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Relapse!
Apr 3, 2009

Dear Dr Bob, This is that pesky medical student who was bothering you back in January.

I had a high-risk sexual exposure in December and took a 28 day course of PEP and had a frightening viral illness in January that had me panicking out of control!

I was doing really well dealing with my fears (after negative antibody tests at 5 weeks and 3 months post expusure and a negative DNA PCR at 8 weeks post exposure as well as starting an SSRI and counselling).

But today I heard that the exposure source has been hospitalized (I don't even know the reason or if it's HIV-related) and it got me panicking again.

I know the recommendation of the CDC post PEP is to test out to 6 months but can you give me some reassaurance the HIV is not my problem? I have my (Canadian) board exams coming up and I'm having huge problems focusing because of this fear. I'm not sure I can wait until June (6 months post exposure) to put this to rest.

I would dearly appreciate any advice you might have for me.

Response from Dr. Frascino

Hello Med. Stud.,

Can I give you some reassurance that HIV is not your problem? Sure. Based on your history, having taken PEP and your negative HIV-antibody tests out to three months and undetectable HIV DNA PCR at eight weeks, I'd say your chances of having HIV are the same as those of Dick Cheney becoming president of PFLAG (Parents and Friends of Lesbians and Gays). OK?

I am more than a bit concerned about your low panic threshold despite SSRIs and counseling! This does not bode well for your future as an effective physician. Doctors frequently find themselves in high stress situations. If you decompensate at this extremely low level of added stress (source patient hospitalized for unknown reasons), I shudder to think how you will handle yourself and your patients when you are in a life-and-death crisis situation. I'd suggest you discuss this with your psychotherapist. Your career choices for what to do after medical school may well be limited by your irrational fears and panic reactions.

Good luck.

Dr. Bob



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