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Jan 3, 2009

Dr Bob,

I am a 33 year old man who made a terrible mistake a year and a half ago. I emailed you before under the title "alcoholism and hiv testing" since my last email I have had 15 hiv tests and a pcr all negative. I can't shake the feeling that I have HIV. Four weeks after my encounter with the escort I had a burning pain in my groin, vision distrubances (I kept thinking I saw a yellow strand of hair in my left eye), pain in my legs, back of the knees and armpits. The vision disturbances and intense pain went away almost immediately after my second HIV negative test at five weeks, but the armpit and groin pain went on for months. I never had a fever. I cannot stop drinking after the incident I used to average 12-16 beers a night, now I have cut back to six, but still go on benders on days off. I never would have done what I did if my boss had not kept doing his best to drive me crazy for the better part of five years. Before the encounter at one point he said "I am going to fire him, make sure he never works again and loses his house". About a month after I got tested for HIV my boss started saying "He's positive, I confirmed it, he has it", this went on for months,it got so bad the CEO told him to stop before he got the company sued. About eight months after my encounter I started seeing floaters. I went to the eye doctor, and told her everything, she said I should believe the tests and that floaters are normal, or at least not something that they know the cause of. Despite her best efforts to write a prescription for eye glasses she concluded i still had 20/20 vision. I also appear to have lost weight according to people but when I get on the scale I have not, I have to tighten my belt all the way and I seem to be losing weight in the trunk and face. I have had boughts of night sweats where my shirt gets wet qround the neck and chest that last a couple of nights. I still feel pain in the groin from time to time about every six months, it seems to build up during the day as my stress increases and then settle down at night. These boughts go on for a few days. A few years ago when I went to the dentitst (before all this) he accused me of having AIDS because my tongue was white. I went to the doctor recently and he said it is irritation from smoking a pre-cancerous condition. Recently, the HR women said to my boss's boss "I can't believe he didn't test positive", to which my boss' boss responded "Thank God". I cannot shake this feeling that I have HIV but somehow because of the excessive drinking and smoking I am negating the anti-body and pcr tests. I feel like I am going to die very soon. I went to the psychiatrist like you suggested and told him everything. After about a dozen sessions he said I was bi-polar and borderline, noone with any knowledge of employment law would say such things like he has HIV. He said there is no way I could have HIV and not test positive at some point in the course of a year, the pcr only confirms it. I stopped seeing him because he did not seem to take my fears seriously, I feel like no doctor will. The women who did the pcr almost laughed when I asked her if given my alcohol consumption could the pcr be a false negative. I have a feeling what you are going to say about smoking and drinking, I wish I could stop but can't despite going to AA and the psychiatrist, but I need to know can alcohol and cigarrette smoking in these quantities affect the test? Is there any way to know for sure wether you have HIV if these tests cannot be trusted due to the massive quantity of alcohol and tobacco. What would CD4 counts (I have not done the testing yet) tell me over the course of months or years? Why would my employer keep saying I have HIV, it certainly hasn't helped with my productivity?

Response from Dr. Frascino

Hello,

As I and apparently multiple other physicians have advised you, excessive drinking and smoking do not affect HIV test results. Period.

You've had 15 negative HIV-antibody tests plus an undetectable PCR since your last e-mail to me. Now exactly what part of "you are absolutely, definitively and conclusively HIV negative" are you having difficulty understanding? HIV is not your problem. No way. No how. How you live with that truly wonderful reality is up to you.

I have absolutely no doubt your problem is psychiatric, not virologic. You need the help of a psychiatrist, not more HIV tests. You also continue to abuse alcohol and nicotine. You are addicted to both and this, too, is ruining both your mental and physical health.

My advice is simple:

1. Stop testing. HIV is not your problem. Fear of HIV is.

2. Reestablish ongoing care with a psychiatrist.

3. Return to AA and completely quit alcohol and nicotine.

4. Stop blaming your problem on other people and take responsibility for cleaning up your act and getting the help you need.

Dr. Bob

hiv test and alchohol Aug 29, 2007

Dr. Bob Thank You for being such an inspiration, I would have done something horrible if I did not find your posts. Six weeks ago, I had an encounter with an escort, I am certain she reused the condom from another patron. I was so depressed and drunk I did not care. I have never done anything like this before and I would like to think that I would never do it again. I was tested for stds and hiv three days after exposure all tests came back negative. I had pain in my groin for a couple of months prior to the incident and the doctor prescribed me cipro for 10 days. I have been a complete train wreck ever since this incident. At four weeks my left groin started burning if I sat too long, then the back of my knees started hurting, then the rest of my groin hurt. For a couple of days I felt like I was burning up my feet and face especially. The symptoms would usually occur during the day but not the morning. I never had a fever. Now with exception of the groin pain they seem to be subsiding. I can't sleep, I am drinking 6-12 beers a night and racing through packs of cigarettes. I got tested at 38 days, the test came back negative. I am going to follow your testing guidelines for 3 and six months, but I am wondering if consuming this much alchohol will make it take longer for hiv to show up on the tests? Also I know what I did was stupid but how much danger did I put myself in? How long can hiv live in a condom? Additionally everyone at the office found out I had an HIV test because HR divulged the information. A month later they said I tested positive. Is there some way they can spped up the cycle in the lab to find out if I will develop HIV? I know it sounds crazy but my boss is a psychopath, and has been saying within earshot that I have it, or he's positive. I tested negative at five weeks three days, the mass hiv hotline says I have nothing to worry about but I am worried to the point of wondering whether or not it makes sense to go on?

Response from Dr. Frascino

Hello,

You do have a problem! I strongly doubt it's HIV, but you definitely do have a problem that requires immediate attention!

First of all, escorts don't reuse condoms! Have you ever tried to reuse one of those things? It's damn near impossible! She may well have unrolled a fresh one for your wham-bam-thank-you-ma'am. If the condom did not break and was used properly, your HIV risk would be essentially nonexistent. Your 38-day negative test is extremely encouraging, but not definitive. You'll need a test at the three-month mark for a conclusive result.

So where is your problem? Well, you clearly delineated it in your comments when you wrote: "I've been a complete train wreck ever since this incident . . . . I can't sleep, I'm drinking 6-12 beers a night and racing through packs of cigarettes . . . . I'm worried to the point of wondering whether or not it makes sense to go on . . . ." You need the help of a psychiatrist. Your level of anxiety, despair, depression and guilt is way out of proportion to any real degree of HIV risk. I urge you to stop abusing alcohol (that's how you got into this predicament in the first place!) and also to quit smoking. Cigarettes will indeed kill you in a very painful and undignified way. Your problems at work may well be related to the fact you are behaving like a hung-over, depressed, anxious lunatic. You need help! Talk to your psychiatrist about your fears that HR divulged confidential information (it is illegal to do so!) and that your boss is a psychopath spreading vicious rumors and lies about your HIV status. You have legal recourse, if this is indeed true.

Finally, regarding your question about alcohol affecting HIV test results, no, it does not. However, that shouldn't even be an issue, because you're going to stop abusing booze, right? I think it would be a good idea to take a copy of your question and my response to your first visit with the psychiatrist and discuss it with him. It will help focus your treatment.

Good luck.

Dr. Bob



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