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i know you get a lot of these but this one is really baffling
Oct 13, 2007

hi dr. franscino, this is my second mail. i have been a mess since all these years. i got mucocutaneous herpes simplex- culture confirmed 7 months ago and now i have angular cheilitis. along with this i have distal sensory neuropathy since 4 years after my antitubercular drug exposure 3 years ago. my neuropathy had improved but has come back. could this all be just coincidence that all these problems have occured in an otherwise completely health person. i wrote to you earlier in 2004 when i told you that i had a high risk heterosexual encounter in thailand in july 2003 and i have been negative on elisa so far. i have done at least 20 elisa and 1 rna pcr 8 months post exposure but all were negative. then i got c4 done 8 months post exposure with cd 4 of 606( 35.3) and cd 8 of 368(21.3). ratio of 1.65. repeated cd 4 counts again 1 year after this and this would be almost 2 years post exposure and it was cd 4 of 978( 45%) and cd 8 of around 550( dont remember percentage) and ratio was 1.85. i know that this is a normal ratio and taking your advice i had given up the thought of hiv but seems like i am getting all these things which really drive me crazy. i really really need ur opinion on this one because i cannot believe that all this can happen inspite of me being negative on all these tests. thank you for your opinion

Response from Dr. Frascino

Hello,

First, it's Frascino, not Franscino. So, perhaps it's best if you call me Dr. Bob, OK?

Next, yes, I do "get a lot of these," but no, this one is not at all baffling! In fact, quite the opposite.

Herpes simplex and angular cheilitis are incredibly common ailments and the vast, vast, vast majority of cases have absolutely nothing to do with HIV! Nada!

As for your "distal sensory neuropathy," who diagnosed that? Chances are that's not what you have. And even if you did, the cause would not be HIV. Why? Because you do not have the disease!

Next, I do not believe you are a "completely 'health' person." In fact I know you are not. You have a very significant psychological or psychiatric problem. You've had "at least 20 ELISA tests," 1 RNA PCR and 2 sets of CD4/CD8 T-cell subset analyses done out to two years from your potential exposure. The ELISA tests were all negative. The RNA PCR was undetectable and, predictably, your two completely unwarranted T-cell subset tests showed a normal distribution of CD4 and CD8 cells. And yet you "cannot believe" you are HIV negative. This clearly demonstrates severe irrational fear of HIV and anxiety.

HIV is not your problem. No way. No how. I just can't say it any more plainly than that. How you choose to live with this reality is up to you. My strong advice is that you seek out psychiatric consultation to help you confront and hopefully conquer your completely unwarranted fears. Bring a copy of your question and my response to your first visit and show it to your therapist. It will help focus your treatment.

Good luck.

Dr. Bob



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