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Following up : Unprotected Intercourse with a POZ women..Strong Symptomes but neg at 12 weeks !
May 7, 2011

Dir Dr BOB,

I check daily your forum, to read the answer you give people, not only because I still concerned, but also to know you are doing well, by responding to people like me, you gave insurance to a hundreds of thousands of people around the world, not only by your answer, but also by the fact that you are doing well, so I tell to my self, even if I AM Poz, Dr Bob, has gone from where I am, but he is doing well, so please, need a big favour, for me and for all the people who like you, for what you are and for what the humanity can offer, a people with good heart like you, Please when you are busy, and can not post for some times, please, just let us know.

Here is my previous post :

http://www.thebody.com/Forums/AIDS/Safesex/Q213121.html

To resume : Unprotected sex with poz women who has very heavy vaginal liquide, symptoms after 2 weeks : - Fever - Painfull muscles and joint - maculopapular rash in the back, - Dairia with mucous and blood - protein traces in urine (some infection in my kidney were seen by ultrasound, The docs said that possibly HIV infecting kidney cells) - enlarged and painful lymph nodes, in arm pit, groin, neck, behind knee, in feet, in face, - trush (confirmed by culture) with canker sore in the mouth. - male yeast infection, untreatable by meds - Severe Peripheral neuropathy, confirmed by neurological tests (EMG) - Eyes infection, with increasing floater. - My TSH are in the high level limite with at 4, high T4 ( the thyroid specialist said its rare to have Both TSH and T4 high in the same times, It is a virus infection who can make them high together) - Fatigue and black circle under eyes.

All those symptoms are lasting till today except fever, Before two months of this incident , I WAS REALLY HEALTHY, in my annually work related global check up

3 months after negative tests had sex with wife, then she has EXACTALLY same symptoms as mine and she still has some of it till today.

A lot of work done, CMV, EBV, Toxo, lupus, rheumatoid and autoimmune disease all ruled out as the cause.

My tests : 20 times Elisa Abbot HIV1/2 Combo, 10 times Insti rapit test, 1 amplicor 1.5 viral load ( 5 months), 1 Naat Aptima (6 months), 1 PCR DNA ( around 6.5 month), all negative.

My wife : Elisa Abbot HIV1/2 Combo test 22 weeks after exposure : negative Abbot combo test.

I know you will say WAHOO, BUTas you see, without exaggerating, all my doctors, were amazed how I have got (and my wife), ALL ARS symptoms, with those negative tests. My ID says it is a though case for her, she sent emails explaining my case to leading HIV expert here in Canada, some of them talked about a divergent strain possibility, as the lady I have got sex with here, had African mates. My ID wanted to report my case to the reference laboratory here in Quebec, But they responded, that they do investigation, only in case of Black African immigrant with clinical symptoms along with Positive Elisa in discordance with negative Western blot.

So, no work is done by theme, if I will turn positive by my own investigation, definitively I will have legal actions against them in court for non assistant of person in danger.

My ID wanted to do Phynotype (or genotype I am note sure) test, but the laboratory said that it require a viral load above 1000 copies, technically for the tests to be done.

So DOC BOB, when all doors are closed, what would you suggest as tests, here is my question:

1- Some expert told me that there is a viral load which measure the viral load by measuring the virus transminase activity, and that test is independent of HIV strain, it is a cheap essay, that is carried out in poor country instead of PRC RNA, should I move to developing country to do this tests, as I can not find it here in Quebec. 2- My CD4 at 3 months were 930, CD4% 41 CD8 count: 730,CD8 34% ratio 1.22 CD4 at 6 months were 760, CD4% 41 CD8 count: 660,CD8 34% ratio 1.22 The test were done in the same times, exactly the same % and ratio, but lower count in both CD4 and CD8, I noticed too that there is a lower count of lymphocyte from 3 to 6 months after exposure, it is indication HIV immune deterioration ?

3- My big fear is my wife, she has all my symptoms, but she has one particular symptoms that worry me a lot. When she is sleeping, she start to have uncontrolled jerk movements in arms, feet, in whole body, along with muscle twitching, in face, but only when she is sleeping, is the virus infecting her brain ?

4- Recently there is a guy who posted in your this forum he tested with all the test I have done so far up to 6 months, but he tested and confirmed pos after one year of infection: Here is the link : http://www.thebody.com/Forums/AIDS/Labs/Q214465.html

Do you think that my case is different, is it rather divergent strain, so it is not an eclipse of the virus in the lymph nodes, as it seem to be the case for him, , as I propably infection my wife. So there is a viral load.

5- I have an appointment on 18 may with the POZ lady doctor, what shoul I ask him, to clarify my case (which strain she has ?)

I know that is a long post, a complicated cases, but I trust you, and judgment.

Merci beacoup de la par d'un Quebecquoi qui vous éstimes.

Response from Dr. Frascino

Bonjour encore une fois mec Québécois!

J'écrirai en Anglais parce qu'il est plus facile pour moi et tu as beaucoup de questions aujourd'hui! Alors, commençons!

First off, thank you for your very kind comments. They are warmly appreciated. Yes, I have been "positively charged" since January 1991. And I hope my experience will be an encouragement to those more recently infected. Working closely with an experienced HIV specialist physician remains the key not only to surviving but also thriving with HIV.

Next, just a point of clarification. I don't actually offer "insurance to hundreds of thousands of people around the world!" That would make me bigger than Blue Cross/Blue Shield! (insurance company) Rather, I try to offer sound scientific advice and "reassurance" whenever possible.

Thanks for your concern about my health and well-being when I'm absent from the forum. I do try to post a notice when I know I won't be able to post responses for more than a week. However, sometimes I find myself in locations or situations where Internet access is unexpectedly either limited or nonexistent. In these cases, there isn't much I can do. If for whatever reason I can no longer post responses or need to take an extended leave, the site content managers will put a notice up (and hopefully find a replacement for me). So if I'm not here for a few days and you don't see a notice from The Body, you can assume I'm OK but "incommunicado" for a time and that I will indeed return, OK? Basically what I'm saying is don't worry about me; there's already way too much worry going on in this forum. Besides, Dr. Steve (expert in the Tratamientos forum and my lawfully married spouse) takes very, very good care of me!

Now on to your questions:

1. No, of course you shouldn't move to a developing country! You probably realize that's a ludicrous idea, right? Of course you do! "Cheap assays" are not the answer to your conundrum!

2. No, absolutely not. Both of your T-cell subset analyses are completely normal and do not suggest any immune deterioration whatsoever! Cd4 T-cells are involved with many aspects of immune function and are not limited only to fighting HIV! Absolute CD4 counts bounce up and down in the normal range continually. CD4% and the CD4/CD8 ratio are less prone to these fluctuations. Your values are all completely normal and not at all indicative of problems with your immune system or immune functioning.

3. Your wife's nocturnal "uncontrolled jerk movements" are not suggestive of or worrisome for HIV disease. These are most likely complete benign myoclonic (muscle) jerks that can occur with dreaming. As for her having "all my symptoms," this would argue against HIV disease! Symptoms of HIV acute retroviral syndrome are rarely, if ever, identical from person to person, because everyone's immune system and immune response varies.

The case you reference doesn't make sense as indicated in Dr. Holding's response (which I absolutely agree with!). This individual needs to see an HIV specialist physician who can review both the medical history and actual test results. Chances are there is a very logical explanation for these seemingly confusing results. We've sorted quite a number of these types of situations over the years and there has always been a reason for the seemingly inconsistent test results. Diagnosing HIV is not rocket science but it can be confusing to those who don't understand test assay limitations or know how to properly interpret test results. I'll reprint the question you reference below.

5. I'm not sure what you mean by "the POZ lady doctor." What I would suggest is that for your own peace of mind you have a consult with an experienced HIV physician specialist. He will review all your lab tests, evaluate all physical symptoms, review in detail your medical history and perform a completely physical examination. He will then advise if any additional HIV testing is warranted, and if not, what your next step should be. I'm concerned about the physician you are currently seeing not knowing that HIV resistance testing (phenotype or genotype) would be completely unwarranted in your case as well as impossible to perform due to your undetectable HIV plasma viral load (quantitative RNA PCR). This indicates to me that the physician is not knowledgable in HIV/AIDS medicine and/or HIV diagnostic methodology. I would advise you not to spend time or energy considering legal actions against a reference laboratory! It's a waste of time and will go nowhere. (Also they've done nothing wrong.)

From your medical history, I do think you may well have contracted some type of infectious disease by having unprotected sex. However, I continue to believe what you have is not HIV or HIV related. I'm not advising you to "crie youpi," because you are still not feeling well. However, I would continue to advise you that HIV is not your (or your wife's) problem. The evidence is now overwhelming and irrefutable.

Bonne chance!

Dr. Bob

Antibody +ve, RNA -ve Apr 10, 2011

I was found to have HIV positive antibodies in May 2010. My last possible exposure was July 2009 and antibodies negative in Jan 2010. My RNA is negative to this day (undetectable), my antibodies have gone from weakly positive to positive and Western blot now positive after previously negative. My p24 is negative and pro-viral DNA negative. I am so confused about what this means and whether I am going to develop HIV or not, despite the fact that it has been a long time since potential exposure and I am constantly having blood tests. The anxiety of it all is really getting to me now. Please help.

Response from Dr. Holodniy

Having a positive antibody and western blot test indicates HIV infection, even in the face of a negative RNA (HIV viral load test). It would be extremely unusual to have a negative HIV-1 proviral DNA test with a positive HIV-1 western blot. You need to sort this out with an infectious disease specialist.



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