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Unprotected Encounter + Symptoms
Mar 5, 2008

Dear Dr Bob, 9 weeks ago I had unprotected oral and vaginal sex with a girl (that I haven't known for too long) of unknown status. Stupid I know, but here in Australia, HIV is not as big of an issue as compared to the USA, and I am confident I always "pull out in time". 4 weeks after the episode I have had non stop itch/rashes all over my body that is still ongoing to this day, rash appears to be raised skin and level of itchiness varies (btw I have no known allergies). Along with the itches, I've had a loss of appetite, the runs, minor muscle/joint pains, 2 mouth ulcers in a span of 1 week, fatigue/malaise, and fevers that are on and off. 6 weeks: have an enlarged lymph node on neck (painless) but did not feel sick at all. - Even had a normal temperature. 7 weeks: Muscle pains have now become more noticeable and the issue is ongoing up till this day. Loss of appetite and runs seems to have disappeared. 8 weeks: Lymph node has disappeared, but muscle pains and itches continue.

I have read from several sources that the risk of transmission is fairly low even without protection, but transmission rate is significantly higher if the person is recently infected. I do remember she was constantly sick when i first met her.

My questions: 1) I did take an antibody test 4.5 weeks after the episode and it came out negative. I have sourced from somewhere that 85-90% of patients will have tested positive at this point, is that correct? 2) I have heard HIV can be highly infective at its early stages, assuming this girl was in the early stages of infection, what is the probability of transmitting it to me? I assume really high. 3) The muscle joint pains: the nature of the muscle pains is abnormal, e.g. I will experience pain on my left knee and struggle to walk straight then 5 minutes later the pain will have disappeared and my right bicep is now aching. This has been ongoing non-stop for the past 1.5 weeks and has been occuring in every possible muscle in my body. Is this a usual symptom for HIV infection? As for someone that is positive, is this something that you personally experience(d)? (if you do not mind me asking)

I have consulted with a GP and he could not explain the muscle ache, as he is fairly adamant that I am Negative. He took a standard blood test of me (sugar, blood pressure etc) and the results were normal. The only concern was my liver but he says that is not related to the muscle/joint pains.

I am not the type of person that gets paranoid or anxious, but the muscle pains really are convincing me I am positive and I feel my body has weakened over the past few weeks due to a large scale virus in me. Every symptom I've experienced I have given the benefit of the doubt and attribute it to other causes, the nature of the muscle pains has convinced me otherwise, its just unexplainable. I will get tested at 3 months, which is 3-4 weeks away, but it seems like an eternity right now.

Thanks Doc.

PS. I will be donating to your foundation and would also like to say that you are just AWESOME, keep doing what you do Doc! the world needs more people like you.

Response from Dr. Frascino

Hello Aussie-Guy,

1. The 85%-90% statistic is difficult to prove, statistically speaking, but it's certainly well accepted that the vast majority of HIV-positive folks will have detectable levels of anti-HIV antibody in the blood within four-six weeks following primary infection.

2. It is true that in the early stages of HIV primary infection HIV viral load often skyrockets. High HIV plasma viral loads are associated with increased risk for HIV transmission. There are no estimated statistics on exact probability, because far too many variables come into play (viral strain, viral load, concurrent infection, immune integrity of the host, genetics, etc.). To assume your risk is "really high," however, would not be accurate. Your overall risk remains relatively low.

3. The migratory muscle and joint pains you describe are not commonly seen in HIV acute retroviral syndrome (ARS) or HIV disease. (No, I did not experience anything like that during my ARS and no, I certainly don't mind you asking.) If your general medical doctor can't figure out what's going on, ask for a referral to a specialist for a more complete evaluation.

At this point, Aussie-Guy, your overall HIV-acquisition risk remains low, but not completely nonexistent. Your negative 4.5-week HIV-antibody test is encouraging, but not definitive. Your plan to get a definitive HIV test at the three-month mark is right on target. Excessive worry between now and then is not warranted.

One thing I should point out is that "pulling out in time" is not an effective HIV-prevention strategy. Entering the Bermuda Triangle of love without your wetsuit on puts you at risk for STDs, including HIV, whether you pull out or plunge onward to greater depths!

Thanks for your generous donation to the Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's warmly appreciated. In return I'm sending you my good-luck/good-health karma that your definitive three-month HIV test remains negative, OK?

"G'day mate; she'll be apples."

Dr. Bob



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