Jun 26, 2008
Hi Dr. Bob, Update from Adam. Summary of events: Possible exposure was 4/13. Negative proviral DNA by PCR on 5/21 (38 days after). Negative ELISA on 6/23 (10 weeks after). I know you told me to take the test again after I come back from Asia in August but can I do an early yabadabadoo? Hope you have received my donation and will send more later. Thanks Dr. Bob. And you are right, my malaise and loose stools magically dissappear.
Response from Dr. Frascino
Yes, a major YABBA DABBA DO is definitely in order and I do not feel it is at all early. As I indicated previously (see below), your HIV-acquisition risk is essentially nonexistent (assuming the latex condom was used properly and didn't break). Nonexistent risk is always WOO-HOOable and YABBA DABBA DO-able!
Your HIV tests, including a negative 10-week ELISA and undetectable 38-day proviral DNA PCR, corroborate what we anticipate from a nonexistent risk, i.e. you are HIV negative. My comments about your 10-week ELISA are that the test result itself would not be considered to be definitive, as it was run prior to the three-month mark (window period). Certainly if you want the reassurance of a definitive, conclusive HIV test, you'll need to retest at three months or more from the date of potential exposure. But from what you've told me so far, your "exposure" was really a non-exposure. Add that to the results of your tests to date and I would certify you WOO-HOO-YABBA-DABBA-DO-able now!
Thank you for your very generous gift to the Robert James Frascino AIDS Foundation. You will soon receive a personalized acknowledgement/thank-you letter from me as well as a small token of my appreciation. In addition, I'm sending you my best good-luck/good-health karma.
Be well. Stay well.
Proviral DNA by PCR Jun 12, 2008
Hi Dr. Bob, I promise I will donate to this great foundation. Here is my story: I went to Amsterdam in April. On 4/13 I had a "massage therapist" come to my room. She is from eastern Europe. Initially she did some light rub on my back. Then we progressed to something else. She put the condom on my penis and did a blow job on me. Then we had protected sex for about a minute. Then I took my penis out, took out the condom and washed my hands. We continued with me sucking her breast and biting her butt cheek. Then I masturbated in front of her with my left hand while my right hand was touching her vagina lips.(outer part) I didn't go in. Immediately the next day, I started coughing. 2 days after I developed a fever on my way back to the states. 3 days after I had night sweat and my temperature was 104. Also I was coughing green phlegm. The 5th day, I was back to normal. About 3 weeks after I had bad allergy on my travel to NY. I was sneezing and coughing. The 4th week I had a fever and sore throat on my travel to Puerto Rico. I got so worried that I took the proviral HIV DNA by PCR test exactly 38 days after possible exposure. The result came back negative. My question is should I take the Elisa test? The reason is that I don't feel normal (like Malaise) and I have been having soft stools lately ( not watery stools). I used to go like 2 to 3 times a day but now more like 4 or 5 times a day. Could this be anxiety or stress?
Please Dr. Bob, I really need some advice as to what I should do.
I have a family and did something stupid that I regret for the rest of my life.
Response from Dr. Frascino
Your HIV-acquisition risk is essentially nonexistent, assuming the latex condoms was used properly and didn't fail (break).
"Symptoms" beginning within days of a potential HIV exposure are not due to HIV infection. The symptoms associated with HIV acute retroviral syndrome (ARS) take weeks, not days, to appear.
Your negative proviral HIV DNA PCR at day 38 is extremely encouraging. However, PCR tests are not recommended for routine HIV screening. The current guidelines recommend an HIV-antibody test (ELISA, EIA, rapid test, etc.) at the three-month mark for a definitive result.
I cannot diagnose the cause of your symptoms immediately after your Amsterdam "massage," but with fever to 104 and cough productive of green phlegm, it certainly sounds infectious. The cause, however, was not HIV. As for your more recent complaints (malaise, soft stools), you ask "could this be anxiety or stress." The answer is yes. Absofrickinlutely! I anticipate these symptoms will magically evaporate when you stop worrying about HIV. Guilt may also be playing a role. I'd suggest leveling with your wife if you have not already done so. It's not only the best way to confront guilt it's also the right thing to do.
Thanks for your donation to the Robert James Frascino AIDS Foundation (www.concertedeffort.org). Your tax-deductible gift is warmly appreciated and urgently needed. In return I'm sending you my good-luck karma that your definitive three-month HIV test is negative. I'm quite confident it will indeed by negative.
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