Is HIV- antibodies the best test to detect HIV+? (ELITE CONTROLLERS, 2010) (ELITE SUPPRESSORS, 2010)


I have a friend of mind who hasn't taken any medications for HIV since 2006 and has maintained 0 viral load and a maximum CD4 after he was decleared cured by a herbalist. He was very sick before then but he's been fine all this while going around energitically. He test HIV antibody positive but has no virus for about 3years-how is this possible. I always accompany him to the hospital but all result still come the same. Finally,we're told antibodies for HIV can't disappear at once and that antibodies are not Viruses. The immune system will gradually eliminate them with time. And untill these antibodies are completely deleted he will continue to test HIV+. So I doubt why some body who was always sick for the past 4years can have such a great turn around,with no medications getting to 4years today and without any signs of fever or cold. What canbe happening in this situation



Your friend was "decleared" cured by an herbalist? Hmm. Another herbalist curing HIV/AIDS? And he's not on the cover of TIME magazine? What's up with that? Sorry Charlie, I don't believe it. The cure for HIV/AIDS has not yet been discovered.

Without more details, I cannot explain what's going on with your buddy. It's possible he's an "elite suppressor" (see below).

The information you were given about anti-HIV antibodies is not correct. Many, many people have had undetectable HIV plasma viral loads for many years; however, they will always test HIV-antibody positive. (Some of these folks are elite suppressors who have never been on antiretroviral medications.)

Whoever is advising you about anti-HIV antibodies does not understand the immune system and/or basic HIV pathology.

I would encourage your buddy to establish care with a certified HIV physician specialist. (See below.)

Dr. Bob

off meds for 4 years , still undetecable w/ 1300 t cells Dec 21, 2009

unfortunatly my specialist is retieng and without giving false hope suggested that if I remained undetectale for 2 more years it is possible i may have cleared the virus. I did begin meds within 8 weeks of exposure and was 99.9% compliant for 3.5 years ( my highest vl was 54k.) I'm not overly concerned about being cured though I am working with a couple of researchers about my somewhat remarkable condition. But lets just say in the interest of science what would be the next steps into looking deeper into that remote possibilty. I am also inerested in makeing myself available to legit researcers. I have contacted 2 such researchers Dr Walker in Boston and Dr Levy in San Fran. it is close to the holidays so responses are slow and I am also inerested and 2nd and 3rd opinions.

Response from Dr. Frascino


Both Bruce Walker, M.D. In Boston and Jay Levy, M.D. in San Francisco are studying "elite suppressors" (Elite Controllers). Michael Lederman, M.D. At Case Western would be another well-known researcher in this field whom you might want to contact.

As for looking deeper into "remote possibilities," you would need to be evaluated and followed in a research setting. Hopefully Dr. Walker, Dr. Levy or Dr. Lederman will be able to help in this regard. I'll post some information about Elite Suppressors below.

Good luck! Happy Holidays.

Dr. Bob

Elite Suppressor (ELITE CONTROLLERS, 2009) (ELITE SUPPRESSORS, 2009) Jan 31, 2009

Dear Dr. Bob.

Last year when I was incredulous at my HIV test, and believed it must be an error, I wrote you and you were so kind. Of course, it was partner had lied. My numbers were good: 220 VL and 440 cell count, but I was still devastated. I waited several months not wanting to go for my next round of lab tests. When I finally did, 7 months later, I found I was undetectable, with a much better cell count. Two subsequent lab rounds, at 3 months later, and then 5 months after that, have confirmed this condition. My wonderful doctor at the Madison Clinic in Seattle is amazed, as am I. Life seems not as bleak as it did. My question is, is this likely to continue? And, what should I there some study I should join or is there some other way to help? I am in financial straits, so monetary contribution to research is not possible at the moment. I thank you for your kindness last year, and for just being there, for people such as I, who never, ever thought to be in this situation. I cry over the difficulties in my relationships still, as he is fearful over contagion, but I have hope now, as I did not before. Bless you for your work.

Response from Dr. Frascino


It appears you may well be an elite suppressor (or "elite controller"). Is this likely to continue? No one knows. It's possible your immune system will continue to control your HIV infection for quite some time. However, some elite suppressors lose control (suppression) for reasons we do not totally understand. There are a number of research groups studying elite suppressors. Your HIV specialists should be able to advise you if anyone in the Seattle area is doing this type of work. If not, he may be able to link you up with researchers at a distant site (such as San Francisco or Boston) where cohorts of elite controllers are being studied. This would require periodic blood specimens be sent to the research group for analysis. I'll repost some information about elite controllers/suppressors below.

Stay well!

Dr. Bob

Insights From People Who Keep HIV in Check Naturally

By Laura Sivitz

Spring 2008

David first learned he had HIV in 1986. "I of course assumed that I'd be dead in two or three years at most," he recalls. (This story uses a pseudonym to maintain his confidentiality.) His first sexual partner died of AIDS around 1993, and his second partner has been HIV-positive and on antiretroviral medications for many years. David used to refer to his regular 6-month medical check-up as his "lottery ticket," never knowing when the virus would trigger disease in him as it had in so many others.

Twenty-two years after his diagnosis, David has not developed HIV-related disease despite never having taken medications to fight the virus. Remarkably, his immune system has remained healthy on its own.

Elite Controllers: Who They Are and What They Might Teach Us

David is part of a small group of HIV-infected individuals -- about 1 in every 3,000 -- whose immune systems naturally and durably control the virus. There is no standard definition for people like him, who are known variously as long-term nonprogressors, elite controllers, elite suppressors, or HIV controllers. Scientists generally define them as people who maintain no more than 50 copies of HIV per milliliter (mL) of blood over a period of at least 1 to 2 years despite never having taken antiviral medications. Some elite controllers have contained HIV at that low level for decades. In contrast, most HIV-infected individuals have between 10,000 and 1 million copies of HIV/mL before they start treatment. The higher the level of HIV, the more likely the person will develop disease and progress toward AIDS.

Elite controllers are of great medical interest. Their immune systems may inform the design of an HIV vaccine that suppresses virus replication and may reveal which cellular activities should be measured as markers of success in participants of HIV vaccine clinical trials.

Mark Connors, M.D., head of the HIV-Specific Immunity Section of NIAID's Laboratory of Immunoregulation, has studied elite controllers for 15 years to unveil the clues their immune systems possess. He first identified these remarkable individuals during his work on virus-specific immunity in the early 1990s. Among participants in his study at that time, "there were a few people who had this inexplicable level of control of HIV," he recalls. "We suspected that they were somehow different." In experiments with specialized mice containing transplanted human cells where HIV replicates, Dr. Connors and his colleagues demonstrated that certain immune-system cells from the HIV controllers mediated control of the virus in the mice. That finding led him to focus on determining how controllers' immune cells were keeping the virus at bay.

Since then, hundreds of scientists -- many in collaboration with Dr. Connors -- have attempted to uncover the mechanism or mechanisms behind HIV control. Most have concluded that biological characteristics of elite controllers, not a quirk of the virus, are responsible. But identifying the factors at work is an extremely complex task because the bodies of elite controllers appear to employ different combinations of tactics to suppress HIV.

Pursuing the Keys to HIV Control Dr. Connors' group focuses on immune-system cells known as CD8+ T cells, also called "killer" T cells. As their name implies, killer T cells hunt down infected cells and destroy them. Our bodies have billions of killer T cells, but only a relatively small number can identify any one particular disease-causing microbe.

To understand the unique characteristics of HIV-specific killer T cells in elite controllers, Dr. Connors, staff clinician Stephen Migueles, M.D., and their coworkers are comparing the immune functions of controllers with the immune functions of two groups of chronically HIV-infected people who cannot control the virus naturally -- people known as "progressors" or "non-controllers." One group of progressors has not started antiretroviral treatment, while the members of the other group take antiretroviral drugs that have reduced their viral loads to levels similar to those of controllers. All these study participants, including David and 49 other elite controllers, come to NIAID from around the country once every 6 months for medical checkups and to donate white blood cells and plasma, the liquid part of blood.

"It's really gratifying to find a research study and people who [are trying] to figure out the mechanism of what's going on that allows me to be different," says David, who learned about the study through an online chat on an AIDS-focused Web site. (Volunteers continue to be recruited.)

Controllers and untreated progressors initially have comparable proportions of HIV-specific killer T cells relative to the total number of T cells in their blood. Yet in the controllers Drs. Connors and Migueles have studied, HIV-specific killer T cells have unique qualities that enable them to destroy HIV-infected cells.

For instance, in controllers, once an HIV-specific killer T cell detects an HIV-infected cell, the killer T cells quickly multiply. In progressors, however, they don't. In fact, controllers have 20 times more HIV-specific killer T cells than treated progressors.

Also, in the presence of HIV, controllers' HIV-specific killer T cells boost production of a molecule called perforin that pokes holes in HIV-infected cells, creating entryways for other molecules that program the infected cells to die. This boost in perforin production doesn't happen in progressors.

Furthermore, when molecules on the surface of HIV-infected CD4+ T cells -- the chief immune-system cells that HIV uses to replicate itself -- present pieces of chopped-up viral proteins to the immune system, the HIV-specific killer T cells of most controllers home in on a limited number of protein fragments presented by just one molecule. In contrast, progressors' HIV-specific killer T cells respond to 15 to 20 different protein fragments presented by a range of molecules on CD4+ cells, yet more is not better.

In addition, the killer T cells of controllers tend to be better "multitaskers" than those of progressors because they send out a greater variety of chemical messengers in larger quantities. This characteristic is called polyfunctionality.

In collaboration with Dr. Connors' group, Richard Koup, M.D., of the immunology laboratory in NIAID's Vaccine Research Center, identified polyfunctionality in both killer T cells and CD4+ T cells. Interestingly, Dr. Koup has found polyfunctionality to be a common thread across multiple viral infections controlled by the human immune system. "The more polyfunctional your T cells, the better the virus is controlled," he says, "or the better the virus is controlled, the more polyfunctional your T cells." More research is needed to determine whether polyfunctionality is a cause or an effect of low viral levels.

Dr. Connors is also investigating cause and effect of the proliferation of killer T cells and their accelerated production of perforin -- normal biological activities of healthy immune systems in response to a pathogen. Dr. Connors' group has demonstrated that using HIV medications to lower progressors' virus levels to the same point as that of elite controllers does not stimulate HIV-specific killer T cells to proliferate or to make more perforin. This indicates that progressors' HIV-specific killer T cells have a defect that persists even in the presence of low levels of HIV. But proving that the proliferation of HIV-specific killer T cells and their ramped-up production of perforin are actually driving forces behind HIV control will require more research. Dr. Connors says his group is gradually beginning to develop animal models to test this hypothesis. If he can prove causation in an animal, his work will suggest that stimulating killer T cells to proliferate and boost production of perforin may be part of the recipe for a vaccine or therapeutic that would help some people maintain low levels of HIV.

Many elite controllers who volunteer in studies like those of Dr. Connors relish the opportunity to contribute to scientific understanding of HIV and AIDS. "It's one of the most amazing things I've ever been involved with," says David, who enrolled in the NIAID study in 2006. "I wish that I'd gotten involved earlier." Some elite controllers are willing to go so far as having a spinal tap or a gut-tissue biopsy to help HIV/AIDS researchers investigate unanswered questions. As far as David is concerned, "I'm just really glad there are peoplewho are willing to dedicate their lives to doing this research."

References MR Betts et al. HIV nonprogressors preferentially maintain highly functional HIV-specific CD8+ T cells. Blood 107(12):478189 (2006). SA Migueles and M Connors. The role of CD4(+) and CD8(+) T cells in controlling HIV infection. Current Infectious Disease Reports 4(5):46167 (2002). SA Migueles et al. HIV-specific CD8+ T cell proliferation is coupled to perforin expression and is maintained in nonprogressors. Nature Immunology 3(11):106168 (2002). SA Migueles et al. HLA B*5701 is highly associated with restriction of virus replication in a subgroup of HIV infected long term nonprogressors. Proceedings of the National Academy of Sciences 97(6):270914 (2000). This article was featured in the spring 2008 issue of NIAID Discovery News.

Is it possible never to be on Meds (ELITE CONTROLLERS) Aug 19, 2007

Hello Dr Bob,

Is it poosible (or have u ever heard of someone) that is POZ and have never been on Meds or needed meds. I am POZ. I have been POZ for a year. My T-Cell is 860 with undectable Viral. I guess I am holding on to hope I will never need meds. Is it possible?

Response from Dr. Frascino


Is it "poosible?????" Considering Dubya and Voldemort (I mean Cheney) were reelected, I assume anything is "poosible!"

Seriously, yes, it is possible. A small number of poz-people have remained healthy and not shown the usual slow immunological decline associated with HIV/AIDS. We call these folks "elite controllers." See below. We also call them damn lucky! Will you be one of them? Time will tell. I certainly hope so!

Good luck!

Dr. Bob

No Meds (ELITE CONTROLLERS) Jul 27, 2007

I have been positive since 1992, and monitor my numbers religiously. I doubt that since this is a drug sponsored site this will ever be published, but it would be doing a service to note that NOT being on meds is what has kept me alive - as I watch others shrink, bloat and pop -- wishing they had never either. Also, what is the proposed co-factor along w/ HIV (as put forth by Montagnier - who believes HIV is not enough). BTW, my highest CD4 counts (non-blips) have occurred in the 14th year of infection and have remained range cound throughout.


Response from Dr. Frascino


As you can see, your doubts that your comments would be posted are unwarranted. Yes, the site does have some pharmaceutical company sponsorship (otherwise it wouldn't be able to function as a free service to all in need), but I can assure you I do not! The experts here present scientifically-sound information not product marketing!

Next, I'm delighted you are doing well never having taken medications. Although I have no idea what ". . . have remained range cound throughout" means, it appears that you may be one of the extremely small and very lucky HIVers who we call "elite controllers" or "non-progressors." We are actively studying such folks to gain additional information as to why HIV has not progressed in cases like yours. (See below.)

As for others who "shrink, bloat, and pop . . . ," I certainly will admit taking HIV meds is no picnic and the side effects can be challenging. However, please note that these medications are for many of us absolutely live saving. I have no doubt I would not be here today responding to your question without them! The miraculous decline in HIV/AIDS morbidity and mortality that occurred simultaneously with the introduction of HAART (highly active antiretroviral therapy) in mid-1996 cannot be denied. So even though you have done well not taking medications, please don't be so presumptuous as to assume those of us who did "wish we never had!" I can assure you that is not the case!

Finally, Montagnier's cofactor concept dates back to the early 1990s. That's ancient history in HIV/AIDS terms! We have learned much since then about HIV pathogenesis. I suggest you spend some time perusing the wealth of information on this site! You have much to learn!

Dr. Bob

Who Are the Elite Controllers?

By Bob Huff

December 2005

Who are the elite controllers? No, they're not initiates of Yale's secretive Skull and Bones Society or members the Trilateral Commission. Elite controllers are people infected with HIV who have been able to suppress their virus without using antiretroviral medications. And Dr. Bruce Walker of Boston wants to meet them and find out how they do it. It's been appreciated for many years that some people with HIV do not progress to AIDS at the same pace as most. Typically, the immune damage of untreated HIV infection will lead to life threatening opportunistic infections within eight to 12 years. But some people have been infected for 20-25 years or more and have not yet experienced the severe loss of CD4 immune cells that signals AIDS.

These people have been termed long-term nonprogressors, and in the mid 1990s, researchers began studying them to try to understand why some people progressed to disease and others didn't. The ultimate hope was that whatever protective qualities these people carried naturally could be stimulated in everyone. There are also other long-term survivors of AIDS who have experienced immune damage but have managed to thwart the virus with treatments, although these people may also have had help from their immune system or a genetic resistance to HIV.

For Walker and colleagues at the Partners AIDS Research Center who are coordinating the study, duration of infection is not the main criterion; they are looking for anyone who can control their HIV without drugs. Elite controllers are defined as people with asymptomatic HIV infection not taking antiretroviral therapy (ART) who have experienced at least one year with HIV RNA below 50 copies/mL (undetectable). Participants must have at least three sets of test results documented within one year. Occasional viral load blips up to 1,000 copies/mL are allowable.

Walker estimates that there may be 1,500 or more elite controllers in the United States. The research group has already collected blood from over 100 people and has set a target of enrolling 1,000 elite controllers into the study. They are also interested in finding a similar group of people with asymptomatic HIV infection who, while not undetectable, do manage to keep their HIV RNA levels under 2,000 copies/mL without drugs. Walker calls these people, who may be much more common, viremic controllers. A long list of prominent HIV physicians have signed up to scout for elite controllers, but individuals who think they fit the criteria can contact Walker's group in Boston directly to submit a blood sample.

The study plans to use gene sequencing techniques of the Human Genome Project to construct a haplotype map for each participant, in hopes of identifying genetic factors that may be contributing to their ability to control HIV infection. A haplotype map allows scientists to look for variations in genes as they are commonly organized on the chromosomes. Advanced data analysis will evaluate if multiple gene variants are possibly associated with spontaneous control of HIV. Genetic sequencing and data analysis will be performed at the Broad Institute in Boston. Additionally, high resolution HLA typing will be conducted to look for genetic differences in these immune markers, and adaptive immune responses and antibody studies will also be performed. The entire genome of each person's virus will also be sequenced to see if some viruses are more controllable than others.

These new genetic tools allow researchers to take the closest look yet at what might make those lucky few who can control their HIV without drugs different from everyone else. If they can uncover some previously unrecognized protein or mechanism that is common to all elite controllers, then the next step will be to look for a drug than can safely produce the same effect in everybody else.

Researchers to Study HIV-Positive "Elite," "Viremic Controllers"

August 17, 2006

Researchers on Wednesday at the XVI International AIDS Conference in Toronto announced plans to conduct a collaborative study on HIV-positive "elite controllers" and "viremic controllers," the Washington Post reports (Brown, Washington Post, 8/17). Elite controllers are HIV-positive people whose immune systems for long periods of time have been able to keep the virus at undetectable levels without using antiretroviral drugs. Viremic controllers are HIV-positive people whose immune systems have kept the virus at barely detectable levels without antiretrovirals. Researchers believe it is unlikely that elite or viremic controllers can transmit the virus (Kaiser Daily HIV/AIDS Report, 7/6). Bruce Walker, director of Partners AIDS Research Center at Massachusetts General Hospital, and colleagues already have enrolled 200 elite controllers in a study, and the researchers in the next six months plan to enroll 1,000 more elite and 1,000 viremic controllers, Toronto's Globe and Mail reports (Abraham, Globe and Mail, 8/17). The researchers plan to compare genetic sequences of the elite participants with other HIV-positive people, as well as HIV-negative people, to determine whether there are genetic variations that can explain why elite and viremic controllers can suppress the virus (Fox, Reuters AlertNet, 8/16). Researchers need to enroll at least 1,000 elite controllers, so that their genetic findings can have significance, the San Francisco Chronicle reports (Russell, San Francisco Chronicle, 8/17). "We're looking at people whose bodies durably live with HIV without it causing a problem," Walker said (Chase, Wall Street Journal, 8/17). "If we could discover how these individuals can coexist with this virus without damage to their immune system and could find a way to replicate that ability in others, we would have a recipe for halting the HIV epidemic," Walker said, adding, "There is a reasonable chance we will come up with something very important with this" (Globe and Mail, 8/17). He also said that while researchers are "excited about the possibilities," they "realize this might not lead to any breakthroughs" (Wall Street Journal, 8/17). Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, on Wednesday said that it is too early for optimism but that the research could be promising. "I believe we should get out and study elite controllers, but we should be conservative in what we expect from this research," Fauci said, adding, "This is still a very problematic and enigmatic virus." The study was funded by a $2.5 million grant from the Mark and Lisa Schwartz Foundation (San Francisco Chronicle, 8/17).

Los Angeles Times Examines HIV-Positive "Controllers," Studies, Research Difficulties

July 6, 2006

The Los Angeles Times on Thursday examined HIV-positive "elite controllers" -- people whose immune systems for long periods of time have been able to keep HIV at undetectable levels without using antiretroviral drugs -- and "viremic controllers" -- HIV-positive people whose immune systems have kept the virus at barely detectable levels without using antiretrovirals -- and the difficulties of conducting research on such individuals. According to the Times, elite controllers are "extremely rare" and account for about one-third of 1%, or about 2,000, known HIV-positive people. Researchers believe it is "unlikely" that elite or viremic controllers can infect others with HIV, the Times reports. "I would say we still don't have the faintest idea why these people are doing as well as they are," Bruce Walker, director of Partners AIDS Research Center at Massachusetts General Hospital, said, adding, "Achieving the state that these guys have reached in their bodies -- if we could do that through some intervention, we would solve the AIDS epidemic."

Studies To learn why and how HIV remains at extremely low levels in controllers, researchers are studying both the innate immune system -- which provides a "general response" that immediately activates to "dismantle" incoming pathogens -- and the adaptive immune system -- which is a longer-term response that relies heavily on antibodies, including CD4+ T-cells -- according to the Times. Steven Deeks of the University of California-San Francisco and colleagues assembled a group of 50 elite controllers to analyze their adaptive immune systems and found that half of the controllers fought the virus through a "powerful response by T-cells," and the other half showed no T-cell response, the Times reports. "The 25 people in our cohort who have no T-cell reaction can provide insight into whole new ways of thinking," Deeks said, adding, "There are 25 guys who have no reason for controlling the virus." In a related study, Jay Levy of the University of California-San Francisco and colleagues focused on the infection-fighting tools of the innate immune system to identify antiviral proteins found in controllers, the Times reports. Controllers show that the immune system is able to contain HIV naturally, Levy said, adding, "This has been a long time coming, but in my opinion we can look forward to long-term survival without toxic drugs."

Research Difficulties Some researchers believe that controllers are able to contain HIV because the strain of the virus with which they are infected is defective, the Times reports. To study every controller for defective HIV would be "prohibitively expensive," Deeks said, adding that if such a study were initiated, the idea would be "to see if the virus is there and if it is defective, because, in theory, that virus will give good insights into making an effective vaccine." Another problem with studying controllers is that there are not enough of them to assemble local cohorts large enough to study effectively, the Times reports. Walker and his research team at Massachusetts General Hospital have assembled 76 elite controllers and 100 viremic controllers from across the country to participate in a new study. "Basically, we want to recruit every single one of these people in the [U.S.]," Walker said, adding, "We have to have a large enough sample to begin to see patterns in this population" (Ricci, Los Angeles Times, 7/6).

elite controllers Jul 12, 2007

Hello Dr Bob you are one funny guy.. Re elite controllers . assuming low or undetectable viral load does antibody test always present positive? Thank you for your response and all the best.

Response from Dr. Frascino


Would that be "funny" as in funny Ha! Ha! or "funny" as in severely twisted individual??? Oh, all of the above!?! I see. Well OK then, I'll answer your question.

Even with undetectable viral loads, elite controllers would always test HIV-antibody positive. (If they didn't, we'd never know they were HIV infected or they were controlling anything, elite or not.)

Dr. Bob

just tested positive (CHOOSING AN HIV SPECIALIST 2010) Jan 25, 2010

iknow i got infected on jan 5th 2009,three weeks after that a had a throat infection.3-4 months after that i develop a lympnode in my neck,both side,arm pit,groin area.8- 9 months after that had a slight night sweat which goes on and off. till date after testing positive i have not done any test to see if i need medication. in how much danger am i putting myself

Response from Dr. Frascino


Without more sophisticated testing (CD4 cell count, HIV plasma viral load, etc.), it's impossible for me to ascertain how much damage has been done to your immune system. Close clinical monitoring and routine laboratory assessments are strongly recommended for all HIVers. What are you waiting for? I urge you to establish care with an HIV specialist physician without further delay. Your health and well being are at stake. See below.

Dr. Bob

HIV Positive and pregnant (CHOOSING AN HIV SPECIALIST 2009) Nov 2, 2009

I tested positive in 2006 and haven't gone for any check up's to check my cd4 count and now I'm pregnant and still afraid to go for a check up. My husband is also positive and we still have sex without a condom, what are the chances that our baby will be infected, when do i start taking medication to prevent my baby from being infected and is it safe to take arv's when you are pregnant because i hear you sometimes get sick when you take them for the very first time?

Response from Dr. Frascino


I find it terribly unfortunate and a bit sad that fear has prevented you from getting appropriate monitoring and treatment for your HIV disease. I hope you realize that by not getting the care you need, you are allowing the virus to replicate unchecked in your body and in turn slowly destroy your immune system. It is imperative that you establish care with an HIV specialist physician and HIV-knowledgeable obstetrician immediately. Certain antiretroviral medications can be taken during pregnancy and they significantly decrease the risk of mother-to-child HIV transmission. Without treatment, the chances your child will be HIV infected will be dramatically increased. Also, if you don't get appropriate care and treatment, the chances you'll be around to see your child grow up are slim to none. I can tell you if I had been too afraid to get treatment when I became HIV infected in January 1991, I wouldn't be here today to respond to your question.

I'll reprint some information below about finding an HIV specialist.

Good luck. Don't let fear keep you from getting the care you need!

Dr. Bob

Just found out... (CHOOSING AN HIV SPECIALIST) Sep 20, 2008

Well, doc, the feelings came and went and I got the nerve to test. It was positive... I don't know what to do now and I don't even know if I have long left cause of how bad I had the ARS and weight loss...

I want to live... I want to live a long happy life... I live in Texas, am I screwed? I'm a student in a grad school, so I'm poor, but what can I do? How do I move forward?

Response from Dr. Frascino


Only those of us who have been through it really understand the full impact of hearing the words "your test came back positive." Many of us feel scared, wondering if we will soon get sick or die. We fear that we will be shunned, lose our jobs or maybe our housing; that we won't be able to have children; that we'll never be able to date, get married or have sex again. None of these things are, in reality, true.

The virus found me while I was working over 17 years ago! Back then, the prognosis for HIVers was about 10 years max. We've made remarkable, in fact miraculous, improvements in treatment of HIV/AIDS, which have dramatically decreased both morbidity (illness) and mortality (death) as demonstrated by the fact I'm still here answering your question rather than pushing up daisies. It is true we do not have a cure, but for many of those lucky enough to have access to antiretrovirals and expert (or at least competent) HIV medical care, "virally-enhanced," healthy and fulfilling lives are truly attainable. Here in the U.S., even for those who don't have or can't afford private health insurance (this includes undocumented immigrants, by the way), it is possible to get quality HIV care and support in most areas of the country.

Now that you know you are HIV positive, I would recommend two simple first steps:

  1. Consult an HIV specialist. She will be able to assess the severity of your HIV disease and also help you access the health care system based on your health insurance or lack thereof. To locate an HIV specialist in your area, check the American Academy of HIV Medicine's Web site at There you will find a roster of certified HIV specialists listed by locale. (I'll also print some information below from the archives that discusses choosing an HIV specialist.)

  2. Get informed! Learn as much as you can about HIV and its treatments. This Web site is an excellent place to accomplish that. Begin by reviewing the information in the "Just Diagnosed" chapter that can be easily accessed on The Body's homepage under the Quick Links heading. Start with the articles found under the "Just Diagnosed Basics" subheading.

Finally, as far as living in Texas, well, yeah, that kinda sucks, but it really shouldn't impact negatively on your HIV disease.

Start learning more about HIV and get evaluated by an HIV specialist. I'm here if you need me. Let's get through this together, OK?

Dr. Bob

Need a Private doctor Aug 14, 2008

I am HIV Positive living in Seattle area. I currently don't have one and i am looking urgently in a private clinic? Do you know a good one? I asked this question earlier & was told about Peter Shalit who is fully booked until end of year. Please let me know if you have a good one in mind. Thank You.

Response from Dr. Frascino


I would suggest you consult the American Academy of HIV Medicine Web site ( There you will find a list of certified HIV specialists arranged by locale. There are a number of well-qualified HIV specialists in the Seattle area. Be sure you hook up with one that you trust and with whom you can easily communicate. Your health insurance plan may have some restrictions, so remember to check this out as well. I'll repost some information below from the archives pertaining to locating an HIV specialist.

Good luck.

Dr. Bob

Choosing an HIV Care Provider

July 18, 2007

Why Is Choosing an HIV Care Provider Important?

Treating HIV disease is very complicated. There are choices to consider at every stage of the disease. It's best if you and your health care provider work together as a team. That makes it easier to choose and stick to your treatment plan. "Care provider" means a doctor, a physician's assistant, or a nurse practitioner.

There are several issues you may want to consider in choosing an HIV care provider. You might decide to have them be your "regular doctor" for all of your health issues. You might use a different care provider for most health issues and use your HIV provider as a specialist. If your regular provider isn't an HIV specialist, be sure they regularly get expert advice on HIV issues.

Training and Experience

Many people with HIV/AIDS get their care from physicians who are specialists in infectious diseases. However, especially now that people are living longer with HIV, it's important to deal with all of your health issues. You might prefer to have a family practitioner or a specialist in internal medicine as your primary physician.

No matter what their specialty, you will get better HIV care from providers who have experience treating people at all stages of HIV disease. Be sure to ask how many patients with HIV they have treated, and how many they currently see. HIV patients do better when their physicians have more experience treating HIV disease.

Do You Have Similar Ideas About Treating HIV?

Some providers are conservative. They prefer "tried and true" methods. Others are more aggressive. They are willing to try new and experimental treatments. Some are optimistic by nature, and focus on the hopeful or positive side when they talk about test results or future prospects. Others are more realistic. Some are pessimistic.

Some providers are comfortable suggesting "complementary and alternative" therapies such as massage, acupuncture, or herbs. Others stick strictly to Western medicine.

If you want a lot of emotional support, you probably won't be comfortable with a health care provider who only talks about test results. The more comfortable you are with their approach to HIV treatments, the easier it will be for you to get the kind of health care you want. Talk to providers and their patients before you make your choice.

The Provider-Patient Relationship

Many patients do better when they take an active role in planning their own health care. These patients do a lot of reading on their own, and bring information to their providers. They work together to make health care decisions.

Other patients are more comfortable with the provider making important decisions. Decide how you want to work with your provider. See if that fits with the way the provider likes to work with patients.

Help Your Provider Help You

Make sure that your provider has all the information needed to give the best advice about your treatment. This starts with your medical records, which may have to be transferred from another office. When you start working with a new provider, they will probably do a lot of tests to collect "baseline" information. This helps you see how well you're doing as time goes by.

Be sure your provider knows how you feel about using medications, and about your illness. Some people don't mind taking a lot of pills. Other people would rather take as few as possible. Are you willing to change your diet, or the amnount of exercise you do? Your provider should also know about other treatments you are using or want to try, including non-medical ones.

Be honest about your lifestyle. Your eating, sleeping, and work patterns can make a difference for your health care. So can your sexual practices and use of recreational drugs. If your provider seems too judgmental, try to change providers. It's better to have a provider who really knows you instead of holding back information.

Let your provider know about the important people in your life: the people who will support you if you get sick, or will help you make important medical decisions.


The best care provider won't do you any good if you can't get in to see them. Ask them (or their receptionist) how long it usually takes to get an appointment. Find out how well they usually stay on schedule during the day.

The type of insurance you have could limit your choice of a provider. Maybe the provider isn't on the list for your health maintenance organization (HMO) or insurance plan. Be sure to find out how you will be able to pay for their services.

Remember, you don't need an HIV specialist to help you with most of your health care needs. If a good HIV provider is hard to find, or if it's hard to get an appointment, use a non-HIV care provider for your general health care. Just be sure that when you are dealing with HIV issues, you see an experienced HIV provider, or one who consults with an expert in HIV.


Some people are very concerned about keeping their HIV status private. You might choose to get your HIV care from a provider in another town to protect your privacy. You will need to find your own balance between confidentiality and convenience.

Changing Providers

Your health care needs might change as time goes by. Also, your ideas about treatment could change. Although you will probably get better medical care from a provider who has known you for a long time, you always have the right to stop seeing one provider and change to another.

To Find a Health Care Provider ...

You can get help finding a care provider from your case manager or from your local Department of Health. You can also ask other people living with HIV. The American Academy of HIV Medicine has a web page to help you find a doctor at com_comprofiler&task=usersList.

The Bottom Line

HIV medical care is very complicated, and changes quickly. This makes it important to find an HIV care provider who works with HIV/AIDS patients and is committed to staying up to date. Your relationship with an HIV provider will be better if you are comfortable with each other's personal style and approach to dealing with health issues in general, and HIV in particular.