November 19, 2012
Dr. Bruce Rashbaum
We fielded a question recently on www.napwa.org, and passed it on to Dr. Bruce Rashbaum. You can submit your own questions for Doctor Bruce by clicking HERE.
Here's the question (personal details edited out!):
I have a question for you. I was diagnosed with HIV two years ago, and it was very hard for me to accept the fact. I had been with the same man for 11 years. I do not see him anymore, that was my choice before I was even diagnosed with this, but I did tell him, and he said he went for a test and came back negative. I have a hard time believing him or could it just be it has not shown up in his body yet? Or is it possible I could have got this more than 12 years ago? When I first saw my doctor, she thought I might have had it for about three years. I was really sickly, then. I am doing so much better today, I am undetectable, and I know I need to stop wondering where I got it and just thank God I am alive. Any info you can tell me I would appreciate.
Doctor Bruce replies:
I am glad to hear you are feeling better, on treatment for your HIV, and almost moving on. You need to. Whether or not this man is the one who infected you will not change anything. You did the right thing by informing him about your situation. I always think it is important to actually see the test results of a potential source, but that can get into sticky legal issues in regard to privacy. For those who are ethical and have a moral backbone, I would think they would have no problem sharing with you results, whether they are negative or positive. This may sound harsh, but, think about it, if you have to hide something, then you have guilt associated with deception. Those with nothing to hide nor fear will be forthcoming.
OK, enough of that. In regard to his test not being positive per his communication with you, there are several possible explanations. He is indeed negative. He didn't get exposed. He could also be one of those with the genetic mutation that causes a defect in the receptor on the CD4 cell that is necessary for infection to be established. This is seen in fewer than10% of individuals from a northern Europe demographic group and they are actually resistant to HIV. Recall the German patient who had HIV, had to undergo chemotherapy followed by a bone marrow transplant for lymphoma. His lymphoma was cured and his physician, quite astutely, searched for a compatible bone marrow donor but also sought out one with the complete mutations to this CD4 receptor. This patient not only appears to have eradicated HIV with chemotherapy but now appears to have made CD4 cells that have this mutated receptor and it is thought that this patient is now resistant to HIV. Incredible!
It can take almost two years for the less than 2% of individuals that do not seroconvert shortly after exposure to HIV to begin producing antibodies that will make a test come back positive. The majority do so within six months of exposure, with most of these seroconverting within the first month after exposure. So, either this guy is lying to you or he fits into one of these categories. Now, what you are asking of your doctor is to tell you when you actually got exposed. There is really no way to tell you when you got infected without having had the laboratory testing over the years that showed a negative result at one time period and now a positive result at another. You can pin it down with that data along with the presence of the Acute Retroviral Syndrome, which is a symptomatic acute flu-like illness (this occurs in less than 50% of new infections) following "recent" infection by HIV, potentially helping one identify a source as well as a date of infection after their exposure. One can guess that you possibly could have gotten infected three years ago because you may have the worst flu ever but that is just a guess. And, yes, you could have gotten exposed 12 years ago, never had the symptoms of an acute viral infection, and only after seeing your doctor more recently been identified with HIV due to having had the actual blood test.
I am sorry for your angst about wanting to know who infected you. I understand why you want to know. But, again, it doesn't change anything for you. Certainly, you would want to ensure that if the source was identified that he was not out infecting others. I hear this from my patients. But it is wasted energy and you did what you had to do. You informed him, he said he was negative, you ended the relationship for the variety of reasons that you felt were valid and important. Move on and continue to take the best care of yourself. Eat well, sleep well, MINIMIZE STRESS, exercise, follow up with someone who has experience in treating HIV ( it makes a difference in the quality of care rendered ), take your medications and consider simplifying your treatment to one of the new single tablet regimens if you are not already on them, even if you are 'undetectable' on a different medical cocktail. They appear to be less offensive especially in adverse side effects. I hope this puts your mind at ease. Happy Thanksgiving and enjoy every day. They are gifts to all of us.