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Thanks from Bill (formerly Boil) in Romania
Oct 9, 2007

Dear Dr. Frascino, Thanks so much for kindly answering my questions and encouraging me to accept my negative HIV test results out to 17 weeks. I feel I can now fully get back to helping the people I came here to help, including some members of the Roma community who are also desperately trying to cope with the challenges of living with AIDS. Although I can't help them medically, I can help build the new water & sanitation systems that greatly reduce the spread of disease and improve community hygiene generally. So yes, I will indeed heed your advice and 'clean up my act', while resuming the hard work of helping to clean up the infrastructure here.

I'm fighting a knee-jerk reaction to ask you follow-up questions: what about my ongoing symptoms and 'HIV-suspicious' abnormal CBC & Liver Enzyme test results: low wbc/ high lymphs; very high ggt/very low ap!? But no matter. Your clinical judgment was received loud and clear, so I'm now "Absofrickinlutely 10+ Woo-Hooing" until the cows come home, which they actually still do in these parts around suppertime!

The good that has come of all this was being introduced to (online-only, alas) wonderful you and your AIDS Foundation. You can count on me as a lifelong financial and spiritual supporter of your good works! So thank you, Dr. Bob, and good luck karma to you too! And one more thing: Thanks for giving me my name back. It's no longer 'Boil', but Bill. All best wishes, Bill in Romania

Response from Dr. Frascino

Hi Bill,

I much prefer "Bill" to boil! I was delighted to get your follow-up note and I totally support your recovery plan for Romania (and for "Bill")! BRAVO!

Just to minimally address your jerking knee:

1. Low wbc and high lymphs is not "HIV-suspicious!" It generally means you have a common respiratory tract virus, i.e. a cold.

2. The abnormal liver function tests are most likely due to your alcohol use. This is not HIV related or suspicious. It will normalize as your act gets cleaned up!

Be well, Bill. Your good deeds in Romania will not go unnoticed by the higher powers. Excellent cosmic karma is coming your way!

Dr. Bob

please help doctor hiv scare(d) in Romania Sep 28, 2007

Dear Dr. Frascino, I very much need your professional opinion. I'm far from home (US) and alone, working for the peace corp in Romania, where until recently I was helping to make a difference in life by helping some of Romania's poor, socially ostracized people. Sadly, for the past four months my HIV scare has paralyzed me with fear: I've been reduced to a self-hating, self-obsessed, depressed boil on humanity's backside, unable to help others or myself.

I hope you can help me. My provincial doctors here are not HIV specialists nor do they speak English very well. My situation is this: one-time unprotected vaginal intercourse with woman of (partly) unknown HIV status four months ago while on holiday in Holland. I say 'partly' because she might have been in her window period when last tested: she had a negative rapid (finger prick) HIV 1/2 test about 6 weeks after we had sex. As she's a friend of a friend, I know there's a real possibility that she had sexual intercourse with someone (in Holland) in the days/weeks preceding our encounter four months ago. She denies this, however, and we no longer have contact.

I've had many ARS symptoms these past four months. I know symptoms don't necessarily = HIV, but mine were/are many common to ARS. The first sign that something was physically wrong with me occurred about one-month post-exposure when I got a very painful sore throat could not swallow food/liquids. Antibiotics were prescribed that helped, followed a few days later by an outbreak of white ulcers on the back of my throat and tonsils (perhaps triggered by drinking the local 80-proof moonshine to excess the previous evening) the ulcers went away in a week.

The ENT doctor who examined me at that time ordered an HIV test (negative 6 weeks post-exposure), plus a microbiological test: Candida sp. - negative. Enterobacter cloacae 10 ^ 3

Over the past 4 months I've had a cold/flu lasting 10 days in summer; various transient minor skin rashes and red spots; generalized itchy skin; random swollen lymph glands; quite severe nerve tingling/burning in my feet, hands, legs and face; and constant eye floaters that started a month ago and persist today. My tongue has remained whitish throughout, although this could be owing to heavy smoking/stress/poor diet.

My tests to date:

Repeatedly negative HIV test results over 4 months on three different (blood drawn) second-generation HIV 1/2 (ab-only) tests at three different Romanian hospitals/clinics.

My latest test today: second-generation Abbott AXSym HIV 1/2 (ab-only test) was negative at 17 weeks (120 days) post-exposure. At 110 days post-exposure: RNA PCR test for HIV-1 (Roche v.1.5) no virus detected. DNA PCR tests are not available here.

CBC I Done at about one month post-exposure: wbc 4.2 (4.1 to 10.5 range) lymphocytes 43.3 (25 to 40) platelets 295 (130 to 440).

Liver Enzymes AST 23 (0 38 range) ALT 35 (0 40) GGT 46 (11 50) AP 71 (98 to 280)

CBC II Done at three months post-exposure: wbc 5.8 (4.1 10.5) lym 34.6 (25 40) platelets 202 (130 440)

Hep B/C tests Liver Test Done at four months post-exposure: HbeAg and Anti-HCV: non-reactive. Liver enzymes: AST 23 (0 to 40) ALT 34 (0 to 55) GGT 60 (0 to 35) very high. As I drink the local moonshine fairly regularly, doctor said this probably accounted for this elevation (I take no comfort from this).

Doctor, what is your opinion of my case - test results and history? What would you advise me to do next?

1) Should I accept my negative status doctors here said I don't need retesting despite the fact that they were older, second generation tests and I have ongoing, worrying symptoms like constant eye floaters?

2) Because only second generation (ab-only) HIV tests are available here, should I break open my piggy-bank and travel to a Western European country to do a 4th generation ab/ag hiv test?

3) My exposure was in Holland, with a white European woman living and socializing among Holland's immigrant community mainly North Africans and West Africans. Is it possible that I have a HIV strain from her that is undetectable by Romania's older, second generation HIV tests?

4) Of note, on the night I was exposed four months ago, I was very weak, just starting to recover from a severe case of flu (high fever/sweating) I had the previous three days. Could the fact that my immune system was weak and producing flu antibodies delay HIV seroconversion up to 4 months post-exposure?

4) I know I cannot Woo-Hoo yet, despite a 4-month negative test. But on a Woo-Hoo scale of 1 to 10, what would you say my Woo-Hoo-ability is right now?

I'm scared, totally stressed-out, confused and very much in need of your help. Regardless of whether you have the time to answer my questions (reading your answers to other folks' online questions these past months has been very helpful and especially amusing in an otherwise dark period of my life), I shall certainly be making a donation to The Robert James Frascino AIDS Foundation. Thank you in advance, Boil in Romania

Response from Dr. Frascino

Hello,

I'll respond to your specific questions first:

1. Yes! Absofrickinlutely!

2. Nope. That is not warranted or necessary.

3. Nope!

4. Nope! The immune system does not work that way.

5. You know you cannot WOO-HOO?!?! Why the hell not? I'd place your WOO-HOO-ability at 10+ on a scale of 1 to 10!

Dude, look at the facts: your risk was unprotected insertive penile-vaginal sex with someone who had a negative HIV-1/2 rapid test six weeks after your horizontal mattress mambo. Added to that you've had repeatedly negative HIV-1/2 tests out to 17 weeks and an undetectable RNA PCR at 110 days. You really just can't get any more negative than that. HIV is not your problem. No way. No how. You are definitively and conclusively HIV negative.

The other thing that's negative about you is your attitude! ". . . I've been reduced to a self-hating, self-obsessed, depressed boil on humanity's backside . . . ." Dude, that's harsh!

Your problem is psychiatric, not virologic. You are severely depressed and leading a self-destructive lifestyle. (". . . heavy smoking/stress/poor diet.")

Additional HIV testing is not warranted or necessary. What you need is a psychiatrist to help you confront your clinical depression, irrational HIV fears and anxiety. In addition you need to clean up your act! Quit smoking; reduce stress; start exercising; improve your diet; etc.

Thank you for your past efforts to help the disadvantaged folks in Romania and for your donation to the Robert James Frascino AIDS Foundation, which will help others in desperate need as they cope with the challenges of living with AIDS. I sincerely hope that you will also help yourself. The road back to health, both mental and physical, is clear. It's up to you to take the next step.

Good luck.

Dr. Bob



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