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Another Thailand unexplained symptoms case - follow-up
Oct 19, 2004

Hello Dr,

I'm writing to you again in the hope that you'll address my questions and offer me some advice. I've outlined below the various unexplained symptoms that I've had following a possible exposure to HIV with a prostitute in Thailand in early Nov 2002.

Rapid unexplained weight loss 20-22 months ago (15-20 lbs in 6 weeks) Temporary red rash around neck 22 months ago Malabsorption (via stool sample tests) Wasting (thinning legs, thighs and arms as diagnosed by Dr) Recurring diarrhea, unusual bowel movements Chronic rhinitis (as diagnosed by ENT Dr) Chronic post nasal drip with foamy, thick, stringy mucous that I cough up Sore throat Dry mouth Receding gums Recurring sores on tongue Fatigue & constant drowsiness Below-normal to low-normal testosterone Difficulty concentrating, memory lapses Muscle aches and pains Numb middle toes & ball of right foot Muscle fasciculations (constant in legs & feet, sporadic elsewhere) Radiculapathy (Peripheral Neuropathy) diagnosed by Neuro Dr at UCSF Vision blurriness Dry skin Below-normal to low-normal absolute CD4+ T-cell count (430 two mos post-exposure; now 600-700) EBV positive

None of these problems were present 23 months ago. I've seen several different doctors that have diagnosed these symptoms (i.e. not in my head) and had a battery of blood tests, MRI's, EMGs, spinal taps, etc. done. No cause has yet been pinpointed for the sudden onset of these very real problems. All HIV antibody tests have been negative thru 22 months post-exposure. Several viral load tests were run between 2-11 months post-exposure and nothing was detected.

1. Should I keep testing for HIV if my last possible exposure was in Nov 2002? 2. Are there any specialized HIV tests that you can recommend in my case? 3. Do you think my symptoms are potentially consistent with HIV? 4. If #3 is yes, should my doctors consider giving me antiviral treatment & drugs on a trial basis? 5. Should my CD4+ count continue to be monitored every 3-6 months? 6. Have you ever seen or heard of any cases like mine?

Everything just continues to get worse and worse over time.I'm 46 years old, married with two young kids, and my body seems to be falling apart. Please help me with your advice.

Response from Dr. Conway

I'm very sorry to hear of your chronic symptoms, and I will try to answer your questions in turn.

1. No, currrent tests are quite reliable and will pick up all strains of HIV, including those acquired in Thailand. Exceptions are quite rare. 2. None, you are done. 3. Not at all 4. Not a good idea 5. NO, the initial decrease in CD4 count you reported is often seen with acute viral (or other) conditions and bears no relationship to HIV or the cause of the disease. 6. Absolutely (quite unfortunately). Doctors are often better at telling people what they don't have, as compared to what they do have. In that light, I can reassure you to forget about HIV as a cause for your symptoms. It will be important that you be evaluated for certain types of chronic infection (like tuberculosis) and certain rheumatologic conditions to explain your symptoms. It may well be that you will find out more of what you don't have, but that information could be helpful to you in beginning to feel better. And who knows? You may find out that you have something that can be treated.

Good luck...



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