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Woman with Positive BF, condom break and low IGG
Apr 27, 2009

Dr. Bob,

I wrote once before and have decided to try again as I would really value your input.

I live in a very small and remote town and do not have easy access to quality medical care. I have an appointment with an immunologist in a large city 150 miles from my home in 2 months time.

My story is this: I am female. My boyfriend is HIV positive, I am negative (hopefully). We always use condoms but last year we had a condom break and he ejaculated inside of me. We went to the ER and I received PEP. I then followed up with an HIV clinic that my man goes to. He had bloodwork and was found to still be undetectable. The doc at the clinic advised that I could drop one of the 3 pills in the combo if I wanted to. I decided to stay the course for the full month even though it was HELL!

Anyway, I tested negative at baseline, 3 and 6 months post.

But, I have been very unwell and continue to see my local PCP. I developed drenching night sweats (every night totally soaked several times) headaches, severe joint pains, visibly swollen lymph nodes in armpits and breasts (went for mammo due to finding a lummp and was found to have several large lymph nodes in my breasts. They were biopsied and found to be benign) and malaise. My PCP ran many tests and found that my IGG is low. It came back as 540 with normal being 600 and up. With my continuing symptoms my doc said and I quote "We need to continue to run your HIV tests as you may be immunocompromised to the point of not being able to develop antibodies". I asked how long we would have to continue before I could be sure of being negative and he responded that he wasn't sure and would set me up with an immunologist.

He ran another ELISA at 9 months post exposure - also negative.

During this time he also found that I had a high titer to Bartonella Hensalae and Bartonella Quintana. He reluctantly gave me 2 weeks of antibiotics and said that was more than enough to cure any Bartonella infection as they are self limiting and very common.

I'm hoping that you can ease my mind during the time that I have to wait to see the immunologist in the city.

Is my IGG so low as to possibly cause me not to be able to mount an immune response to HIV in 9 months time?

Is the fact that I mounted an immune response to Bartonella a good sign? If my immune system was really bad I wouldn't have been able to do that would I?

Do I need to keep teting for HIV????

I really hope you will be able to answer these questions for me. I feel I am not HIV positive but I want to get rid of any doubt.

Thank you so much!

Response from Dr. Frascino

Hi,

I do not agree with your PCP. A total IgG of 540 does not suggest significant immune compromise. Nor would that level impair your ability to produce specific antibodies. Your negative HIV tests at three, six and nine months following your broken-condom episode are definitive and conclusive. You are HIV negative. No further HIV testing is warranted. Unfortunately I cannot diagnose the cause of your current symptoms over the Internet. However, what I can do is advise you with great certainty what is not causing them. It's not HIV! No way. No how. Because of your "severe joint pains" and "drenching night sweats," I'd suggest you be evaluated by a rheumatologist. Hopefully there is one closer than 150 miles away who can see you sooner than two months from now. (My, you really do live in the boonies!) If a rheumatologist is not available, I'd suggest an infectious disease specialist. Clearly your PCP hasn't been able to figure out what's going on, so it's time for a second opinion.

Good luck.

Dr. Bob



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