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Re: need advice and importantly your karma(please) - will donate
Jan 27, 2011

Dear Dr. Bob,

Thanks for your reply again. I have duly (and happily) donated to the The Robert James Frascino AIDS Foundation. As promised, I hope to be able to make a generous donation at the 3 month stage too.

I got the results. My lymphocytes were slightly higher 48 (reference range 20 - 45), but I guess than is because of my sore throat etc. My eosinophils were slightly higher at 7 (1-6). Other than that, my peripheral smear, VDRL, Gram stain of throat swab, urine examination, urine culture, throat swab culture were all good. my hsv 2 igg was at 0.42 and hsv 2 igm at 0.36 (below the 0.9 value)

1. My HIV Elisa was negative at 0.26 (<0.90 U/ml). Is that totally inconclusive, given that was at the 3 week stage? Or is it a good sign for the 3 month test? Any comments on a 0.29 no. at a 3 week stage - any indications?

2. given that I had several symptoms in the week preceding the test (discussed earlier), am i right in assuming that those specifically were not linked to HIV. (and that future symptoms may/ may not be linked but at least the ones at the 2 week stage were definitely not linked to HIV?)

3. do i need to take a second test before/after the 3 month stage? or just at the 3 month stage?

4. how relaxed\happy should i really be? i dont want to get my hopes up and then see it dashed 2 months hence.

I have also shared my guilt about the incident with someone. It was extremely tough and embarrassing. But now I atleast have someone to calm me if i get over-anxious.

Thanks for your patience. You are truly a hero.

Response from Dr. Frascino

Hi,

1. Any negative HIV test can be considered encouraging, but tests taken prior to the three-month mark are not considered conclusive or definitive. Regarding your test result, anything less than the cutoff value of 0.90 u/ml is negative. How much less than 0.90 has no clinical significance. Negative is negative!

2. No. You cannot make that assumption based only on an inconclusive three-week negative HIV-antibody test.

3. A test at the three-month mark is all that is warranted.

4. As mentioned previously, your HIV-acquisition risk is exceedingly low. Your level of anxiety is not proportional to your level of actual risk. Psychotherapy to help you deal with your anxiety and irrational fear of HIV would be very helpful.

Dr. Bob

Re: need advice and importantly your karma(please) - will donate Jan 24, 2011

Dear Dr. Bob,

thanks for your reply. i wish i could be writing that it calmed my fears, but as things have gone i am more anxious. in continuation to the earlier mail, i now have a few 1(1-2) papule(i guess) like itchy red dots on different parts of my body - thigh, leg, stomach, shoulder back, arm etc. they are not over a large area just 1-2 at these locations. in addition, i didnt feel hungry at supper yesterday and ended up eating when i got up in the middle.

i am more scared than ever. it seems like the writing's on the wall.

1. i know symptoms are not the best way to look at it. but what else could connect all these symptoms. i have basically hit all of them except for swollen lymph nodes - but there is still time =(

2. could i be the person that accounts for as per wikipedia the 0.5 chance per 10000 cases of a man being fellated with an HIV+ person OR the 5/38*0.15 chance per 10000 cases for insertive vaginal intercourse with an HIV+ female? that is very unlucky.

3. i have gotten cbc, gram stain, hsv, elisa, peripheral smear, throat swab culture, urine culture, urine routine examination, vdrl. do you think anything else can give an idea of my hiv status at present. i know we need the 3 month test for confirmation.

4. as per my research, i understand that other stds you mentioned are largely curable or kept under control and its hiv that is the most dangerous - in the sense that it can lead to aids over time and comes with serious lifestyle changes. is that right?

managing the worst case scenario. 5. should the test results hint/confirm at hiv+ (which i hope and pray it does not) - would you advise starting on an anti-retroviral therapy straight away?

6. i understand you can make out a person with aids (lesions etc) but can you make out an hiv+ person who is on anti-retroviral therapy.

7. i have lost the joy in my life. even the few times i am happy i remind myself how bad it could be in the future if the tests... i feel i might lose my motivations for all my life-goals (and there were quite a few). i mean getting hiv+ at such a young age. that too so cruelly. i would probably just take out a laid back job and just count out the years..i know its not a question.

anyways, i promise to send a generous donation if i do turn out to be hiv negative (without any std which requires major lifestyle change). its been a life-changing experience alrady. i will never do such activities no matter what the hiv statistics say. if only i could be spared this time.

thanks for your time - i know its long. i really appreciate your help. i may require further counselling. please bear with me.

p.s. - i tried sending you the donation. does a payment made through paypal mention concertedeffort.org on my credit card statement. in which case i'll need a day or two to figure out a clandestine mode of money transfer. i just wish that doesn't impact the karma and affects my test results tomorrow adversely. maybe i'll ask some friend to transfer funds. but i'll do it before the test results. don't want no more risk.

Re: need advice and importantly your karma(please) - will donate (Submitted Jan 23, 2011)

also forgot to mention, my stool is blackish. and on an unrelated note - i have pain in my coccyx (not sure whether it is autoimmune). if it helps you in connecting all the symptoms to a different disease.

Response from Dr. Frascino

Hello,

As mentioned previously, your HIV risk is exceedingly low. Your problem is anxiety and fear of HIV leading to depression ("I have lost the joy in my life . . ."). I would recommend you seek counseling (psychotherapy) to help with your anxiety and depression while you await your definitive three-month HIV test. The odds you are HIV negative remain astronomically in your favor.

Regarding donations to The Robert James Frascino AIDS Foundation, the PayPal or credit card statement will list the name of the foundation. (How else would anyone be able to keep track of their transactions?) If you wish to send an anonymous gift, you could send a cashier's check or cash. An extra dose of good-luck karma is being sent your way (even though I strongly doubt you need it!).

Good luck. Be well.

Dr. Bob

need advice and importantly your karma(please) - will donate Jan 23, 2011

dear dr. bob,

huge fan. appreciate your work and effort. will keep it objective so that i dont take up much time. please read through.

t minus 3 weeks: had protected vaginal and unprotected oral intercourse with a csw in thailand. she looked healthy except she had chapped lips - which she was peeling off for some reason. didnt force her. should have noticed alarm bells ringing =(. there was also naked rubbing involved (precum). i nearly put the condom inside out in the dark but realised and put it correctly before inserting. [should have used a new condom =( ]. both had shower before. woman on top and missionary.

went back home - winters.

t minus 1 week: sore throat sets alarm bells ringing. and slight neck pain (went in 2-3 days). slight headache (almost light-headed). feel more sleepy than usual.

t minus 5 days: sore throat and headache (empty head) continues/re-occurred. lower back pain. neck pain. weakness. 1 small ulcer inner cheek appears and clears up.

yesterday: sore throat, mild headache, lower back pain, weakness continue. 2 more ulcers appear inner lip and cheek and are clearing up again. notice 3-4 tiny mini-zit (dry, white) on thigh. cant notice if rash or not with the hair. thigh seems rough (not sure it was like this before).

visit doctor (MD + some fellowship). scares the shit out of me. orders all tests. tells me has a kid of my age (22) and how we take things for granted. even tells me kissing put me at risk (what BS!!). dont know whether i should show him the test results or not. atleast confirmed no swollen lymph node. yet.

today: everything continues as yesterday. plus a single folliculitis on thigh. also felt nauseous on 3-4 occasions in the last week.

will be getting all my test results. know its too early for hiv. will do that in 3 months (?)

scared as hell. it was so not worth this. i had so many things to do in life (have). cant believe i may have screwed it all. feeling super guilty in front of my parents and friends. cant imagine what will i do if tests come out negative. been the worst month of my life. didnt imagine myself saying that. from a positive guy have become totally pessimistic. cant seem to convince myself that i should have low risk, right.

please please please send some good karma my way. please

now for the questions: 1. what are my risks for std (esp hiv)?

2. what are the odds these symptoms are related to that? please be honest and as blunt as can be.

3. let us assume worst case there was a small hole in the condom. what would you answer to 1 and 2?

4. if there was some minor ulcer at t minus 3 weeks incident. what would your answer be to 1 and 2?

sorry for the long reply. i hope you understand. will make my humble donation to your foundation on concertedeffort.com

thank you so much. please answer. please remember to send good karma. could use every drop of it.

will my remaining 9 weeks be like this. please no!

Response from Dr. Frascino

Hello,

1. Unprotected insertive oral carries only a very slight risk for acquiring HIV. Other STDs can be much more readily transmitted via unprotected oral sex -- gonorrhea, syphilis, herpes, chlamydia, non-gonococcal urethritis (NGU), etc. Your doctor will have screened for the most common STDs.

2. Extremely unlikely. (By the way, I'm always honest!)

3. Condoms don't have small holes.

4. Unchanged.

Take a read through the archives of this forum. You will find many testimonials and stories similar to yours. You should find this information both enlightening and reassuring.

Thanks for your support of The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's warmly appreciated. In return (and as requested), I'm sending my good-luck karma that your definitive three-month HIV-antibody test is negative.

Good luck.

Dr. Bob



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