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Need advice on testing from the cute Doc
Sep 16, 2008

Hey Doc (BTW, I am totally straight; still think your cute in a totally non-gay way ;)

I've got a testing question for you. 3 weeks ago I had unprotected vaginal and anal sex from a woman I meet the same night (total stranger). A week and a half later I came down with a fever of 100.3 and malaise for about 6 hours and one total day of a mild headache, fatigue and severe eye pain. I just recently tested at 19 days and had a negative test. My question is should I test again at 28 days with rapid test or should I immediately receive a p24 antigen test? Will one week + a few days make that much difference in when it comes to treatment and immune system preservation? Thanks for anwsering all these seemingly strange questions.

P.S. if I were gay you would defintely be my type. Ah hell, were all gay in some little way!

Response from Dr. Frascino

Hi "Totally Straight" Guy,

Unprotected sex does place you at some degree of risk for STDs, including HIV. Symptoms are notoriously unreliable in predicting who is and is not HIV infected. The reason to worry (and get tested) is related only to HIV risk and not to whether you have symptoms. Your negative HIV-antibody test at 19 days is encouraging, but not conclusive. HIV-antibody tests taken prior to the three-month mark are not considered to be definitive. I would recommend repeating your HIV-antibody test (ELISA, EIA, rapid test) at the three-month mark.

If you are HIV infected the question of whether to treat during the primary infection is still a topic of much debate. (See below.)

Thanks for the compliment about definitely being your type if you were gay. Well, let's hope you look like George Clooney, dance like Justin Timberlake and think like Barack Obama, because then we just may be a match (if you ever decide to take a walk on the wild side).

Dr. Bob

Treatment during seroconversion Sep 15, 2008

Hi

Is there any evidence that a short time early treatment during the seroconversion phase of hiv has an beneficial effect on the later disease development?

Thanks and best regards, Helmut

Response from Dr. Frascino

Hello Helmut,

The question of whether to recommend treatment during primary HIV infection remains a hotly debated topic. The clinical trail data that we have are limited and produced mixed results.

Some researchers have hypothesized that starting antiretroviral therapy around the time of initial infection may improve the immune system's ability to fight HIV, limiting the spread of the virus throughout the body and reducing the rate of disease progression. There have been conflicting reports as to whether this early treatment improves (lowers) HIV viral "set-point." Treatment during primary infection might also have a beneficial effect on long-term immune function, although here too the data are mixed. Researchers with the CASCADE study found that individuals who receive a three-month course of HAART during primary infection experience significantly slower CD4 cell decline during the three years following seroconversion. Other investigators, however, have shown this advantage does not appear to last long after treatment is discontinued. One final and more recent hypothesis arguing for early treatment concerns decreasing immune activation. As an immunologist, I would recommend offering HAART to all patients during primary infection, even though the risk-benefit tradeoff of very early treatment remains uncertain. The treatment pendulum is certainly swinging in the direction of earlier treatment. However, that must always be balanced by the risk of side effects and toxicities of taking antiretroviral drugs. I have no doubt that as HIV therapies improve, treatment will continue to be recommended earlier and earlier. Personally, if I had the option of being treated during primary HIV infection today, I would take it. But that is only my personal opinion as we don't yet have firm scientific data to completely support that position and make it a generalized recommendation or treatment guideline.

Dr. Bob



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