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$100 donation soon to be father needs closure please help
Oct 12, 2008

hello doc i write you once again because lately i have been getting very conflicting info i went from woo hooing!! to boo hooing i recently asked you a question about the oraquick study in seattle so i decided to call the hiv/std hotline talked to a gentelman told him about my eposure over in vietnam 1 time unprotected vaginal sex with a csw later confirmed to be hiv+ now since i have been back i have had the following tests elisa 8,10,12,14,22 weeks they all came back neg and oraquick advance at 6 months and 7 1/2 the gentelman i spoke to after telling him about my exposure saidthat the tests used in america are not likely to detect subtype E aka crf a/e and this was horrible news now im back at square one i still have folliculitus on my face scalp and arms and been having stomach problems and mouth ulcers as well my wife is having our first child due on the 17th and i need to be sure i did not infect her or my daughter if this is true is it true? if so what kind of test do i need that will accurately pick up this strain?he also stated orauick advance hiv 1/2 will not pick it up and it only detects subtype B doc im sooo stressed out please help

Response from Dr. Frascino

Hi,

This topic gets a bit confusing, but let me try to explain it once again. The strains of HIV-1 are classified into groups: the "major" group M, the "outlier" group O and the "new" group N. These three groups most likely represent three separate introductions of Simian immunodeficiency virus (SIV) into humans. The O group appears to be restricted to west-central Africa. The N group discovered in 1998 in Cameroon is extremely rare. More than 90% of HIV-1 infections belong to group M. Within group M there are at least nine genetically distinct subtypes (or clades) named A, B, C, D, E, F, G, H, J and K. Sometimes two viruses from different subtypes combine and create a new hybrid virus. (The process is analogous to sexual reproduction and is sometimes called "viral sex!") Many of these new strains are weak and do not survive very long. However, those that can infect people are known as "circulating recombinant forms" or CRFs. The classification of HIV strains into subtypes and CRFs is obviously quite complex and the nomenclature may ultimately be changed to simplify and clarify viral typing.

One CFR is called A/E, because it is thought to have resulted form hybridization between subtype A and some other "parent" subtype E. However, no one has isolated a pure form of subtype E yet. CRF A/E is prevalent in Southeast Asia, but originated in Central Africa. According to the U.S. Centers of Disease Control and Prevention (CDC), current HIV-1 EIA (enzyme immunoassays, such as ELISA) "can accurately identify infections with nearly all non-B subtypes and many infections with group O HIV subtypes." You can check with them if you remain concerned. Your negative ELISA tests at 8, 10, 12, 14 and 22 weeks followed by your negative OraQuick Advance tests at 6 months and 7.5 months are definitive and conclusive. No additional testing is warranted. If you need additional reassurance, consult a local HIV specialist. I have absolutely no doubt he will review your history and lab results and come to the exact same conclusion.

Stop stressing and start WOO-HOOing. HIV is not your problem.

Dr. Bob



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