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finger cut verses sexual transmission
Apr 14, 2007

Dear Dr Bob,

Thank you so much for being who you are and doing what you do. I have only entered this forum 3 days ago by chance and am glued to the Q's and A's.

I am sending this from Africa. I am an African. We have as you may know the highest rates of HIV incidences in the world. I have been very cautious not to place myself at risk. Unfortunately excessive alcohol consumption with some friends led me to take home a prostitute and we had protected sex. The problem is I had a deep cut in my finger that was still bleeding until the next day.

1. I think my bandage which was not water resistant came into contact with some fluids. How risky is that?

2. I woke up in the middle of the night to find her giving me a blowjob whilst I slept. I asked her to stop and we slept. What chances of this oral of catching HIV?

3. In the morning I found my toothbrush obviously used by this girl so I threw it away and asked her kindly to leave. This shows that she does not protect herself and makes her a high risk.

Before this experience for 2 days I was experiencing numbness in my left side which led to dizziness and allmost passing out along with diarrhea and a sore throat. (an implication of a viral infection) The diarrhea continued for over 2 weeks with the following symptoms. a. Fatigue b. Mallaise c. swollen armpits d. Itchy abdomen and arms and face. e. Severe gases and abdominal cramps f. recurrent fever

The fever has continued for 4 weeks now . The abdominal cramps were only reduced aftr I took a dose of dewormers. Occasionaly I get slightly swollen armpits.

From surfing the net and reading your forum I understand that all the above are not necessarily due to HIV and only a test can be conclusive. I did have a test 12 days after the encounter when the symptoms were really at the peak (4th generation Elisa), It came back negative and I was slightly relieved. But now I understand from your forum that test should be in 3 months and this test is probably non-significant.

I am sorry for being so talkative but where i'm from there is nobody to discuss this matter with at all. I will be a society reject. People here are very ignorant.I can't even trust the doctors to be confidential.

Can you please advise me and also when is the best time after exposure that one should start treatment just in case my 3 month test comes positive? I know it is related to CD4 cell counts and viral loads , but on average when do most people start treatment? I did a standard TWBC test yesterday and a Hemoglobin the results are as follows TWBC's :5000 HB 13.7 gm_dl 90%.

Please I have no other person to consult other than you.

I am definately going to donate to your organisation not for your answer but because I am satisfied with your cause. Please send me your details for donation for an international transfer.

Again, Thank you for being you and doing what you do.

Response from Dr. Frascino

Hello African-Guy,

Welcome to the forum.

Proceeding directly to your questions:

1. Without knowing if your partner was positive or not or the severity and openness of your cut, the type of bandage covering the wound and other related details, it is impossible to give you an accurate assessment of your specific risk. My general assessment would be that your HIV-transmission risk would be remote at best.

2. The estimated per-act risk for acquiring HIV from unprotected insertive oral sex with a partner confirmed to be HIV positive is 0.5 per 10,000 exposures. Your estimated statistical risk would be even less, as we do not know the status of your partner.

3. I wouldn't characterize her as high risk simply because she used your toothbrush.

4. HIV-antibody tests taken prior to the three-month mark are not considered to be definitive or conclusive. You'll need to repeat your ELISA at three months from the date of possible exposure. Symptoms are unreliable in predicting who is and is not infected.

5. Considering I strongly doubt you are HIV positive, I think it is very premature to begin worrying about the best time to start treatment "just in case." In reality there is not "average" start time. There is great variability from person to person, due to a variety of both host and viral factors, which can influence the rate of immune deterioration resulting from HIV infection. Current guidelines recommend HAART (highly active antiretroviral therapy) be considered when the CD4 count falls consistently into the 250-350 range. We can discuss this in greater detail if and when you have a need for this information, OK?

Thank you for your donation. Donation information can be found on the Foundation's Web site at www.concertedeffort.org. There you will find details about direct wire transfers for international donations. We also accept credit cards, PayPal, checks, foreign currencies, oil wells, whatever. I'll send you my good-luck/good-health karma in return that your definitive three-month test remains negative, as I very strongly believe it will indeed be.

Stay safe. Stay well.

Dr. Bob



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