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Tugging on your saintly heart-strings and also a few comments
Sep 3, 2011

Dear Dr. Bob

Firstly my best wishes for your continued health and happiness.

I will appeal to your infinite patience and compassion for an answer whilst I wait for the opportunity to fly out of here and get a test.

(You may recall you kindly responded to me a few months ago. I am an expatriate in an Arabian Gulf oil state where a positive result will result in my immediate deportation and loss of my livelihood I still havent had a chance to fly home to test because of work schedule. You wrote a very apt opinion that such attitudes can only undermine the fight against HIV. You also very graciously pulled down the post because I was paranoid about too many personal details of mine appearing a fact I am ashamed of now, sorry!)

Question is on ARS: how much of a scientific handle is there on this syndrome? By its nature, surely all we know of it is anecdotal because there is no reason to suspect HIV whilst people are experiencing it or we havent introduced HIV to people in a lab and monitored them etc. Therefore it comes from interrogation of HIV +ve people? Is this why there are such a varied range of symptoms and severity? Does it even exist? In addition to The Body, the CDC and other eminent sources reference it of course, I cant claim to know better, but very curious how we know about it. Logically this re-enforces that the only way to determine HIV status is to test, but as I while away the time day by painful day, I would really appreciate an answer as I sit and prepare myself for all eventualities a positive test for me is very complicated due to my current dependence on this job ... hence the appeal to your saintliness!

As quick recap: my risk is due to unprotected penetration (few strokes before coming to senses) of higher-risk females (potentially associated with IV drug using males, developing country - Myanmar, uneducated about HIV etc) when I had i) recently-healed genital herpes at base of penis and ii) mild prostate infection

My comments are the following: 1) I want to re-enforce to your readers what you say in your blog that although treatment has progressed, there is no room for complacency as individuals or as the collective human race in our efforts to prevent HIV. I reconnected with an old friend by chance thru the wonder that is Facebook and found out he has been living with it for past 10 years and it hasnt been a tea-party for him.

2) You are a rare human being, what are your flaws? How are you so worldly compared to other Americans? (No offence to anybody). I am always so impressed by your courage, by your compassion, erudition, intelligence and good humour, and this is coming from a guy who has often been labeled a misanthrope. You are good looking too! I saw your picture in the podcast transcript of Dr. Steve and you are shredded like julienne salad man! You are 30 years older than me and you look 10 times better I swear although no comment on that 80s photo of you with the bouffant do and the moustache :P

I will contribute to your charity again when we get paid end of this month!

Many thanks and best wishes

A

Response from Dr. Frascino

Hello, A.

HIV acute retroviral syndrome (ARS) has been well studied. (Remember we've been intensely studying HIV/AIDS for over 3 decades now!) There are many instances when we know the exact date of exposure (occupational exposures in the healthcare setting, blood transfusions before we had the ability to screen for HIV, etc.). Consequently the syndrome is not merely anecdotal reports, but rather a scientifically observed, monitored and studied phenomenon. The symptoms correspond to events in the natural history of HIV infection and the body's immune response to the infection. The wide range of symptoms and severity of these symptoms are related to many factors including both viral (viral strain, etc.) and host (immune integrity, concurrent infections, etc.) components.

Does HIV ARS exist? Oh yes, I can attest to that from personal experience! Check out my two-part blog (part two to be posted soon) entitled "HIV Guidelines: Some Evolve; Some Don't. What's Up with That?" I briefly discuss ARS in the context of diagnostic testing. Hopefully you'll find the information enlightening.

Finally, thanks for your very kind comments. They are warmly appreciated. By the way, if you think the 80s photo is tragic, you should see my 70s photos -- positively cringe-making!

Thanks for your ongoing support of The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's warmly appreciated. In return I'm sending an extra dose of good-luck/good-health karma that you are now and will forever be HIV free.

Good luck. Be well.

Dr. Bob



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