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Is your advice becoming more conservative?
Apr 28, 2007

First let me just make it clear I have a great deal of admiration for you and your service to the world (& if I had my way I would make you the President of the United States. You and I have pretty similar opinions about the incumbent.)

It may be my imagination, but I am just noting of late your responses are somewhat more precautionary than before, for example, for handjobs/finger play, you now mention the proviso if the skin on your finger was intact. Maybe you should clarify what you would qualify as skin to be not intact, for example, will paper cut qualify or should it be a deep bleeding cut. Okay I dont want to be difficult here, I know you have to cover all the bases.

I have also noticed you mentioning the six-month window period a bit too frequently for my (and all the WWs) comfort. This is understandable in case of repeated exposure with a confirmed positive. But you also mention this in cases where nPEP was prescribed. I know you are going by CDC nPEP guidelines.

However, in my case you very boldly told me that 3 months would be the definitive test window for me, even though I had taken 6 weeks of ARVs (you dont know how thankful I am for this.) But perhaps my case was different because PEP was never warranted, i.e. hetero-sexual unprotected sex with two girls that had tested negative post exposure. But I still wonder if I had brought my case to you now, would your advice be the same, especially since I had a false positive quantitative PCR test. Anyway, after my countless testing beyond six months, it turns out you were right. No surprises there.

Dr. Bob I know you are a busy man whose time is invaluable in trying to run a HIV foundation, a clinic and at the same time calm all the WW world over, including Ol Macdonald who orally seduced Seabiscuit (cant stop laughing about that). I also heard you are a concert pianist, where do you find the time? Anyway, you dont have to respond to this post at least. Just thought I would touch base.

Your friend, Complicated

Response from Dr. Frascino

Hello Complicated,

I can assure you I certainly am not becoming more conservative. I continue to do what I have always done: evaluate each question based on the information provided and give advice based on the most current and reliable scientific facts available.

Would I change my advice in your situation? No, absolutely not! You had unprotected sex with two girls who tested HIV negative following your exposure. PEP was not warranted. A three-month test is the most I would recommend and that only to rule out the remote possibility that one of your playmates was still in her window period. Your "countless testing beyond six months" is also unwarranted (as well as excessive and wasteful). Your false-positive PCR and the anxiety it caused you is just another example of why I don't recommend PCR testing for routine HIV screening.

I'm not really here to provide you or any WW with comfort. Rather I'm here to provide facts from which you should then find comfort, OK?

Mr. Complicated, there has never been anything the least bit complicated or confusing about your case as far as I'm concerned.

Dr. Bob



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