This blog entry was written by Steven Natterstad, M.D. ("Dr. Steve"), Dr. Bob's husband and partner of 18 years.
The conclusion to Dr. Bob's obituary read: "In addition to his husband (Steve) and sister (Linda), Bob is survived by his parents, Jennie and Angelo Frascino ... and by many friends, colleagues and 'eyeballs' around the world." You, Dr. Bob's global online family, have suffered an immeasurable loss. He was truly a larger-than-life persona, and so he leaves a huge void in our lives. However, because of the great man he was, he also leaves us with a giant presence, one that will continue to guide, reassure, educate and empower all of us.
We learned of Dr. Bob's unexpected passing just days before this blog entry was scheduled to post: Gentle Readers, welcome to Part Two. Let's talk about detecting very recent HIV infections and emerging diagnostic guidelines. As we have learned more about the natural history of untreated HIV infection and the body's immune response to the virus, we've developed a better understanding of measurable events occurring during recent HIV infection. For instance, the HIV viral load spike that occurs shortly after acquiring the virus correlates in time with a corresponding spike in HIV p24 antigen level. As the body's immune response kicks into gear several weeks after infection, the immune system begins making specific anti-HIV antibodies. The first to appear is anti-p24 antibody. As that antibody increases, the p24 antigen and HIV viral load decline.
Among the most common questions cramming their way into my inbox at the HIV Prevention and Safer Sex Expert Forum are an impressively wide spectrum of concerns about HIV-diagnostic testing. Everything from the very basic -- "to test or not to test; that is the question" (a favorite of Shakespeare aficionados) -- to the ridiculous -- "Grandma farted getting out of the barcalounger. I think I smelled an HIV-charged fart. Should I get an AIDS test?" In between these extremes are HIV-diagnostic-testing conundrums, such as:
The HIV/AIDS wave crested in the mid-nineties and the once underground disease had now become mainstream. Most Americans were talking about condoms and safer sex without embarrassment. Greg Louganis disclosed he had HIV/AIDS.
On October 2, 1985, a bombshell dropped on Hollywood. Rock Hudson died of AIDS. Now the deadly disease had a face.
The friendly folks at Body Central have asked if I would interrupt my regularly scheduled blog-o-rants to address the following "question-on-the-street" in preparation for an upcoming feature on this year's Gay Pride celebration. Question-on-the-Street: "What do you think generations of LGBT folks before or after yours need to understand about the way your generation has responded to HIV/AIDS?"
Note to reader: Before proceeding, I should probably fill you in on what's going on here. I'm on Bondi Beach in Sydney, Australia with some friends (mates). I have just had a rather spectacular wipeout trying to surf. After being gobbled up by the wave and scraped helter-skelter across the ocean floor for a distance that seemed to me to be roughly the size of Manhattan Island, I was grabbed by a buffed smiling Aussie lifesaver (beach lifeguard). He then shouted, "Look out mate! There's a bluey over there. Let's get you outta here." As he cross-chest carried me across the rip, I saw something that looked like a giant blue condom with strings float by.
As I mentioned in Part I of this three-part blog-a-thon, HIV is far more clever and cunning than any of us realized in the early days of the epidemic, when we all assumed that with the three Ts -- time, talent and treasure -- we could cure HIV in the not-too-distant future. Three decades later, despite billions of dollars and the best efforts of research scientists, HIV still has no cure and has prematurely snuffed out the lives of over 25,000,000 people.
1. There is now very sound and growing evidence that we cannot "treat our way out of this epidemic," as philanthropist Bill Gates stated at last summer's International AIDS Conference in Vienna. Even with improved access to testing and treatment, for every individual who starts antiretroviral therapy (ART), two additional people become newly infected with the virus, according to the UNAIDS report.
Hey HIV. Yes, I'm talking to you HIV. You found me exactly 20 years ago today! Do you remember how when I was performing a procedure on Mr. X, a gentleman with advanced-stage AIDS, a myoclonic jerk of his leg caused a deep hollow-bore needle stick and nasty laceration in the palm of my hand? I certainly do. I also remember my first thought (expletives deleted), quickly cleaning the wound, and promptly popping an AZT (one of the only antiretrovirals available in 1991).