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Re: Is this ARS or something else...Please help...I want to donate
Nov 27, 2010

Dr. Bob, thank you so very much for your good luck karma!! It seems like your karma has really worked. I got a DNA PCR test at day 34 and I just got the result that its negative! Two negative PCR tests at day 17 and day 34. One ve antibody test at day 28. 1) Should I whoo-hoo yet or wait for another test at 3 months?

My CD4/CD8 ratio was 690/357 = 1.9 on day 17 (based on the viral load report). The DNA PCR does not report the CD4/CD8 ratio, but says that low lymphocyte counts could result in false negative results. 2) Do you know what the threshold lymphocyte level is below which false negatives could occur? 3) Is it likely/possible that my lymphocyte levels drop that significantly from day 17 to 34 to cause a false negative DNA PCR report?

This experience has really changed my life and now I want to donate $500 to your organization once I get a conclusive result. Please don't think of this as a bribe to get your attention. You are a real hero for me After this experience, I really want to restructure my life and help out people who are not as lucky as many of us are. And secondly, I would like to get your autograph if I ever get a chance to meet you!

Kudos Dr. Bob!

Regards, Andy.

Response from Dr. Frascino

Hi Andy,

Glad to hear my good-luck karma is still performing well and batting 1000.

Responding to your specific questions:

1. As I mentioned last time, your HIV-acquisition risk is so extremely remote that it's essentially negligible. The need for any HIV testing is questionable at best. Your undetectable 17-day HIV RNA PCR, negative 28-day ELISA and undetectable qualitative HIV DNA PCR at day 34 would certainly strongly suggest you are not HIV infected (as would be expected). Regarding the WOO-HOO, well, that depends on if you want a formal FDA guidelines-approved definitive result. If so, you would need to repeat your HIV-antibody test at the three-month mark, as HIV-antibody tests taken before the three-month mark are not considered conclusive and HIV DNA PCR is not FDA approved for routine HIV-diagnostic testing. I have absolutely no doubt whatsoever that your three-month test will be negative.

2. Your concerns about low lymphocyte counts affecting your HIV DNA PCR result are unwarranted. That warning applies to a very specific and quite severe condition of severely depressed lymphocytes. It certainly does not apply to you!

Thank you for your pledge to support The Robert James Frascino AIDS Foundation (www.concertedeffort.org). Your generous gift would touch many lives in desperate need. On behalf of those lives, please accept my heartfelt thanks. In return I'm sending an extra dose of my good-luck/good-health karma that you are now and will forever be HIV free!

Good luck. Happy Thanksgiving Leftovers Day.

Dr. Bob

Is this ARS or something else...Please help...I want to donate Nov 26, 2010

Dear Dr. Bob.

Firstly, my sincere thanks to you for years of dedicated service helping HIV+ people and so many scared people like me in understanding the risks and symptoms of HIV. I am re-posting this email because I did not receive an answer from you the last time with a promise to donate $100 to your foundation. I have been reading a lot on this forum and you guys have really helped me calm my nerves. Please help me diagnose my symptoms and understand my risk. Im a 29 year old married male and 6 weeks ago I had a low risk exposure at a strip club in PA. My big mistake: I went to the pvt.room and got an unprotected handjob from a stripper. There was only ONE instance when the stripper spat on her hand and used the saliva for lubrication. I did not see any visible strains of blood on my penis after the encounter, however, as the room was pretty dark (and especially after considering my symptoms), I am scared to imagine if there was really some blood in there. Also, I am uncircumcised, and after the encounter, I noticed a couple of very minor abrasions on the my penis head (due to rubbing against underwear). But again did not see any blood or anything. Historically, I have been a healthy individual, and may have been to the doctor only 2-3 times in the last 4-5 years. Here's a timeline of my symptoms after the exposure: days 9 - 12 Mild Sore throat days 14 - 15 - Diarrhea (1-2 times a day) days 15 - 24 - Loose bowels (semi-soft stools which disintegrate after being in the bowl for about 5 mins) day 27 - Unexplained bruise under my arm (could be from stretching) days 27 - 32 Reoccurrence of the Sore throat Not much phlegm or coughing, but this time with an ulcer on the back of my throat. I read that the throat ulcer is a textbook symptom of PHI, and all the symptoms combined, are really scaring me to death. Also, noticed low grade fever 99.3 couple of times. I dont know what else could cause an ulcerated sore throat and other symptoms given above. Also, I have had moderate weakness in the legs over the entire the period (days 9 32). Recently, Im feeling weakness in the arms. Although, I am able to perform all my daily activities like going to work etc. I find it difficult to walk fast for long periods or run, go to gym etc. My Tests so far: Day 5: Std Panel (HSV-2, gorronhea, etc.) - negative at day 5. Haven't yet tested for Mono. Day 17: HIV RNA PCR test - negative. Day 28: Elisa antibody test negative. Based on the symptoms, I cant help but believe that I am one of those rare cases of HIV transmission by non-typical means. I am in stress and tears almost every day. My wife is tired of convincing me that I dont have HIV. I would really appreciate some independent honest advice on how my symptoms could be that similar to HIV and fall in the same time frame, and yet, could be something else. I know you generally dont recommend PCR tests for diagnostic purpose. But specifically in my case (considering the symptoms), can you advice how much should I believe the combination of negative 17 day PCR test and 28day Elisa. Dr. Bob please, please please help me!!! I am dying of anxiety.

Response from Dr. Frascino

Hello,

Your HIV-acquisition risk is negligible at best. Your symptoms are not worrisome for HIV acute retroviral syndrome (ARS). Your undetectable 17-day HIV RNA PCR and negative 28-day ELISA are encouraging, but not yet definitive.

Most of your symptoms could be related to anxiety.

You may "believe" you are "one of those rare cases of HIV transmission by non-typical means"; however, I'm quite confident that is not the case.

I suggest you seek counseling (psychotherapy) to help you cope with your anxiety and irrational HIV fears. Anti-anxiety medication may also be beneficial during the window period as you await your conclusive test results.

Get a single HIV-antibody test at the three-month mark. The result will undoubtedly be negative.

Thank you for your support of The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's warmly appreciated. In return I'm sending my good-luck karma that your definitive three-month HIV-antibody test remains negative. I'm very confident it will.

Good luck.

Dr. Bob



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