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seeking closure
Feb 6, 2010

Dear Dr Bob

This is the resident with the occupational exposure again..Im quite relieved to test negative yet again @ 6 months.

But I do have some doubts now and then regarding my status, I think for genuine reasons.... I live in an asian country where the subtype pattern HIV 1 subtype C and HIV-2 is quite similar to that found in Africa. We also have a large African student population in the cities here. This has me worrying about subtypes. So far I have tested at 9.5 weeks, 12 weeks, 19 weeks and now at 6 mths by atleast 4 different tests -a 3rd gen elisa, an immunocomb rapid , combo and now the SD Bioline rapid test for subtype 1,2 and O. Can I be sure that some rare subtype like N or some yet to be discovered subtype of HIV-1 or HIV-2 hasnt been missed. Ive had a colleague tell me I should have a Western blot to be absolutely sure? Is he correct in saying so?

Inspite of knowing symptoms shouldnt be relied upon, the timing and nature of my flu like illness still does scare me. Since i didnt have a sore throat or any obvious skin, eye or oral/dental infection during my flu like illness, I do sometimes wonder if it truly wasnt HIV that caused so many of those swollen nodes.

Im seeking closure Dr Bob, and I so badly need your assurance to put this behind me...please tell me Im OK? Thank you Dr Bob Regards

Response from Dr. Frascino

Hello Worried Resident,

Congratulations on your definitive and conclusive HIV-negative status. WOOO-HOOO!

Worrying about a "yet to be discovered subtype of HIV" is a bit wacky, don't cha think? Such worries are irrational. As a physician, you'll need better skills in differentiating reasonable worries form nebulous far-fetched hypotheticals. Do you also worry about being squashed by an errant meteorite or being gobbled alive by a rabid Tasmanian devil? If not, you shouldn't worry about being infected with undiscovered HIV subtypes either!

I would very strongly advise against a Western Blot test. Western Blot (WB) tests, because of their high degree of specificity, should only be used as confirmatory tests following a repeatedly reactive (positive) ELISA, EIA or rapid test. There is a significant risk of a false-positive result for WB tests run independently of a preliminary positive screening test. Don't do it! And please educate your colleagues as well. That they would think this is the correct thing to do is worrisome. Talk to your senior resident or training director; a refresher course on this topic for all residents in your program may well be warranted.

Dr. Bob



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