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Dear Dr. Bob, I need your help/hope/advice
Jan 30, 2009

Dear Dr Bob, I am the medical student who posted a thank you last week. After making a very unwise decision one night while feeling stressed out about upcoming residency interviews, I'm in the midst of a scare. My 5 week post-event test was negative, but now I'm reasonably certain I'm in the process of seroconverting. I know "symptoms are notoriously unreliable," but I really can't explain my these ones away, try as I might. I have generalized adenopathy and a flu-like illness which started right after I was tested.

I have a couple of questions for you: 1. How time-sensitive is this situation (i.e. do you think I should get tested again before the 3 month mark in order to start being treated?) 2. As a final year medical student, can I realistically expect to be well enough to endure a difficult 5-year residency programme or should I start readjusting my plans? 3. Will I be putting patients at risk? 4. Do you have any tips for dealing with the guilt and self-hating thoughts I'm having since having done something so risky?

Thank you Bob, really, you're an inspiration to me, and your site is getting me through these weeks.

Response from Dr. Frascino

Hello Medical Student,

How can you be reasonably certain you are in the process of seroconverting when you haven't even started your internship and residency yet??? You really don't know enough about clinical medicine to be reasonably certain about anything yet!

To briefly address your questions:

1. If I thought you were seroconverting, which I doubt, I'd suggest getting a plasma viral load and HIV-antibody test. If the viral load is undetectable and the HIV-antibody test negative, your symptoms would not be HIV related.

2. Don't you think you are jumping the gun worrying about a purely hypothetical situation? I do. Let's take things one step at a time, OK?

3. No. Universal precautions are used to prevent the transmission of bloodborne diseases, such as hepatitis and HIV.

4. Counseling would definitely help. I suggest you give it a try.

Dr. Bob



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