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early treatment during seroconversion?please help
Oct 29, 2008

can I ask you why you suggested(i am referring to ur reply to hte milano story)in the case of seroconversion(when you have pos elisa indet wb but the vl is present)-this is my case unfortunately-to start medicine immediately?my specialist stack with the guidelines,but I would like to listen to another opinion and which evidence support your statement. my situation is even more complicated because my partner who is negative, would like me to start meds soon to lower my viral load and lower the risk-even if we never have unsafe sex-but i am really terrified about the side effects.

Response from Dr. Frascino

Hello,

I suggested she see an HIV specialist physician to ascertain if indeed she was in the midst of seroconverting to HIV positive and if so to "consider" beginning antiretroviral therapy. Recent clinical studies have shown that compared to beginning treatment earlier, delaying the start of treatment until the CD4 count significantly declines greatly increases the risk of death. Some of this information is just being presented for the first time at the infectious diseases meeting in Washington, DC this week. We have also learned more about HIV pathogenesis and the negative consequences immune activation, which would argue for beginning antiretroviral therapy as soon as possible after primary infection before HIV has the chance to become widely disseminated. Very early treatment is not yet a formal recommendation, but it's a treatment option that should be discussed with patients undergoing seroconversion. That is why I wanted the Milano questioner to be seen by an HIV specialist physician now.

In your case, you have two additional competing forces to consider. It is true that if you were on effective antiretroviral therapy, which drove your HIV plasma viral load down to undetectable levels, your risk of transmitting HIV to your HIV-negative partner would be significantly decreased. Many magnetic couples have opted for this harm-reduction strategy. Please note this intervention is not 100% effective and therefore safer sexual practices (latex condoms for penetrative sex) remain essential even if you were on effective antiretroviral treatment. The other competing factor is your fear of antiretroviral side effects and toxicities. This is a valid concern. You should discuss these concerns with your HIV specialist and your boyfriend, weighing all you potential risks against potential benefits. There is no easy or correct answer!

Good luck.

Dr. Bob

Waiting for results (from Milano) part 4 WB indeterminate Oct 28, 2008

I received my WB results and they're indeterminate. GP160 reactive, GP120 absent, P65 reactive, P55/P53 absent, GP41 absent, P31 absent, P24 reactive and P15 absent. I'm prepared for the worst but I can't really interpret this results. I'm in serconversion. Could it be that after 2,5 month of possible exposure no definitive result is available. I had also 2 reactive Elisas.

Response from Dr. Frascino

Hello,

At this point, I would suggest you see an HIV specialist. He will run additional tests to ascertain if indeed you are in the process of seroconversion. If so, consideration should be given to beginning antiretroviral therapy immediately to preserve immune function and decrease immune activation.

Good luck. I'm here if you need me.

Dr. Bob

Waiting for results (from Milano) part 2 Oct 17, 2008

Thank you very much for your support. Unfortunately I received the first exam results and it is HIV reactive. Now I'm waiting for the Western Blot results. No Hep B or C reaction. I'm in a nightmare. Could it be a false positive? I'm scared and desperated.

Response from Dr. Frascino

Hello,

All preliminary HIV-screening diagnostic tests (ELISA, EIA, rapid tests, etc.) require a confirmatory test, such as a Western Blot, before the test can be considered a true positive. Is it possible you could still be HIV negative? Yes, it is possible. Either way, I'm here if you need me, OK?

Dr. Bob

Waiting for results (from Milano) Oct 16, 2008

After some high risk exposures like insertive anal sex without condom I decided to get tested. I have to wait 20 days for the results. I delevoped a lymadenopathy in the groin. The nodes are quite big. No fever or rashes but sometimes night sweats. My doc told me that the sweats could be stress related. Obviously I'm a bit scared. I know I made misstakes and I finally decided to have a complete blood test done including other STD's. Is there a chance to be neg.? It's a QTND but you're the only person I can tell at the moment. Your reply would be very helpful.

Response from Dr. Frascino

Hi,

Is there a chance you are HIV negative? Yes, absolutely. Not every exposure to HIV leads to HIV transmission/acquisition. In fact, the vast majority of exposures do not result in transmission of the virus (thankfully!). That said, I'm glad you are getting tested. Unprotected anal sex does place you at some degree of risk for STDs, including HIV. Consequently, testing is certainly warranted. Try not to worry about your symptoms. Symptoms are notoriously unreliable in predicting who is and is not HIV infected. You can read much more about HIV testing, HIV-sexual transmission and symptoms in the archives. We have entire chapters dedicated to these topics.

Good luck. I'm here if you need me.

Dr. Bob

Waiting for results (from Milano) part 3 Oct 20, 2008

Thank you so much. I have only one more question. Is it common to not have any hepatitis B or C coinfection with HIV? I mean aren't this 2 virus much easier to transmit than HIV?

Response from Dr. Frascino

Hello,

Hepatitis viruses (A, B or C) are completely different viruses than HIV. The vast majority of people with HIV do not have any type of hepatitis virus infection. Likewise, most folks with viral hepatitis of any type do not have HIV. Yes, viral hepatitis is more easily contracted than HIV. And yes, it is possible to be coinfected with HIV and a hepatitis virus.

Dr. Bob



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