Case numbers for rare subtypes (TESTING FOR SUB-TYPE O)


Dr Bob,

I'm a frequent follower of your forum and enjoy your wit, humor, consistent honest answers. I know all of us worry wells do try your patients sometimes. Thank you for helping educate us. I have donated and will again.

So many people worry about rare subtypes but it's hard to find numbers to define rare. For example, I searched for Type O infections in the US and all I could find was a story about a lady from 1996 and that in Africa 6% of infections were Type O.

I think it would put a lot of our minds at ease to see/hear statistic numbers for the US. Do we only have 1 case of Type O in the US? is it 100? or 1000? What is the number for rare? Could we assume 6% also?

I'm willing to research but can't find the information on the internet or in your archive.

Thank you so much in advance and again, thanks for all that you do.



Worry about being infected with HIV-1 subtype O in the U.S. Is completely unwarranted. Only two patients with subtype O were detected in the U.S. through March 2000! The newer HIV-antibody tests can fairly accurately detect subtype O and so far it is not a problem in the U.S. It remains primarily a problem in West-Central Africa, mostly in Cameroon. If folks worried about contracting subtype O aren't much more worried about being zapped to death by an errant bolt of lightening or dying from falling out of bed, then their fears are out of proportion to reality. (See below.)

Dr. Bob

Testing for HIV 'O' and 'N' in the United Kingdom Oct 26, 2007

Dear Dr Bob - I am hoping you can answer some anxiety-inducing questions I have about HIV testing...I live in the UK and have, over the years, had unprotected sex with long-term partners, one of whom was from Japan (don't know how relevant that is!), behaviour which was stupid and irresponsible, I now know. I have been married now for nearly 8 years and both my husband and I have been faithful all that time. During pregnancy in 2004, I became extremely worried about HIV and had ante-natal testing for HIV 1 and 2, which came back negative. This didn't assuage my fears and so 9 months later, in 2005, I was tested again for both HIV 1 and 2, again negative. STILL not appeased, I had another test in 2006 (again for HIV 1 and 2), still negative. However, as I'm sure you've heard a million times before, once a person is preoccupied with HIV, they start reading all the literature and get more and more frightened - and indeed I am...On your site, I have read about HIV strains O and N - yes, I know they're rare but they exist! My question is would HIV tests in the UK over the last 3 years pick up these strains 100% of the time or would I need to ask specifically for these types to be assessed? I just want to be absolutely certain that I don't have this disease so that I can finally get on with my life! I have a feeling you're going to say that 'HIV is not your problem, no way, no how' but I really feel that I need to know the most up-to-date information on these strains and the testing for them. What should I be asking for? Please, please advise me for the sake of my little family! Many, many thanks for taking the time to read and, hopefully, answer this question, a desperate Mum

Response from Dr. Frascino

Hello Desperate UK Mum,

You are absolutely correct: I am indeed going to advise you in no uncertain terms that HIV is not your problem. No way. No how! Your problem is being "preoccupied" with the fear of being HIV infected, not HIV itself! Your repeatedly negative HIV-1 and HIV-2 tests out many years after your last potential exposure are definitive and conclusive. Do you need testing for extremely rare strains? No, absolutely not. You don't need anymore HIV tests whatsoever. What you need is a bit of perspective on your irrational fears. Often our worries are way out of proportion to actual risk. For instance, most people worry more about being murdered than committing suicide, yet each year the number of Americans committing suicide is twice that of those murdered. Similarly folks worry more about being struck dead by lightening bolts than falling out of bed, yet 10 times as many Americans die from falling out of bed. Your chances of being HIV infected are essentially nonexistent, despite the existence of extremely rare strains of the virus. Certainly the chances of your being HIV positive are far, far, far less than the chance of your being hit by lightening. So if you put all this together, if you are not absolutely "preoccupied" and completely anxiety-ridden over the possibility of your falling to your death from your Sealy Posturepedic each and every time you crawl into bed, then your fears of HIV are way overblown and completely irrational!

My advice is that you need to acknowledge you real medical problem anxiety and unwarranted HIV fears and to get these problems attended to by seeing a psychologist or psychiatrist who can help you confront and hopefully conquer these irrational worries!

So "what should you be asking for, for the sake of your little family" (not to mention your own sanity)??? The answer is a referral to a competent psychiatrist. Bring a copy of this post and my response to your first visit and show it to your therapist. It will help him help you!

Good luck.

Dr. Bob