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Dr. Bob, it is Mister X writing in as you suggested
May 11, 2007

Dear Dr. Frascino;

The following is my history of events, as you may see from the test results below, all of them came out normal but I believe I may have HIV phobia because I keep on worrying about my CD4 count, thinking that I have a rare HIV subtype which slowly diminished my CD4 count without the anticore or virus appearing on any serology and viral load tests during the last 20 months. At this point I would like to know if you are aware of any other tests that might reveal rare HIV strains to end my worries or any other tests to reassure me. I have not been involved in any risky behaviour associated with HIV from month 0 to this day and I do not have any HIV symptoms (confirmed by my Doctors in Turkey and England). Thank you so much for your help, It will be a pleasure for me to make a donation to the Foundation.

Here is my history of events;

Up to Month 0 (August 18, 2005) = unprotected insertive vaginal sex with several female commercial workers from Russia/Ukraine/Turkey.

Month 1; Anti Hiv 1/2 Combo tests in Istanbul Memorial Hospital= all negative

Month 6; Anti Hiv 1/2 and P 24 antigen tests in Istanbul Memorial Hospital= all negative

Month 8; Anti Hiv 1/2 and P 24 antigen and Anti HCV test in Istanbul Memorial Hospital= all negative

Month 8; Anti Hiv 1/2 and P 24 antigen tests in The London Clinic, London, England= all negative

Month 8; Anti Hiv 1/2 and P 24 antigen and Hepatitis A/B/C tests tests in The Doctors Lab, London, England= all negative

Month 12; Anti Hiv 1/2 and P 24 antigen tests in Istanbul Memorial Hospital= all negative

Month 12; Hiv 1 (negative) and Hiv 2 (negative) and Viral Load (entirely negative) and cd4/cd8 (cd4=590, cd4/cd8 ratio is 1.5) tests in the Lister Hospital, London, England

Month 17; Full check-up at The London Clinic London England (normal results)

Month 20; Anti Hiv 1/2 and P 24 antigen tests in Istanbul Memorial Hospital= all negative

Response from Dr. Frascino

Hello Mister X,

The Foundation office advised me that you might be sending in a question. Welcome to the Forum!

Your HIV risk is clearly stated. I agree unprotected sex does put you at risk for STDs, including HIV. However, it may be worthwhile putting that risk into its proper perspective. The estimated per-act risk for acquiring HIV from unprotected insertive penile-vaginal sex is 5 per 10,000 exposures to a partner confirmed to be HIV positive. Your estimated per-act risk would be less, as we do not know the HIV status of your partners in Russia, Ukraine and Turkey. I would agree HIV testing would be warranted. However, over-testing is not.

Your repeatedly negative HIV tests out to 20 months are definitive and conclusive. Unequivocally HIV is not your problem. No way. No how. Not only have you had eight negative HIV-1 and HIV-2 antibody tests and six negative p24 antigen tests, you've had a negative HIV plasma viral load test and normal T-cell subset analysis at 12 months. Wow, you just can't get any more negative or normal than that!

Your concerns about rare HIV subtypes, slowly diminishing CD4 counts and lack of anti-HIV antibody responses are completely unjustified based on your extensive testing and completely normal "full check up" at 17 months at the London clinic.

First, rare subtypes are indeed "rare!" The risk of acquiring one is far less than, say, dying from rolling out of bed while asleep at night! So if you're not also very worried about croaking from rolling out of bed or getting struck dead by an errant bolt of lightening, you shouldn't be obsessing about rare HIV strains. Besides, even if most anti-HIV antibody screening tests fail to detect some "N" or "O" subtypes, your other tests (HIV viral load, p24 antigen and CD4 count) are not antibody dependent. Since these tests are also completely normal, there is absolutely no indication that you have HIV of any type whatsoever!

Next, your fear of slowly diminishing CD4 counts is not justified by your lab results! Your T-cell subset analysis, including absolute CD4 count and CD4/CD8 ratio, is completely normal at the 12-month mark!

Finally, your concern about not producing anti-HIV antibodies is also unwarranted for the same reasons given above. Your other HIV-related tests are antibody independent and are completely normal!

Mister X, you ask if there are other tests I could recommend to reveal rare HIV strains and/or to reassure you. No, there are not. I absolutely agree with your own assessment that you have "HIV phobia!" Your problem is not HIV, but rather completely unwarranted "worry about HIV." Irrational HIV fear resulting in anxiety is a very real medical condition and one that requires attention. Additional tests will not solve this problem, as demonstrated by your extensive testing for 20 months, all normal, but you still remaining worried! You need to focus your attention on your real medical problem, the unwarranted worry, rather than on continued testing and retesting. You now have overwhelming evidence that you are definitively and conclusively HIV negative. This evidence is irrefutable. You must now get the help you need to accept the truly wonderful news and undeniable fact that you are HIV negative. I would suggest you get some counseling to help you confront and conquer your irrational HIV fears. Additional testing is not the answer. We have seen many folks with stories very similar to yours at the Frascino Medical Group. With counseling and constant reassurance from HIV specialists, they have all been able to conquer their fears. I'm confident you can do the same.

Good luck and congratulations on dodging the HIV bullet! Thank you for your offer to make a donation to The Robert James Frascino AIDS Foundation to help those who weren't so lucky.

Be well. Stay safe. Stay well. Remember HIV is not your problem!

Dr. Bob



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