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Dr. Young (about the ARS question)

Feb 11, 2002

I had really nasty ARS; my doctor diagnosed it as the Flu. He never said anything about doing an HIV test. He handed me an Rx for Zithromax and sent me on my way. 7 months later I went for a routine physical and tested HIV+.

1. This is a gay doctor who is an HIV specialist, I am a gay man. Not that it would do me any good now (a year later) but should he have done an HIV test? (Would you have requested one had you been the doc?)

2. My ARS lasted 7 full days and moved throughout my body (one day chest, one day stomach, etc) It was like the worst "flu" I've ever had. You said in your response to the other ARS question, something about the host immune systems response to the virus. Is the fact that mine was so violent a good or bad sign for the future? Do you have any insight you could share?

I know this is long winded, but these two questions have been nagging me for a very long time.


Response from Dr. Young

Thanks for your questions (they're actually not long-winded).

As for the first question, one of the most difficult diagnostic issues is detecting acute retroviral sydnrome. The clinician needs a very high index of suspicion, since the appropriate tests would need to be ordered (usually a HIV viral load). Since these tests are expensive, there is at least some barrier to ordering them with every mild "flu". I do think that we don't ask the diagnostic question with enough frequency, though, so even experienced clinicians, with an at-risk population, might miss the opportunity to diagnose. In recent months we've started actively looking for HIV viral loads among persons with the "flu from hell", that don't have influenza; recently, have diagnosed several persons with ARS.

As for the severity of ARS symptoms and prognosis, I don't have any intellegent to add other than knowing your CD4 count and viral load at steady state (set point).

Hope this is helpful, BY

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