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What's the point of getting tested

Feb 14, 2010

Dr. Frascino,

What's the point of getting tested at 8 weeks, and at 3 months, if the HIV tests are not "conclusive" until the 6 month mark after PEP?

Why not just wait the full 6 months and then get tested ONE time, rather than put myself through all that anxiety of taking 3 separate HIV tests?

I had unprotected receptive anal intercourse and he completely finished inside me with all his ejaculation. There was also some small specs of blood on the white wash cloth I used when I cleaned myself up.

I'm unemployed and had to pay $1,000 for PEP. The HIV specialist said it was worth paying for.

The sex only last 5 minutes. He is a known drug user (weed, shrooms, alcohol, cigarettes, and occasionaly ecstasy, coke, and meth a couple times a year).

He is also an "escort."

I dont think it gets any more high risk than that; however, I do NOT know his HIV status.

He's 18, unmedicated bipolar-1, and sleeps around unprotected with all his "boyfriends" 100% of the time. He refuses to get tested. He claims he "knows he's HIV-negative" because he doesnt have sex with HIV-positive people.

Ironicaly, one of his ex-boyfriends whom he "dated" last year is now HIV-positive.

Dr. Bob, , I offered him $100 and a carton of cigarettes if he would let me drive him to get an HIV rapid test. He still refused. Was I out of line asking him to get tested? After all, it is MY life he put at risk.

The nerve of me?

The good news is I just completed my last dose of PEP. I was on a 30 day regimen of 1 pill of Epzicom, and 4 pills of Kaletra, taken once daily. It made me sick as a dog.

If living with HIV means feeling this sick from all the HIV meds, then I dont know if it's even worth getting tested.

Thank you Dr. Bob for your brilliant website. I made a donation.

Response from Dr. Frascino


Welcome back to the forum. First of all, I'm glad you took my advice, saw an HIV specialist, and had your PEP regimen adjusted. (See initial post below.)

While it is true that only the six-month post-PEP HIV-antibody test gives you a definitive "all clear," there are several reasons to recommend the interval tests at six weeks and three months post-PEP. First of all, the vast majority of folks who are HIV infected will develop detectable levels of anti-HIV antibodies in their blood within four to six weeks. Consequently, the six-week test will pick up most PEP failures. Three months is the standard window period that should pick up slow seroconverters (those that take a bit longer than six weeks). The three-month test is fairly definitive. However, the CDC recommends that anyone who has had a very significant HIV exposure get one additional confirmatory test at the six-month mark. (Anyone who needs a course of PEP would qualify.) If HIV infection can be caught in the seroconversion phase, there is some evidence that aggressive treatment with antiretrovirals could decrease HIV-related morbidity and mortality by preserving immune function and decreasing immune activation. All things considered, if financial concerns or "test stress" are significant factors for you, then the six-month test is unquestionably the most important (and definitive) test for you to take.

Regarding asking your escort to get tested, no, you definitely were not out of line. In fact, if he had accepted your generous and very reasonable offer (even though I disapprove of cigarettes intensely), you might have had a very significant effect on his future health.

Congratulations on completing your course of PEP. I agree with your HIV specialist: PEP was definitely warranted. It's a good thing for folks who think taking a course of PEP is no big deal to be reminded that these meds are no picnic. I've been shoveling them in for over a decade and the side effects can indeed by challenging. However, I should also mention that in the event you are HIV infected and need to start treatment, there would most likely be an effective combination antiretroviral regimen for you that would be better tolerated than Epzicom and Kaletra.

Thank you for your very kind donation to The Robert James Frascino AIDS Foundation ( It's warmly appreciated. In return I'm sending you my good-luck karma that your definitive post-PEP HIV tests confirm you are HIV free! Keep me posted.

Good luck.

Dr. Bob

Very concerned about PEP regimen Truvada & Epzicom Feb 3, 2010

Thank you Dr. Bob for your priceless website.

I had "receptive anal intercourse with ejaculation" with a promisuous 18-year-old drug user (and high school drop out) of unknown HIV status. I did bleed a little.

I know this is one of the most risky exposures, and I have beaten myself up over it ever since (to the tune of $1000 in prescription HIV "PEP" medication).

I'm freaking out that my HIV specialist might have made a big mistake with the PEP regimen he prescribed after I browsed Truvada's website.

Is it a "safe and effective" PEP therapy to use TRUVADA and EPZICOM together (as a regimen) for 28 days, even though the TRUVADA website says NOT to use EPZICOM with TRUVADA because both contain some of the SAME medication?

Isn't this a valid reason for me to be concerned, and FREAKING OUT?

I wanted the doctor to prescribe Atripla, but he said Atripla is *NOT* a good PEP medication because the virus is most likely resistant to Atripla.

Anyways, should I continue taking this PEP regimen of Truvada & Epzicom, or should I stop immediately?

He wanted to put me on this PEP regimen for 6 weeks, rather than 28 days, given the "nature and circumstances" of my exposure.

I'm taking a regimen of 4 pills of TRUVADA, combined with one pill of EPZICOM, every day.

That's 5 pills a day!

I have 16 days left. Hopefully my "partner" is HIV-negative, and all this anxiety is for nothing.

I will make sure to play safe from now on. Many thanks for your help Dr. Bob, and thanks again for your amazing website.

Response from Dr. Frascino


Assuming your "receptive anal intercourse with ejaculation" was unprotected, it is indeed the most risky sexual activity for potential HIV transmission. That there was bleeding increases the risk. PEP was certainly warranted. Hopefully it was begun shortly after the exposure. (PEP is most effective when started as soon as possible after an exposure. If more than 72 hours have lapsed since exposure, PEP is no longer recommended.)

Regarding your PEP regimen and duration of treatment, whether you should change or alter your regimen is open to some discussion. However, there is no doubt in my mind that you should consider changing to a more competent HIV specialist! The facts, as I see them, are:

1. A full course of PEP is 28 days. The "nature and circumstances" argument for extending the course of PEP is bizarre and not supported by any scientific evidence (or common sense!).

2. There was absolutely no reason to assume there would be resistance to Atripla from your exposure to someone of unknown HIV status. Again, no scientific evidence backs up this hypothesis and it, too, flunks the common-sense test.

3. Atripla would have been an excellent choice for PEP due to the convenience of one pill, once per day. Atripla can have side effects, but then again, so do most HIV medications.

4. Truvada and Epzicom are not the same medication. Both are combination products: Truvada is tenofovir plus emtricitabine; Epzicom is abacavir plus lamivudine. Although these are not the same medications, they are all in the same class of antiretrovirals: reverse transcriptase inhibitors. Generally speaking, we would use two reverse transcriptase inhibitor drugs plus one drug from another class of antiretrovirals (protease inhibitors or non-nucleoside reverse transcriptase inhibitors). Atripla, for example, has two nucleoside reverse transcriptase inhibitors (tenofovir plus emtricitabine) plus a non-nucleoside inhibitor (efavirenz). Some HIV specialist physicians recommend only a two-drug regimen for PEP. Truvada has been used for this purpose. However, for more significant exposures, often a three-drug regimen is recommended. I routinely recommend a three-drug regimen.

So what should you do now? Here are a few suggestions:

1. Establish care with a more reasonable and competent HIV physician specialist. (See below.)

2. If you are still in contact with the 18-year-old tweaker, perhaps you could convince him to get a rapid test. If he's negative, great! That means your only risk would be the remote possibility that he is in his "window period."

3. Consider discontinuing Epzicom in favor of Sustiva (efavirenz). Sustiva plus Truvada is the same as Atripla (even though you'll have to take them in separate pills rather than in the convenient three-in-one combination product.)

4. Take PEP for 28 days only. Then follow the post-PEP testing guidelines (six weeks, three months, six months).

Good luck.

Dr. Bob

just tested positive (CHOOSING AN HIV SPECIALIST 2010) Jan 25, 2010

iknow i got infected on jan 5th 2009,three weeks after that a had a throat infection.3-4 months after that i develop a lympnode in my neck,both side,arm pit,groin area.8- 9 months after that had a slight night sweat which goes on and off. till date after testing positive i have not done any test to see if i need medication. in how much danger am i putting myself

Response from Dr. Frascino


Without more sophisticated testing (CD4 cell count, HIV plasma viral load, etc.), it's impossible for me to ascertain how much damage has been done to your immune system. Close clinical monitoring and routine laboratory assessments are strongly recommended for all HIVers. What are you waiting for? I urge you to establish care with an HIV specialist physician without further delay. Your health and well being are at stake. See below.

Dr. Bob

HIV Positive and pregnant (CHOOSING AN HIV SPECIALIST 2009) Nov 2, 2009

I tested positive in 2006 and haven't gone for any check up's to check my cd4 count and now I'm pregnant and still afraid to go for a check up. My husband is also positive and we still have sex without a condom, what are the chances that our baby will be infected, when do i start taking medication to prevent my baby from being infected and is it safe to take arv's when you are pregnant because i hear you sometimes get sick when you take them for the very first time?

Response from Dr. Frascino


I find it terribly unfortunate and a bit sad that fear has prevented you from getting appropriate monitoring and treatment for your HIV disease. I hope you realize that by not getting the care you need, you are allowing the virus to replicate unchecked in your body and in turn slowly destroy your immune system. It is imperative that you establish care with an HIV specialist physician and HIV-knowledgeable obstetrician immediately. Certain antiretroviral medications can be taken during pregnancy and they significantly decrease the risk of mother-to-child HIV transmission. Without treatment, the chances your child will be HIV infected will be dramatically increased. Also, if you don't get appropriate care and treatment, the chances you'll be around to see your child grow up are slim to none. I can tell you if I had been too afraid to get treatment when I became HIV infected in January 1991, I wouldn't be here today to respond to your question.

I'll reprint some information below about finding an HIV specialist.

Good luck. Don't let fear keep you from getting the care you need!

Dr. Bob

Just found out... (CHOOSING AN HIV SPECIALIST) Sep 20, 2008

Well, doc, the feelings came and went and I got the nerve to test. It was positive... I don't know what to do now and I don't even know if I have long left cause of how bad I had the ARS and weight loss...

I want to live... I want to live a long happy life... I live in Texas, am I screwed? I'm a student in a grad school, so I'm poor, but what can I do? How do I move forward?

Response from Dr. Frascino


Only those of us who have been through it really understand the full impact of hearing the words "your test came back positive." Many of us feel scared, wondering if we will soon get sick or die. We fear that we will be shunned, lose our jobs or maybe our housing; that we won't be able to have children; that we'll never be able to date, get married or have sex again. None of these things are, in reality, true.

The virus found me while I was working over 17 years ago! Back then, the prognosis for HIVers was about 10 years max. We've made remarkable, in fact miraculous, improvements in treatment of HIV/AIDS, which have dramatically decreased both morbidity (illness) and mortality (death) as demonstrated by the fact I'm still here answering your question rather than pushing up daisies. It is true we do not have a cure, but for many of those lucky enough to have access to antiretrovirals and expert (or at least competent) HIV medical care, "virally-enhanced," healthy and fulfilling lives are truly attainable. Here in the U.S., even for those who don't have or can't afford private health insurance (this includes undocumented immigrants, by the way), it is possible to get quality HIV care and support in most areas of the country.

Now that you know you are HIV positive, I would recommend two simple first steps:

1. Consult an HIV specialist. She will be able to assess the severity of your HIV disease and also help you access the health care system based on your health insurance or lack thereof. To locate an HIV specialist in your area, check the American Academy of HIV Medicine's Web site at There you will find a roster of certified HIV specialists listed by locale. (I'll also print some information below from the archives that discusses choosing an HIV specialist.)

2. Get informed! Learn as much as you can about HIV and its treatments. This Web site is an excellent place to accomplish that. Begin by reviewing the information in the "Just Diagnosed" chapter that can be easily accessed on The Body's homepage under the Quick Links heading. Start with the articles found under the "Just Diagnosed Basics" subheading.

Finally, as far as living in Texas, well, yeah, that kinda sucks, but it really shouldn't impact negatively on your HIV disease.

Start learning more about HIV and get evaluated by an HIV specialist. I'm here if you need me. Let's get through this together, OK?

Dr. Bob

Need a Private doctor Aug 14, 2008

I am HIV Positive living in Seattle area. I currently don't have one and i am looking urgently in a private clinic? Do you know a good one? I asked this question earlier & was told about Peter Shalit who is fully booked until end of year. Please let me know if you have a good one in mind. Thank You.

Response from Dr. Frascino


I would suggest you consult the American Academy of HIV Medicine Web site ( There you will find a list of certified HIV specialists arranged by locale. There are a number of well-qualified HIV specialists in the Seattle area. Be sure you hook up with one that you trust and with whom you can easily communicate. Your health insurance plan may have some restrictions, so remember to check this out as well. I'll repost some information below from the archives pertaining to locating an HIV specialist.

Good luck.

Dr. Bob

Choosing an HIV Care Provider

July 18, 2007

Why Is Choosing an HIV Care Provider Important?

Treating HIV disease is very complicated. There are choices to consider at every stage of the disease. It's best if you and your health care provider work together as a team. That makes it easier to choose and stick to your treatment plan. "Care provider" means a doctor, a physician's assistant, or a nurse practitioner.

There are several issues you may want to consider in choosing an HIV care provider. You might decide to have them be your "regular doctor" for all of your health issues. You might use a different care provider for most health issues and use your HIV provider as a specialist. If your regular provider isn't an HIV specialist, be sure they regularly get expert advice on HIV issues.

Training and Experience

Many people with HIV/AIDS get their care from physicians who are specialists in infectious diseases. However, especially now that people are living longer with HIV, it's important to deal with all of your health issues. You might prefer to have a family practitioner or a specialist in internal medicine as your primary physician.

No matter what their specialty, you will get better HIV care from providers who have experience treating people at all stages of HIV disease. Be sure to ask how many patients with HIV they have treated, and how many they currently see. HIV patients do better when their physicians have more experience treating HIV disease.

Do You Have Similar Ideas About Treating HIV?

Some providers are conservative. They prefer "tried and true" methods. Others are more aggressive. They are willing to try new and experimental treatments. Some are optimistic by nature, and focus on the hopeful or positive side when they talk about test results or future prospects. Others are more realistic. Some are pessimistic.

Some providers are comfortable suggesting "complementary and alternative" therapies such as massage, acupuncture, or herbs. Others stick strictly to Western medicine.

If you want a lot of emotional support, you probably won't be comfortable with a health care provider who only talks about test results. The more comfortable you are with their approach to HIV treatments, the easier it will be for you to get the kind of health care you want. Talk to providers and their patients before you make your choice.

The Provider-Patient Relationship

Many patients do better when they take an active role in planning their own health care. These patients do a lot of reading on their own, and bring information to their providers. They work together to make health care decisions.

Other patients are more comfortable with the provider making important decisions. Decide how you want to work with your provider. See if that fits with the way the provider likes to work with patients.

Help Your Provider Help You

Make sure that your provider has all the information needed to give the best advice about your treatment. This starts with your medical records, which may have to be transferred from another office. When you start working with a new provider, they will probably do a lot of tests to collect "baseline" information. This helps you see how well you're doing as time goes by.

Be sure your provider knows how you feel about using medications, and about your illness. Some people don't mind taking a lot of pills. Other people would rather take as few as possible. Are you willing to change your diet, or the amnount of exercise you do? Your provider should also know about other treatments you are using or want to try, including non-medical ones.

Be honest about your lifestyle. Your eating, sleeping, and work patterns can make a difference for your health care. So can your sexual practices and use of recreational drugs. If your provider seems too judgmental, try to change providers. It's better to have a provider who really knows you instead of holding back information.

Let your provider know about the important people in your life: the people who will support you if you get sick, or will help you make important medical decisions.


The best care provider won't do you any good if you can't get in to see them. Ask them (or their receptionist) how long it usually takes to get an appointment. Find out how well they usually stay on schedule during the day.

The type of insurance you have could limit your choice of a provider. Maybe the provider isn't on the list for your health maintenance organization (HMO) or insurance plan. Be sure to find out how you will be able to pay for their services.

Remember, you don't need an HIV specialist to help you with most of your health care needs. If a good HIV provider is hard to find, or if it's hard to get an appointment, use a non-HIV care provider for your general health care. Just be sure that when you are dealing with HIV issues, you see an experienced HIV provider, or one who consults with an expert in HIV.


Some people are very concerned about keeping their HIV status private. You might choose to get your HIV care from a provider in another town to protect your privacy. You will need to find your own balance between confidentiality and convenience.

Changing Providers

Your health care needs might change as time goes by. Also, your ideas about treatment could change. Although you will probably get better medical care from a provider who has known you for a long time, you always have the right to stop seeing one provider and change to another.

To Find a Health Care Provider ...

You can get help finding a care provider from your case manager or from your local Department of Health. You can also ask other people living with HIV. The American Academy of HIV Medicine has a web page to help you find a doctor at com_comprofiler&task=usersList.

The Bottom Line

HIV medical care is very complicated, and changes quickly. This makes it important to find an HIV care provider who works with HIV/AIDS patients and is committed to staying up to date. Your relationship with an HIV provider will be better if you are comfortable with each other's personal style and approach to dealing with health issues in general, and HIV in particular.

Can you get HIV as your first STD
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