What exactly is "clinical suspicion for HIV"?


Dr. Bob:

You been so kind to answer several questions before. I have a new one, different but as important, that seeks to answer when clinical suspicion for HIV is really clinical suspicion for HIV.

Im still having a lot of issues two years plus (March 2006) from an unprotected exposure with a female of unknown status. Some of the issues include: more tired than normal, recently diagnosed gastritis, apthous ulcers (one currently), what look like small zits on scalp (folliculitis? I shave my head), mild low back pain, and coating on tongue. I had surgery in March of this year to correct urethral narrowing, but now have ED and require daily Cialis (nerve damage not healing??). This in addition to the diagnosed Sinusitis and vitreous detachments in both eyes (May 2006).

Though Ive had many negative/undetected results from antibody (blood draw and Oraquick HIV 1/2 finger prick) and viral load testing, I remain with abnormally low CD4 counts (ranging from 441 to 410, between June 2007 and November 2007). I started seeing an immunologist in November 2007 to see what else might be causing it, but he does not know. Hes having me do another CD4 panel in November of this year (to see if it has changed over a year).

Im only 38. None of the stuff I described above happened until after the March 2006 exposure. But on some sites and in some literature, you hear of folks who were diagnosed HIV after ongoing clinical suspicion led to further testing. If you could please answer the following questions to help me understand what is going on.

  1. Is/should what I describe raise clinical suspicion for HIV??

  2. Is it possible for a person with HIV to be antibody negative AND undetectable 18 months past exposure (as described in my previous posts)?

  1. Can HIV lie in sort of a resting state and fool folks and tests until some time that it becomes active and then generates a response??

I appreciate your advice.



  1. No, absolutely not. Your "many negative/undetected results" definitively eliminate the possibility of HIV.

  2. No.

  3. No.

I suggest you follow up with the immunologist for a repeat CD4 count in November as planned. I also suggest you stop worrying about a disease you could not possibly have! Your test results provide overwhelming and irrefutable evidence that HIV is not the cause of your problems.

As for your unprotected exposure in March of 2006, that's a red herring. You are (incorrectly) associating your medical problems with that event. Please note there is a big difference between a temporal association between two events and a true cause-and-effect relationship. I'll repost below something from the archives that discusses associations compared to true cause-and-effect relationships.

Dr. Bob

I find this hard to believe Jan 13, 2004

I think your story of getting a needle stick infection is a great story. Are we to belive that a gay guy got this not from gay sex? Are you telling this story to keep everyone having their gay ass sex?

Im sure you will not answer this question to protect yourself and your gay community. But lets get it out that gay sex can result in AIDS. You talk way too much BS which deflects the real issue. I realize others can get it. And don't give me stats of hetrosexuals getting it more. They get it from switch hitters. It has to start somewhere. POST THIS EMAIL. But I'm sure you won't. I think you are full of crap. Gay sex is what happened. No response means I am right.

Response from Dr. Frascino

Hello Angry Confused Man,

Whether I post your absurd bigoted remarks or not, I'm sure you'll continue to "believe" exactly what you want to believe. Unfortunately, there's not much I can do about that. However, please note, what you believe does not change the scientific facts concerning HIV/AIDS, the modes of its transmission, or its epidemiological trends.

I certainly won't confuse your distorted belief system with concrete facts. However perhaps you might try reviewing information about HIV/AIDS at any of a number websites for instance The World Health Organization, the CDC, or the United Nations AIDS Organization. I will do is warn you that your fantasy world of heterosexual HIV invincibility is a dangerous one. Forty-two million people are living with this virus that's a whole lot of "switch hitters."

Perhaps if I give you an example or two of associations -- completely unrelated to HIV/AIDS --- where simpleminded obvious assumptions are not what they appear to be, you'll reconsider what you think you know or, at the very least, not be so insulting next time you write in. These are examples where associations are not "caused and effect" related.

  1. Birds fly south in the late fall and within a week or so it starts snowing in New England. By your "logic," it would be reasonable to believe that birds cause winter. It's painfully obvious right? Every year they fly south and then bingo the snow arrives. From a scientific perspective, I hope you realize that birds are not the real "cause" winter.
  1. You impress me as the type of redneck who enjoys eating at McDonalds on your way to the next NRA gun rally. OK, fine. While munching on your Triple Quarter Pounder, super-sized fries, and a Diet Coke, watch the folks ordering. Pay particular attention to the massively obese folks. No matter what the chubsters order Big Mac, McNuggets, or McSalad they always, always, always order Diet Coke. Right? OK, so again, using your logic, one must "believe" that Diet Coke causes obesity. That's because it's the only consistent thing they all consume. Do you "believe" Diet Coke causes obesity? Why not? It's logical based on what you just observed.

You are making the same mistake with HIV/AIDS, but again, the chances of you believing me are similar to those of the Pope believing sex is desirable for something other than procreation.

It's particularly interesting to note how deep-seated your pathology is. Do you really think a gay person cannot contract the virus form a well-documented occupational exposure? Are you aware we can now type viruses and document transmission of a particular strain from person to person --- for instance from patient to exposed healthcare worker?

You may be surprised I posted your question. I do so only to show the world that we have a very long way to go in the fight against HIV/AIDS ignorance, discrimination, and hysteria.

OK, we're done with you now. You can go back to your KKK meeting or abusing your pets or whatever fills your obviously very lonely and sad existence.

Dr. Bob