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Apr 16, 2011

Doctor Bob,

I wrote to you while you were on vacation. (I trust you had a great time...I'm jealous) The letter was titled, "Scared of what's to come 2". This was a follow up to a letter I wrote you a month or so ago titled, "Scared of what's to come....help". I did donate to your very worthwhile foundation both times. You have not replied to my follow up letter yet probably because you just got back from vacation. I am asking you to please review and reply to my letter, I need your help badly. The latest now is that I am having dull aches in my kidneys and also sharp pain on the right side that comes and goes. My doc did a urinalysis and it came up positive for a bunch of things, such as protein, nitrates, bacteria to name a few. He wants me to come back to get a test where my urine is collected over a period of time. Doc, please look at my last email and let me know what you think. With everything that's happened to me, how could this not be HIV? Oh and by the way I am writing you on my iPhone so I noticed on my last letter I made a few typos that made the beginning of my letter sound strange. Such as I called people sacred (lol) but I meant to say was scared. Makes more sense. Anyway please help me doc. I am still having major issues 5 months past my exposure. God Bless you for you work and your help.

Scared of what's to come....part 2

Doctor Bob,

I heard you were on vacation recently.... I hope you had a wonderful time! Of course I will be submitting a donation to your foundation. The service you provide is powerful. There are so many desperate, sacred, hurting individuals in need. I have always been blessed in my life until I got cocky and didn't appreciate what I had and my actions have put my family in jeapordy. Now, I am the scared, desperate one and I understand what it's like to be hurting. In a way that I never thought possible. You help in giving people someone to talk to and answers in extremely difficult times. Thank you for what you do.

I wrote you over a month ago and you have me filed under your positive I'm positive category in you archives. Here is the link so you can review it. http://www.thebody.com/Forums/AIDS/SafeSex/Q213418.html Unfortunately, my thoughts haven't changed. I wanted to give you an update and ask for your help.

To recap from my last email. I went to the Philipinnes 11/12-13 2010. I had protected vaginal sex 3 separate times with the same female sex worker. Although unprotected oral sex one time for about 20 seconds (her performing fellatio). Lots of deep kissing. When I returned from my trip it's been non stop with health issues. Day three- horrible diarrhea for a week then constipation for a week and abdominal cramping for weeks after. Week 4, 5, 6 elevated liver enzymes (20x the normal) protein and blood in urine. High LD readings (747) Extreme fatigue. 10 pound weight loss (muscle) that I can't seem to recover. Aches in my lower back in my kidney areas. Week 7 and 8 to present- strange white patchy skin mouth ulcers on inside of cheeks and rashes all over my back. Small rash on face under eye. Bright red flat spots appear and disappear within a week of appearing (different than rash on back). I've even had one that randomly started bleeding on my face. Week 9 to present- Continual burning skin on entire upper back and on arms. Burning tongue and random general strange skin problems and sensations. Hands and feet go numb while sleeping and wake me up. Week 17 to present- Dull pain in both of sides of my hips. When I start brushing my teeth my gums bleed!

Now let me tell you what I've done. I'll leave out some of the tests because the doctor has run many multiple STD, CBC, liver tests, and micro organism type tests. Also had my back sores biopsied which the dermatologist said it was possibly pityriasis rosea in her opinion. Ok so here it goes,...several Hepatitis C tests and D and E antibody tests. (inoculated for A and B) tests including a Hep C RNA test. HIV 1/2 antibody blood tests at weeks 8.5, 12.85, and 17.5. A bDNA test at week 13. Oraquick advanced oral swab week 14. I had a PCR test at 9.5 and one at 18.85 weeks. All negative or (below the detectable amount which was 50 copies on the last PCR) Also one T cell test to see if they appeared unusual which the doctor said there is no inversion in the ratio as of yet. The most recent urine test does flag for elevated protein in my urine. Doc, I've been healthy man my whole life. Never experienced problems like this before. I am starting to get frustrated when people say stress. Stress doesn't cause elevated liver enzymes 20x their normal levels. I have served in the military in extremely stressful training, been to combat where I thought I would never see my home or family again, I've been to two very stressful law enforcement academies and have had a strenuous career. I have never manifested symptoms of stress. Never. I am a professional, (debatably) intelligent, intuitive, married father of two. Being that I'm in law enforcement I am very keen on observation. I am not crazy, a hypochondriac or making up this for whatever reason. In fact I wouldn't wish my circumstances on anyone.

Now the worse of the whole thing is my kids. I mentioned this in my first email. I know this is enough for you and my doctor to tune out but please hear me out. I am telling you that there is a problem! When I was feeling sick with a this I took time off from work and was home around my kids in January. I specifically recall this event. I want to remind you of the blood found in my urine. My daughter has bad eczema on her hands, wrists. Lots of breaks in her skin. I had urinated into the toilet standing up without lifting the seat. I noticed splatter on seat but did not do a even passable job of wiping the seat like I should have. My daughter age 7 is small. She went in like 30 seconds after me leaving the bathroom to use the toilet. She uses her hands to get herself up on seat, direct contact with toilet seat and her hands. I had yelled at her for something and she put her hands on her face near her mouth and then wiped her eyes with her hands. I wanted to yank her off seat and wash her hands and sterilize the seat but I didn't because I didn't want my wife thinking I was over reacting. Then I didn't supervise her to make sure she did a good job of washing her hands she kept putting her hands near her mouth and face afterwards. Biggest mistake of my life. Two to three weeks later she had diarrhea (looked like mine in toilet when I had the diarrhea), intermittent fever, swollen lymphnodes in neck and looked like she got run over by a truck. Pain in her left abdominal area. Exhaustion. Red spots all over tongue. Swollen redness around her eyes. Her lymph node right under jawline in front of ear lobe remained large and I bet still is there but I'm afraid to feel for it. Weight loss as well. Sore throat. Dry unproductive cough. She used to have perfect facial skin now there is red blotches under skin all over cheeks and they are turning in to discoloration. While she was like this she was at her best friends house with my son. She is a full of life hard to put down girl and will play even through being sick. I went over there and they had fruit drinks with the straws in it all around table. My son, my daughter's friend and my daughter's 45 year old mother drank after my daughter! I was giving them all lecture about it but it was too late. Guess what? All of them came down with same thing within two weeks. The mother said it was the worst flu she ever had. I took my kids in to see the pediatrician and she said it was a virus but tested them both for strepp which was negative. My son and daughter haven't been the same since this incident. Both were bright beautiful clear complected thriving kids. Now, swollen eyed, sullen looking, strange skin issues, rash on faces and my son has a weird skin rash all over body. Like chicken skin. They both have unproductive coughs that haven't cleared up. Now my son is complaining of an ache in his lower left back. Kidney? He is saying his feet are falling asleep as well just like I am experiencing.

Doc, what the heck am I supposed to do here? I'd take my kids back to Doctor but I had them in during their worst and all I got was they are fighting a virus. I have been focusing on diagnosing what's wrong with me first because I am telling you that they have whatever I have. A=B=C! I have never seen them like this and I have been there for flu, stomach bugs and everything else through the years. They are different. They are approaching the time frame when I started to really get funky nerve and rash issues. I watching them carefully. It's been two months for them roughly. Flu effects don't last that long! With blood in my urine, and the cuts on her hands, then a super high viral load in her saliva am I crazy here or is it possible? Possible that I spread a hard to diagnose HIV infection to my daughter and then my daughter to my son, her friend and mother?

I feel alone and my and my children's only advocate. My wife is clueless and thinks I'm crazy and wants me to stop with all this. My doctors admit I have been fighting a Virus but don't know where else to go. Doc, all I know is I had sex with a sex worker and this has transpired. What else could this be other than HIV? I have heard concerning my situation that the strain in Asia is possibly a very virulent variant (CRF01_AE) and it seems to be spreading easier through heterosexual mucosal routes and maybe I wasn't as careful with the condoms as I thought.

What do you think of all this? I know this a is alot to digest but my issues and my observations of my children are dead on. Obviously I am really frightened, but wouldn't you be? Help me figure this out. Please. I feel that I can't just let this go and discover that all my theories are correct but my kids get sick and die in 5 years because I couldn't get a diagnosis for them and myself. This is a nightmare.

Is it likely that my body just has not produced antibodies yet with all my crazy symptoms and it's only a matter of time? I have been tested out to over 4 months with the antibody tests and have had three specific tests looking for the virus. Should I be anticipating a 6 month positive antibody test?

Is it possible that I have contracted a strain that is not showing up because it is a unusual type like O, or N or the strain I mentioned CRF01_AE? Perhaps HIV type 2? The PCR and bDNA tests I have had look for the major types of HIV 1 correct? Remember my exposure was in the Philippines.

I am beside myself with the differences in my children since they got sick. I am lost and scared Doctor Bob. I need your very educated opinion on what you think the outcome is here and what I should do. Thank you very much.

Scared of what's to come........HELP! Feb 3, 2011

Thank you for your time sir. I have run out of hope due to my symptoms and I feel as though I am infected. I dont know what to do and feel so alone. I am afraid for my children and my life. I apologize for the length of this post but I have to give you everything to hear what you think. Please help me! I have donated to your foundation through your website. You are an amazing accomplished man. I went to Manila in the Phillipeans 11/12-13 for a work trip. While I was there I had sexual relations with a sex worker. I met her in one of the establishments set up for that kind of thing. Supposedly the girls that work in these clubs have to go through weekly STD tests, but who knows if that is true. This is one of the biggest well known clubs in town. The first night I had protected sex with her. The one part that worries me is she took my penis into her mouth for not more than 30 seconds without a condom on, and there was no ejaculation on my part. Protected vaginal sex followed right after, and I am positive the condom did not break. I did kiss her deeply throughout the encounter. The next morning, the same thing. No oral sex. Just protected vaginal sex with deep kissing. Once again condom was intact. The next night I had the same girl. Protected sex, deep kissing, condom intact. She was grinding into me fairly hard pelvic area to pelvic area and was quite rough on my shaft, enough to where I was very sore in that area for a few days. Once I may have accidentally brushed the outside tip of my penis with the removal of the condom with the outside portion of the condom. I had diarrhea starting about 3 days after I returned from the trip. It was ongoing for 5 days then turned into almost constipation for a week. My doctor had a liver test done when I went to see him on 11/22/10 due to my trip to the Philippeans and my bad diarrhea and stomach abdomen pain. My readings were- ALT 44 AST 27 Which were normal but the incident that I was concerned with happened on 11/12/10 so it was fairly early still. After this I went on with life and had did not dwell on anything thinking I must of just had a stomach bug. I still had a little abdominal discomfort. On the 17th of December I had to have a blood draw from my employer for a biannual physical and I received a call from them because they were concerned with my liver readings which were- ALT-163 AST- 470 Also my LD reading was in the 700s and I had high protein and blood in my urine. Now I was freaking out. I went back my doctor and he did a full liver and hepatitis panel. The blood draw was on the 12/20/10 which was 39 days after the incident. Roughly 5.5 weeks after the incident. The results were- ALT 131 AST 80 He also did a Hepatitis panel and the results were- Hep A IgM, EIA Non-Reactive Non-Reactive- Hep B surface AG, EIA Non-Reactive Non-Reactive- HEPATITIS C VIRUS AB, EIA QL Non-Reactive Non-Reactive- Hep B core IgM, EIA Non-Reactive Non-Reactive- The next week (week 6) he did another CBC and liver function panel and the readings were about back to normal. During this time. Week 4 through week 7 my urine smelled, I had stomach pain around my belly button area and I was extremely tired. I felt like I was hit by a mack truck. I convinced my doctor to do a RNA Hep C test which came back negative. (I am immunized against Hep A and B). My doctor seemed to be fine with this and stated that I must of caught an unknown virus but everything seemed to be normalizing. Continuing on around week 7 I began to lose weight. I have lost 10 pounds. I developed a rash on my back which was in a small area on my back near my armpit consisting of a raised flat half inch lesion with smaller dots around it. I went to see my doctor again and he said it was too localized and in his opinion, and not an ars rash and was not suspicious. Week 8.5 I had an ELISA antibody test completed for HIV 1 and 2 which came back negative. Week 9.5 I had a PCR RNA HIV 1 test completed which also came back negative. This was done through Lab Corp. Around this time my mouth developed white patchy flaky loose skin on the inside of my cheeks for about 3 or 4 days. Then it settled into a white raised line that stretches across the entire length of the inside of both of my cheeks. My breath is bad and my mouth is still healed yet . I once again went to my doctor and he did a visual inspection and said in his opinion it was not thrush. I also had my dentist look and she said it was not thrush. My mouth has never done this in my whole life. I feel like what else can it be then? The doctor never did a culture of it. I feel that it is just a mild case therefore not alarming my doctor. It was only bad before I could get in into see the doctor. Also I forgot to mention that my stools and frequency of my stools have never returned to normal after my diarrhea. Week 10 through 11, my skin on my upper back is constantly feeling like it is burning and I have a few red pimple like raised lesions on my back in addition to the original rash that has never gone away. You can still see it albeit a little lighter. It doesnt itch but more burns. I have been woken up at night with my arms and hands going completely numb. I cannot gain my weight back and my appetite is better than it was. I notice now my arms seem to have a numbness even when I am awake sometimes now. I feel very weak. Doctor help me!! I am getting another HIV ELISA 1 and 2 test done in another week and I have never been more scared of anything in my life. My body has reacted since the incident with that woman and I have always been healthy my whole life. I know that my body is different, I can feel it. To top it all off after thinking about things that she had said, I believe that she probably was HIV positive. Question 1. Based on everything I have told you is there no hope for me? I am convinced that I am infected because my body is freaking out and I have never felt so physically messed up. Question 2. My doctor says that symptoms dont show up in a linear fashion like mine, but how else can all of my symptoms, high liver readings and everything else not be a complete totality of circumstances? Everything fits in the Acute ARS time frame, and my symptoms all from what I have read are all acute symptoms. Question 3. What do you make of my ELISA test at 8.5 and my RNA HIV1 test? Is there hope? It seems strange that the RNA test didnt pick up the virus. Could I be looking at HIV2? Question 4. I am afraid for my 7 year old daughter and 9 year old son. My daughter may have come in contact with small urine splatter (im sick thinking about it) on the toilet seat right after me and she has exzema and has open breaks in her skin on her hands and wrists. She uses her hands to get up on seat! She was upset and had her hands near her mouth and wiped her eye because she was crying because I had yelled at her for something. I noticed that she has had a quick bout of diarrhea, sore throat, and lymph node swelling recently. My boy had swollen lymph nodes as well. I know that there has been some sickness at their school and in my neighborhood but I cant shake the feeling that I may have done this! Plus I put Neosporin on her wrists sometimes and before I realized that I may have been sick we were sharing the same tube of Neosporin that I was using to treat a a weird dry breakage in my skin on my finger (no blood). I am freaking out!!!!!!!!! Are they at risk Doctor? Thank you for your time I dont know how I can find the strength and will to get through this. I feel as though I may have ruined my families lives forever. My joy and zest for life has been extinguished..help meplease!

Response from Dr. Frascino

Hello,

Feeling as though you are HIV infected and actually being HIV infected are two completely different things! Your HIV-acquisition risk (30 seconds of unprotected insertive oral and several bouts of protected vaginal sex) is negligible, assuming the latex condoms were used properly and didn't fail (break). Although over the Internet I cannot diagnose the exact cause of your transient elevation in your liver transaminases and the blood in your urine, I can advise you these are not common symptoms associated with HIV acute retroviral syndrome (ARS).

Your negative 8.5-week ELISA and undetectable HIV PCR RNA at 9.5 weeks are extremely encouraging. I very strongly anticipate your definitive HIV-antibody test at three months will also be negative.

Regarding your specific questions:

1. On the contrary, I think there is every hope for you! I don't think your body is freaking out nearly as much as your mind! ("I have never been more scared of anything in my life.") You are basically "worried sick!" (Your anxiety is making you ill and that's why you feel "so physically messed up.")

2. As both I and your doctor have advised, your symptoms and the timeline are not consistent with HIV. You may feel "everything fits in the acute ARS time frame," but in reality that just isn't the case.

3. Not only is there hope, but I have every confidence that you are HIV negative. There really isn't anything at all strange about your undetectable HIV PCR RNA at 9.5 weeks, considering your negligible HIV-acquisition risk! In fact we would have anticipated it would be undetectable. As for HIV-2, it is endemic in West Africa; you were in the Philippines!

4. Your fears regarding your daughter and son are completely unwarranted and quite irrational. They again suggest you are suffering from anxiety, guilt, depression and completely irrational fears about HIV. ("My joy and zest for life has been extinguished. . . .") I would advise you seek psychotherapy (counseling) to help you confront your irrational HIV fears. You may also need help managing your depression and anxiety.

Good luck.

Dr. Bob

Scared of what's to come....part 2 (Submitted Apr 4, 2011)

Doctor Bob,

I heard you were on vacation recently.... I hope you had a wonderful time! Of course I will be submitting a donation to your foundation. The service you provide is powerful. There are so many desperate, sacred, hurting individuals in need. I have always been blessed in my life until I got cocky and didn't appreciate what I had and my actions have put my family in jeapordy. Now, I am the scared, desperate one and I understand what it's like to be hurting. In a way that I never thought possible. You help in giving people someone to talk to and answers in extremely difficult times. Thank you for what you do.

I wrote you over a month ago and you have me filed under your positive I'm positive category in you archives. Here is the link so you can review it. http://www.thebody.com/Forums/AIDS/SafeSex/Q213418.html Unfortunately, my thoughts haven't changed. I wanted to give you an update and ask for your help.

To recap from my last email. I went to the Philipinnes 11/12-13 2010. I had protected vaginal sex 3 separate times with the same female sex worker. Although unprotected oral sex one time for about 20 seconds (her performing fellatio). Lots of deep kissing. When I returned from my trip it's been non stop with health issues. Day three- horrible diarrhea for a week then constipation for a week and abdominal cramping for weeks after. Week 4, 5, 6 elevated liver enzymes (20x the normal) protein and blood in urine. High LD readings (747) Extreme fatigue. 10 pound weight loss (muscle) that I can't seem to recover. Aches in my lower back in my kidney areas. Week 7 and 8 to present- strange white patchy skin mouth ulcers on inside of cheeks and rashes all over my back. Small rash on face under eye. Bright red flat spots appear and disappear within a week of appearing (different than rash on back). I've even had one that randomly started bleeding on my face. Week 9 to present- Continual burning skin on entire upper back and on arms. Burning tongue and random general strange skin problems and sensations. Hands and feet go numb while sleeping and wake me up. Week 17 to present- Dull pain in both of sides of my hips. When I start brushing my teeth my gums bleed!

Now let me tell you what I've done. I'll leave out some of the tests because the doctor has run many multiple STD, CBC, liver tests, and micro organism type tests. Also had my back sores biopsied which the dermatologist said it was possibly pityriasis rosea in her opinion. Ok so here it goes,...several Hepatitis C tests and D and E antibody tests. (inoculated for A and B) tests including a Hep C RNA test. HIV 1/2 antibody blood tests at weeks 8.5, 12.85, and 17.5. A bDNA test at week 13. Oraquick advanced oral swab week 14. I had a PCR test at 9.5 and one at 18.85 weeks. All negative or (below the detectable amount which was 50 copies on the last PCR) Also one T cell test to see if they appeared unusual which the doctor said there is no inversion in the ratio as of yet. The most recent urine test does flag for elevated protein in my urine. Doc, I've been healthy man my whole life. Never experienced problems like this before. I am starting to get frustrated when people say stress. Stress doesn't cause elevated liver enzymes 20x their normal levels. I have served in the military in extremely stressful training, been to combat where I thought I would never see my home or family again, I've been to two very stressful law enforcement academies and have had a strenuous career. I have never manifested symptoms of stress. Never. I am a professional, (debatably) intelligent, intuitive, married father of two. Being that I'm in law enforcement I am very keen on observation. I am not crazy, a hypochondriac or making up this for whatever reason. In fact I wouldn't wish my circumstances on anyone.

Now the worse of the whole thing is my kids. I mentioned this in my first email. I know this is enough for you and my doctor to tune out but please hear me out. I am telling you that there is a problem! When I was feeling sick with a this I took time off from work and was home around my kids in January. I specifically recall this event. I want to remind you of the blood found in my urine. My daughter has bad eczema on her hands, wrists. Lots of breaks in her skin. I had urinated into the toilet standing up without lifting the seat. I noticed splatter on seat but did not do a even passable job of wiping the seat like I should have. My daughter age 7 is small. She went in like 30 seconds after me leaving the bathroom to use the toilet. She uses her hands to get herself up on seat, direct contact with toilet seat and her hands. I had yelled at her for something and she put her hands on her face near her mouth and then wiped her eyes with her hands. I wanted to yank her off seat and wash her hands and sterilize the seat but I didn't because I didn't want my wife thinking I was over reacting. Then I didn't supervise her to make sure she did a good job of washing her hands she kept putting her hands near her mouth and face afterwards. Biggest mistake of my life. Two to three weeks later she had diarrhea (looked like mine in toilet when I had the diarrhea), intermittent fever, swollen lymphnodes in neck and looked like she got run over by a truck. Pain in her left abdominal area. Exhaustion. Red spots all over tongue. Swollen redness around her eyes. Her lymph node right under jawline in front of ear lobe remained large and I bet still is there but I'm afraid to feel for it. Weight loss as well. Sore throat. Dry unproductive cough. She used to have perfect facial skin now there is red blotches under skin all over cheeks and they are turning in to discoloration. While she was like this she was at her best friends house with my son. She is a full of life hard to put down girl and will play even through being sick. I went over there and they had fruit drinks with the straws in it all around table. My son, my daughter's friend and my daughter's 45 year old mother drank after my daughter! I was giving them all lecture about it but it was too late. Guess what? All of them came down with same thing within two weeks. The mother said it was the worst flu she ever had. I took my kids in to see the pediatrician and she said it was a virus but tested them both for strepp which was negative. My son and daughter haven't been the same since this incident. Both were bright beautiful clear complected thriving kids. Now, swollen eyed, sullen looking, strange skin issues, rash on faces and my son has a weird skin rash all over body. Like chicken skin. They both have unproductive coughs that haven't cleared up. Now my son is complaining of an ache in his lower left back. Kidney? He is saying his feet are falling asleep as well just like I am experiencing.

Doc, what the heck am I supposed to do here? I'd take my kids back to Doctor but I had them in during their worst and all I got was they are fighting a virus. I have been focusing on diagnosing what's wrong with me first because I am telling you that they have whatever I have. A=B=C! I have never seen them like this and I have been there for flu, stomach bugs and everything else through the years. They are different. They are approaching the time frame when I started to really get funky nerve and rash issues. I watching them carefully. It's been two months for them roughly. Flu effects don't last that long! With blood in my urine, and the cuts on her hands, then a super high viral load in her saliva am I crazy here or is it possible? Possible that I spread a hard to diagnose HIV infection to my daughter and then my daughter to my son, her friend and mother?

I feel alone and my and my children's only advocate. My wife is clueless and thinks I'm crazy and wants me to stop with all this. My doctors admit I have been fighting a Virus but don't know where else to go. Doc, all I know is I had sex with a sex worker and this has transpired. What else could this be other than HIV? I have heard concerning my situation that the strain in Asia is possibly a very virulent variant (CRF01_AE) and it seems to be spreading easier through heterosexual mucosal routes and maybe I wasn't as careful with the condoms as I thought.

What do you think of all this? I know this a is alot to digest but my issues and my observations of my children are dead on. Obviously I am really frightened, but wouldn't you be? Help me figure this out. Please. I feel that I can't just let this go and discover that all my theories are correct but my kids get sick and die in 5 years because I couldn't get a diagnosis for them and myself. This is a nightmare.

Is it likely that my body just has not produced antibodies yet with all my crazy symptoms and it's only a matter of time? I have been tested out to over 4 months with the antibody tests and have had three specific tests looking for the virus. Should I be anticipating a 6 month positive antibody test?

Is it possible that I have contracted a strain that is not showing up because it is a unusual type like O, or N or the strain I mentioned CRF01_AE? Perhaps HIV type 2? The PCR and bDNA tests I have had look for the major types of HIV 1 correct? Remember my exposure was in the Philippines.

I am beside myself with the differences in my children since they got sick. I am lost and scared Doctor Bob. I need your very educated opinion on what you think the outcome is here and what I should do. Thank you very much.

Response from Dr. Frascino

Hi,

I've combined your various posts for continuity. I must say I'm amazed. Not so much by your story, but rather by the fact you typed all this on your iPhone! Now that's impressive!

Even with the extensive recap and additional update, my assessment and advice haven't changed:

1. Your symptoms and medical history are not consistent with HIV.

2. Your repeatedly negative HIV-antibody tests and undetectable quantitative HIV PCR RNA and bDNA tests are to be expected, as HIV is not your problem! You are not HIV infected.

3. Believing you are HIV infected and actually being HIV infected are two very different things!

4. Your fears regarding your kids are completely unwarranted and totally irrational.

5. There is no doubt you had some type of transient illness when you returned from the Philippines that resulted in your elevated liver enzymes and other problems. This illness was not HIV related. No way. No how.

6. I would advise you follow up with a good general internist as needed for ongoing symptoms or abnormal laboratory tests. (I can't diagnose these problems over the Internet, but I can with absolute certainty advise you that HIV is not the cause!)

7. I again suggest you seek psychotherapy (counseling) to help you confront your irrational fears and guilt as well as to manage your depression and anxiety. I urge you to stop chasing a disease you could not possibly have.

Thanks for your support of The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's warmly appreciated.

Good luck.

Dr. Bob



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