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Is my whoo hoo still safe
Jul 9, 2011

Dr Bob,

Thank you for all you do to provide honest, straightforward real advice on a topic that is so frequently misrepresented. You have given me a whoo-hoo previously, but I am writing to inquire if your confidence level changes at all based on a few new developments. My fear is it might.

My exposure was six seconds of insertive oral sex with a massage parlor girl (first and only time). You gave me a difinitive whoo hoo for pairing a DNA PCR test at the 20 day mark with antibody testing out to 4.5 months (18 week mark). Your whoo hoo was well received and literally brought ms to tears (I put incredible stock in your opinion because you deliver both good and bad news so well.)

I had been having some stomach problems, so my doctor ordered a celiac test that included iga testing. My iga test revealed a very low level (36) with the normal levels being between 70-400. My doctor has followed this test up with a complete ig panel (igg,igm,iga,igd) but did indicate that he felt like these tests will come back fine. I do not have a history of being sick, and barring some persistent diahrrea I have had virtually none of the ARS symptoms.

Naturally my mind starts racing, and as such I have a few questions only you can answer:

1) Having tested out to 4.5 months with both rapid and lab conducted antibody testing, is this still considered conclusive if there are some potential issues with my immune system?

2) I am assuming my PCR test is now pretty relevant, can I rely on that result 20 days passed exposure?

3) I did have igg testing done when testing for HSV, tested positive for HSV-1 and throughout the last 90 days my HSV igg antibody level was never the same number. Does this indicate my immune system is functioning well enough to create HIV antibodies?

4) At what point does everyone produce antibodies (even those with potentially abnormal immune systems) that would show up on the HIV tests? 3 months - 6 months- 1 year?

5) Do I need another PCR test or are my current tests "definitive", "conclusive" and " hiv is not your problem no way no howable"

6) Would my ig levels have to essentially be non existent to have the immuno suppressed levels that render antibody testing invalid, or would mild abnormalities skew the result?

I am not sure if this impacts your opinion but I have had 3 CBC's done in the last six weeks, all of which were completely normal.

I am pretty scared right now, and as my doctor and I work through this, I would love to be able to keep the door closed on HIV if in fact I can safely do so.

Is this truly a "whoo-hoo" or a "whoo hoo redo" with further testing needed (another pcr)?

I know you get flooded with mail, and I am sorry to ask, but if you could please reply to me it would mean a lot!

I will be donating $500.00 to your foundation- this takes my total donation up to $2,500.00. I do not highlight this in hopes of iliciting a response but rather in hopes of inspiring others who have the means to give to this incredible cause. Thank You Dr Bob!

Ryan

Response from Dr. Frascino

Hi, Ryan.

My assessment has not changed. Responding to your specific concerns:

1. Your negative results remain definitive, conclusive and WOO-HOO-able. Your stomach problems may be related to selective low (but not absent) IgA deficiency. I tend to doubt you have significant common variable immunodeficiency (CVID). Some folks with low IgA have symptoms similar to CVID, including gastrointestinal complaints (discomfort, bloating, nausea, vomiting, diarrhea, weight loss, etc.). Many folks with selective low IgA are asymptomatic.

2. HIV DNA PCR testing is generally not recommended for routine HIV screening. That said, your undetectable qualitative HIV PCR DNA is consistent with your negative HIV-antibody tests and would be expected following such an extremely low-risk exposure.

3. That your immune system makes specific antibodies (IgG anti-HSV-1) indicates that portion of your immune system is functioning normally.

4. The HIV seroconversion window period is defined as the first three months following exposure. The CDC also recommends a follow-up HIV-antibody test at the six-month mark for occupational exposures and also for significant non-occupational exposures (such as anal receptive sex with a partner confirmed to be HIV infected and not on antiretroviral therapy).

5. Your tests are definitive, conclusive and WOO-HOO-able. HIV is not your problem. No way. No how. No further HIV tests are warranted.

Your Dr. Bob-certified WOO-HOO remains intact!

Thank you for your ongoing support of The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's urgently needed and warmly appreciated. Your gifts will touch many lives in desperate need. On behalf of those lives, please accept my heartfelt appreciation. In return I'm sending additional good-luck/good-health karma that you are now and will forever be HIV free.

Be well Ryan!

Dr. Bob



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