS is generalized and not painful, which means it occurs in many locations throughout the body. Swollen submandibular glands may be present.

So, my assessment is that HIV is not your problem. No way. No how. Sure, you have a few other medical issues to deal with diverticulosis, mild radiculopathy (not HIV-related!), IBS and, most likely, some anxiety plus irrational fears of HIV. I suggest you stop chasing a diagnosis you could not possibly have and concentrate on your other very treatable and much less catastrophic medical problems, OK?

Thanks for your inquiry about The Robert James Frascino AIDS Foundation. Donation information can be found on the foundation's Web site at www.concertedeffort.org. The foundation's address is:

The Robert James Frascino AIDS Foundation 1000 Fremont Ave., Suite 145 Los Altos, CA 94024

Finally, as for "giving it to you straight," sorry no, not in my fantasy world. No way. No how.

Happy New Year.

Be well!

Dr. Bob



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"crazed HIV-positive phlebotomist with excellent aim and technique" guy again, scared as hell
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