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Archives no help for this testing question
Feb 3, 2010

53 year old married male that messed up and had unprotected vaginal sex with a female who turned out to be a prostitute.Had tingling in penis so went to clinic for antibiotics for chlamidia and gonhorea (Rocephine shot and Z-Pak).1 week later went back to clinic for possible prostate infection and prescribed 2 weeks of cipro.A week later developed black hairy tongue that turned into thrush at about 8 weeks post exposure.For 10 weeks after exposure I drank lot's of beer cried,prayed,surfed web for hiv info(I was totally ignorant of hiv),and plotted suicide.My wife and I live in separate cities due to economy.Had every symptom but fever. tested neg at 4,6,8,9,and 10 weeks with home access test.At 10.5 weeks had a pcr dna qualitative test and an antibody test through Labcorp.At 11 weeks saw an ID Dr. who did a realtime pcr quantitative test and hiv-1,2 test through Quest Labs.All tests were neg,and the realtime pcr undetected > 48 copies. But my cd4 was 333 and cd4% was 40%.Absolute lymphocytes were low 825 lower range for test was 850.ID Dr. thinks stress, alcohol,diet,and diarrhea are my only problems.I'm also pre-diabetic and haven't watched it lately. My weight is returning and diarrhea is better now, but my face still very thin.I really admire you and think you're very special for all you do! Please help!(Could this be rare form of hiv)Thanks!

Response from Dr. Frascino

Hello,

"Could this be a rare form of HIV?" No. No way. No how. No additional HIV tests are warranted. You are HIV negative.

You screwed up by screwing with a Naughty Lady from Shady Lane without protection. That did place you at some risk for STDs, including HIV. You were aggressively (perhaps over aggressively) treated with antibiotics to cover STDs. The antibiotics caused the "black hairy tongue" and "thrush." Your repeatedly negative HIV-antibody tests out to 10.5 weeks plus your undetectable qualitative HIV PCR DNA and undetectable quantitative HIV PCR RNA confirm your negative HIV status. There was no reason to obtain a CD4 count and CD4%. The physician who ordered those did so in error, in my opinion. Yes, your CD4 count is slightly low, which is most likely due to the low absolute lymphocyte count (certainly not HIV!). There are many reasons CD4 cell counts can fluctuate.

At this point, you test results prove you are HIV negative. Your problems stem primarily from guilt ("plotted suicide") and lifestyle ("drank lots of beer"). My advice is simple and straightforward:

1. Level with your wife. It's not only the best way to confront your guilt and anxiety; it's also the right thing to do.

2. Clean up your act! Time to get healthy with less crying in your beer and more sweating on the treadmill.

3. Stop perseverating on a disease you do not have!

4. Get informed about STDs, including HIV. HIV has been with us for over a quarter of a century. There is no reason you should be "totally ignorant about HIV!" Time to wise up! This time you dodged the HIV bullet. Next time you might not be so lucky!

Dr. Bob



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