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Just donated to your foundation
Apr 1, 2008

Dear Bob, I wrote to you a few days back, with a promise to donate to your foundation. Although I still did not hear from you on my previous question, I just read in a recent answer to another customer you are HIV positive. My respect for your work just increases and regardless of your answer I will keep getting involved and support where I can. In case you do have time, my orginal question was regarding being tested positive on March 3rd for HBV Acute and Negative for HBC and HIV. I have had one previous HIV test which came negative on July 07. The 1st symptoms of HBV came while I was travelling and working, around second half of January, beginning Feb. There is much literature on risk of HBV on HIV positive patients. But have not read much about the risk other way around. If I test positive for HBV and subsequently negative for HIV, what would you say are my risk of still testing positive for HIV. My estimation is that my HBV infection took place around 3rd week or 4th week of December. Since Begining of January I have basically had sexual encounter with one partner who has been tested recently negative for HBV. I am very concerned and would appreciate some re-assurance from you regarding my risk. I have read somewhere that typically if the infection of HBV and HIV is from same person, HIV test is normally positive before HBV, is this true? Although a resident of Germany, I live in Italy, and now know you have Italian roots. Again congratulations and hope the US$ 1,000, although modest, does add to the amazing job you do. I will keep reading what you do and from time to time continue to support, and perhaps more importantly, seek ways to get more personally involved and help take stigma of HIV away and courage to speak more and comfort more. Wish you well and again compliments for your work.

Response from Dr. Frascino

Hello,

You tested negative for HIV July 07. On March 3, 2008 you tested positive for acute HBV but negative for HCV and HIV. Without additional risk exposures I see no reason for you to be concerned about subsequently seroconverting to HIV positive, assuming your last potential HIV exposure was at least three months prior to your March 3rd negative HIV test. (Concurrent HBV and HIV would not be expected to delay HIV seroconversion.)

Regarding HBV diagnosis, HBsAg will be detected in an infected person's blood on average four weeks after exposure to the virus (range of one to nine weeks). HIV generally takes longer to diagnose. These two viral illnesses are diagnosed differently. HIV uses primarily anti-HIV antibody screening tests (ELISA, Western Blot, etc.) to detect the presence or absence of specific antibodies. HBV is diagnosed by looking at a combination of antigens (fragments of the virus) and antibodies (proteins produced by the immune system directed against specific antigens). Consequently it is somewhat difficult to directly answer your question comparing the time to diagnosis for these two different viral infections.

For our readers' general information I'll mention a few details about HIV/HBV coinfection, as this topic is not addressed nearly as often as HIV/HCV coinfection. HIV/HBV coinfection is relatively common, because the two viruses are transmitted via similar risk behaviors. However, HBV is one hundred times more infectious than HIV through blood-to-blood contact. It is much more likely to be transmitted via unprotected sex than HCV. Approximately 95% of adults infected with HBV clear the virus spontaneously after initial (acute) infection. The remaining 5% develop chronic HBV or become chronic carriers of the virus. The likelihood of clearing HBV is lower for HIVers than HIV-negative folks. HBV is present in ejaculatory fluid (semen), vaginal fluids and blood. Sixty percent of new HBV infections are acquired via unprotected sex. It can also be transmitted by sharing drug equipment (syringes), via tattooing if equipment is not sterilized properly and through a needlestick. In addition it's possible to transmit HBV by sharing anything that might have contaminated blood on it (razors, toothbrushes, cocaine straws, etc.) and via mother to infant during childbirth. HBV is not transmitted by sharing cups, glasses, silverware, etc.

The best way to prevent HBV infection is to be vaccinated! Hepatitis B vaccines have been available for nearly 25 years and are very effective and safe.

Thank you for your very generous donation to the Robert James Frascino AIDS Foundation. Your one gift will touch many lives in a very meaningful way. On behalf of those lives please accept my heartfelt appreciation. I'll be sending you a formal acknowledgement and small token of my appreciation via routine mail in the near future. In addition I'm sending you my very best good-luck/good-health karma that you will quickly and completely clear your HBV infection.

Finally yes, I am "virally enhanced." The virus found me at work. I sustained a hollow-bore needlestick and laceration while performing a procedure on a patient with advanced-stage AIDS in January 1991. I applaud your efforts to get personally involved in helping to reduce HIV/AIDS stigma and promote HIV/AIDS awareness and prevention. BRAVO!

Be well. Stay well.

Dr. Bob



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