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Question

hi dr bob,i like you very much and think you r doing a fantastic job helping out god knows how many millions of people out there.if i was an american i would have definetly voted you for president(i am portuguese by the way).This is long so please take a deep breath and take me serious,Your advice is at worst 99.99% correct, but the remaining 0.0001% wrong advice is regarding late seroconversion...to my story, hiv positive woman walks in a hospital bleeding quite heavily from a knife attack,and i quickly went to try and give her a hand(i didnt know she was positive)but was later told,blood on my hands and fingers,as soon as i got home blood on my shirt and through my vest,not sure if there were any cuts apart from skin peeling on fingers and flaky skin,anyway when i was told she was hiv positive, my heart almost stopped, doctor thought it wasnt risky enough for pep coz there were no visible cuts,anyway after four weeks, i get not the ordinary ars,this ars is even scarier,extreme numbness in one foot(neuropathy) accompanied with malaise(had to call an ambulance),extreme lethargy,complete loss of appetite,12 kgs weight loss,fatigue,one gland swollen(parotid),pain in the armpits,multiple skin conditions including white patches on my face and my chin very visible and very disturbing,spots with pus that kept reappearing,nails going white,thrush(confirmed by gp)loose stools,a very disturbing rash that went away after 3 weeks, it was on the hands,tongue ulcers,depression which has never occured in the history of my family, i was the first one, i am like the strongest guy mentally and i get depression wat the heck, this isnt right, i know wat ur thinking already.. jus another worried well, well i wish,neways....i do a hiv 1+2 + p24 after 5 weeks negative,after 2.5 months negative again but i also do a full blood count and guess wat my lymphocytes are on 14(normal is 20-50), neutrophils 85(normal is 20-75)white blood cells 4.1(normal 4-11)this is still low,at this moment my lethargy is very disturbing, i am supposed to be in my second year of medicine, but its impossible..how my life turned out from the highest to the lowest point for something like this,trying to be helpful.i repeated the tests at 4 and 5.5 months both negative,i thought that would be it for me but went to see a doctor and showed him my tongue and he says that i my spleen isnt functioning properly,also my digestive system,i have also recently gained a lot of weight and asked the doctor about this and he said that it was due to my digestive system not functioning properly, that it wasnt absorbing everything properly,i have also had very bad pains on my butt and back, i should note that i did a follow up fbc and everything went back to normal,now to my headline and questions, first of all as this was an occupational exposure it would mean that i test out to a year right,secondly if my spleen isnt functioning properly that would be why i havent produced antibodies yet?...also on my fbc lymph low and wbc normal low thats hiv hallmark(i have been very educated on hiv since this happened..i reckon i am a phd)... and if i wasnt producing antibodies how would the doctors find out because i have gone through all the emotions related with a possible positive infection, that really it would not shock me and i would accept it, but i would really like to find out wat i haveand deal with it than not finding out and let it destroy my immune system before i could get treatment..also if you were my doctor which i wish u were, which test would u reccomend me to do, because i want a test to look for the virus itself, because i know that i am either a late seroconverter or that i dont produce antibodies.Believe me dr i have gone through hell and back and i really want this resolved one way or the other because i really need my life back, i really did have everything in life before this but now i have absolutely nothin,MY LIFE IS DESTROYED.., i dont really care about having hiv, but wat i really care about is how my family will react to this, it will destroy my mother, so please doctor,please tell me wat i should do, if i wasnt seroconverting how would doctors find out, and which test that looks for the virus itself will definetly confirm or rule out hiv(no antibody tests please)and how long should i carry on testing, and 1 more question since the elisa test dont pick out the rare strains like the recent ny case, how would they find out if he had hiv..please doctor answer my questions and dont make me type all of this for no reason,you can reply on my email if u think this would freak out some of the readers, i dont mind as long as u answer it.As i am a honest man i am not going to say that i am going to donate because i am so broke(no work, no uni, just sitting at home with hiv in my head).thanks a million

P.S. if i am positive can i move over to the U.S so you can be my doctor and hiv specialist.Life isnt fair,as people can still get hiv even if they are as careful as anything)sorry for the long story but i made sure i told u everything.

Answer

Hello Portuguese-Guy,

My advice regarding late seroconversion is wrong? What???

To summarize your case, you had an occupational exposure of blood on intact skin, which your doctor advised was not risky enough to warrant PEP. I would agree with him. You've had negative HIV-1+2 and p24 at 5 weeks and 2.5, 4 and 5.5 months, all of which were negative. This is excellent news and quite expected, because HIV cannot pass through intact skin.

During this period, you became depressed and developed some symptoms. Remember symptoms are notoriously unreliable when it comes to diagnosing HIV disease. Also remember symptoms do not equal HIV disease. I don't know why the doctor you saw told you your spleen wasn't functioning properly after you showed him your tongue. That doesn't make any sense to me. Certainly the vast majority of your symptoms are commonly seen in people suffering from anxiety and depression.

I have no reason to believe you are a late seroconverter or that your immune system is impaired and not producing antibodies. You may "reckon you're a phd," but only if "phd" stands for person highly depressed.

I don't believe you've "gone through hell and back." Rather, I think you are still in hell "worried-well hell".

My advice is simple. Continue to follow the protocol for occupational exposures at your hospital. Here in the U.S., testing would be recommended at 6 weeks, 12 weeks and 6 months. Direct virus assays for routine follow-up are not recommended.

HIV has not destroyed your life, but anxiety and depression could. I strongly urge you to see a psychiatrist to help you cope with your fears.

This may not be the advice you wanted to hear, but it is indeed the advice you need.

Good luck.

Dr. Bob