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Author Topic: HIV and SEVI Enhancement  (Read 11767 times)

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Offline JohnD99

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HIV and SEVI Enhancement
« on: March 11, 2012, 04:25:05 pm »
I wanted to start a thread conveying my experiences so that others may benefit.  I have benefited from some threads on this site, and I have appreciated reading the posts.  Brighton88's story comes to mind.

That being said ....

Exactly 27 days ago I had unprotected vaginal sex with a Thai prostitute, two times in a 20 minute period.  I ejaculated in her both times.  The first time I remember urinating and washing up.  The second time I can't remember, as I was drinking.  I passed out.   I woke up 5 hours later and realized what i had done.  She agreed to test, and 8 hours post exposure she tested positive for HIV.  Her viral load came back as 4,300. 

I began PEP (Efavirenz & Generic Combivir) exactly 8 hours post-exposure.  My brother, an ER doc, suggested switching in Kaletra instead.  At 33 hours I dropped the Efavirenz and took my first Kaletra pills.  Also upgraded to brand name Combivir. 

First 3 days on PEP I had almost no food, and zero sleep.  Then a 34 hour flight back to the USA.  When I arrived home on day 3 of treatment, I was destroyed.  I had developed a painful sore throat and fever, which antibiotics cleared up immediately upon arrival home. I hope the meds did their job despite my total lack of an immune system.

Day 7 post exposure I developed itching and inflammation all over my upper torso.  It felt hot, tender, and painfully itchy.  I also developed a purple/black pigmentation the size of a quarter on my foot.  At first my skin was just enflamed.  Then I developed little red dots on my shoulders, upper chest, neck, and inside of my wrists.  Topical Benadryl and Cortisone cream cleared this up.  It has been a "condition" i have had to manage the entire 30 days on these drugs.  They're harsh.

CURRENT STATUS:

Day 27 post exposure, and on meds.  I have 1 day left of meds.  I am ready to drop them as much as I am terrified to drop them.  They have made me feel like utter hell.  Yet I feel like im dropping poisonous, cancer causing medications and in exchange, leaving myself open to develop HIV. 

The next 7 to 14 days are going to either suck, or be great.  Ill either feel better because im off these toxic pills, or I'll feel better and then begin to *really* get sick (HIV ARS).  A lot of people have posted on here that they've had numerous physical problems AFTER dropping the meds, yet they continue to test negative.  I don't think I could deal with that.  Mentally. 

I have left this situation in Gods hands.  Asked His forgiveness for my arrogance and reckless self destructive behavior.  And requested his Mercy and Grace.  It has caused me to re-evaluate my entire life. 

POST HIV PEP TESTING .........................

I work in the medical industry.  Have done exhaustive research on HIV and STD's.  Probably know a little too much for my own good.  Im aware that CDC and sites like these prefer to stick to conservative suggestions for post-PEP testing.  And I fully respect that.  I also understand exactly why.  However, the current recommendations for HIV PEP meds, and Post-PEP testing, are old.  Nearly 7 years old.  Better medications are available, and reliability in PCR testing is common today.  The prices have also dropped drastically.

It used to be that PCR testing after exposure was discouraged because of the risk of false-positives.  Now however, PCR testing is done with confirmatory testing.  This virtually eliminates that concern.  In addition, many PCR tests are combination antibody tests, adding yet another layer of security.  Therefore, the statement that PCR testing should not be relied upon, is incorrect. 

MY QUESTION

All of that being said.  I realize the conservative (circa 2006) recommendation is to wait 3 months post completion of PEP meds to get an antibody test.  Can someone please tell me why a PCR test 28 days post-completion is not just as acceptable?  I phoned Dr. Houghton, one of the most well known HIV specialists in San Diego to ask this very question.  His protocol now, is to do PCR testing 10 days post completion of PEP.  Ten days.  If at that point you are showing not detected, he gives you a 90% chance of a clean bill of health.  The wise individual will wait at least 14, or the full 28 days. At which point a negative will provide a 98% chance of no HIV.

I have seen people post on here, miserable out of their minds, 6 weeks after completing PEP, and being told that their negative PCR test is only slightly reassuring.  They were then advised to sit another 2 months and get an antibody test, because that PCR test wasn't sufficient.  That really frustrated me because it is not accurate. 

This begs a very important question. 

Why should someone who knows they had HIV exposure, and suffers through 30 days of torturous, poisonous medications, be forced to wait 3 more months to find out if they worked?  I personally don't believe they should.  The medical literature seems to back that up. 

Can someone please tell me why a PCR test 28 days post-completion of PEP is not sufficient for 98% peace of mind on your status?  I am aware that antibody tests are the only test which tell you if you actually GOT infected (seroconverted / created antibodies).  But if you are not on meds, and you are below 50 copies, 1 month after taking meds, and 2 months after exposure .... why is this not sufficient?

Thank you.

JD
« Last Edit: March 11, 2012, 05:07:53 pm by JohnD99 »

Offline RapidRod

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Re: My Story - HIV Exposure and PEP
« Reply #1 on: March 11, 2012, 05:20:31 pm »
And it's really going to suck if you have to take medication the rest of your life for a stupid act.

Offline JohnD99

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Re: My Story - HIV Exposure and PEP
« Reply #2 on: March 11, 2012, 06:10:58 pm »
Wow.
« Last Edit: March 11, 2012, 06:41:04 pm by JohnD99 »

Offline RapidRod

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Re: My Story - HIV Exposure and PEP
« Reply #3 on: March 11, 2012, 06:54:56 pm »
You can obtain your conclusive test result 3 months post your last dose of nPEP. PCR-RNA tests are not standalone tests they are supplemental tests used in conjunction with an antibody test.

Offline JohnD99

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Re: My Story - HIV Exposure and PEP
« Reply #4 on: March 11, 2012, 07:01:14 pm »
Thanks Rod, but I already addressed that in my initial post.

Your response does not answer my question.

Here again is the question:

Quote
Can someone please tell me why a PCR test 28 days post-completion of PEP is not sufficient for 98% peace of mind on your status?  I am aware that antibody tests are the only test which tell you if you actually GOT infected (seroconverted / created antibodies).  But if you are not on meds, and you are below 50 copies, 1 month after taking meds, and 2 months after exposure .... why is this not sufficient?

PCR tests are, on their own, fully capable of identifying the presence of HIV.  The antibody test is only combined with it to determine if seroconversion has completed yet.  Any positive quantification on the PCR test means a positive or impending HIV infection.  I know of absolutely no data which shows a positive PCR and no subsequent seroconversion.  Therefore the antibody test is actually the one that is "supplemental" in this combination.  Not the other way around. 

The *only* exception to this is the sometimes "transient positive viral load" levels during the first weeks PEP therapy.  Only in those such cases would a positive PCR test potentially abort, and the individual not seroconvert.  This is why PCR is only *NOT* recommended if you are still on meds.

My question is about after meds are completed.

Anyone else?
« Last Edit: March 11, 2012, 07:19:17 pm by JohnD99 »

Offline RapidRod

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Re: My Story - HIV Exposure and PEP
« Reply #5 on: March 11, 2012, 07:19:28 pm »
What part aren't you understanding? They ARE NOT approved to give a conclusive test at anytime. 

Offline Andy Velez

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Re: My Story - HIV Exposure and PEP
« Reply #6 on: March 11, 2012, 07:22:39 pm »
Listen, you can do whatever you want to about testing. We follow the CDC recommendation which is to test at 3 months after completion of PEP.

You can test initially at 6 weeks afterwards if you choose. If you test negative at 6 weeks then the likelihood is that you will continue to test negative for a conclusive result at 3 months.

That's our official position. You're free to do otherwise if you choose to. But we are not going to debate the merits of that versus your evaluation
doing a PCR, which is not approved for a conclusive result.

Call it cautious or call  it overly conservative, but that's the deal here.

You're just trying to find a shortcut for yourself. Listen, you had a risk through your own carelessness. Doesn't it occur to you that it makes sense to test in a manner which will leave you with absolute reliability in what hopefully will be a conclusive negative result?
« Last Edit: March 11, 2012, 07:25:46 pm by Andy Velez »
Andy Velez

Offline JohnD99

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Re: My Story - HIV Exposure and PEP
« Reply #7 on: March 11, 2012, 08:14:37 pm »
Quote
Doesn't it occur to you that it makes sense to test in a manner which will leave you with absolute reliability in what hopefully will be a conclusive negative result?

Yes.  And given that PCR tests at 28 days *are* absolutely reliable and conclusive in detecting HIV in the blood - as per *all* the data out there (not as per my opinion), then I am doing just as you suggest.  The way you phrase it, it still seems that you don't believe PCR tests are accurate.  I am confused as to why.  That really is all I was asking. 

There is absolutely no reason why anyone should have to sit and be tortured with uncertainty for months and months with this disease anymore.  And when the CDC and the FDA finally decide to update their documents, not only will you see PCR testing but you will see a whole new group of medications recommended.  That, as per another HIV specialist here in Miami Florida 2 weeks ago I spoke to.

Based on the responses I have received, you dont disagree.  You just prefer to stick to the 7 year old CDC recommendations.  And I totally respect that.  100%.  But lets not take it a step further and imply that a PCR at 28 days is inferior, unreliable, or ineffective at what it does.  That simply does not jive with any of the medical literature in existence.  And i have to admit i have a problem with people being told that they can't know anything with any certainty via PCR test.  That's quite simply total misinformation.

I would encourage everyone to look at the following link, from world reknown UC San Diego University.  Now calling the PCR test by the name "The Early Test".  Blatantly calling it the new way to receive accurate diagnosis of HIV infection in as little as 7 days.  They do run an antibody test with it, which is standard protocol, and which I already acknowledged was beneficial and helpful:

https://theearlytest.ucsd.edu

Thanks everyone.  I will bow out now.

And for the record - people like RapidRod make me not want to use this site.  I have seen his posts for many years.  He is a caustic individual with the grammar skills of a 2nd grader.  And his first response to my sincere post was utterly appalling and uncalled-for.  He is a detriment to this community.

JD

« Last Edit: March 11, 2012, 08:24:43 pm by JohnD99 »

Offline RapidRod

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Re: My Story - HIV Exposure and PEP
« Reply #8 on: March 11, 2012, 08:19:41 pm »
Yes.  And given that PCR tests at 28 days *are* conclusive, as per *all* the data out there (not as per my opinion/evaluation), then I am doing just as you suggest.  The way you phrase it, it still seems that you don't believe PCR tests are accurate.  I am confused as to why. The real question here is why the data, and recognized science is being ignored.  Not why I recommend a PCR test.

I have a mountain of studies proving my position. 

I have yet to hear a single reason why its wrong.

I respect your decision to stick with the CDC's 7 year old recommendations.

Totally your choice, and i totally understand why you go that route.

But since I don't run a web site, this is about the data for me. 

Not what's popular.

I would encourage everyone to look at the following link, from world reknown UC San Diego University.  Now calling the PCR test by the name "The Early Test".  Blatantly calling it the new way to receive accurate diagnosis of HIV infection in as little as 7 days:

https://theearlytest.ucsd.edu

Thanks everyone.  I will bow out now.

And for the record - people like RapidRod make me not want to use this site.  His first response was appalling and uncalled for.

JD
Now you are speaking about shit you have no idea what you are talking about. PCR-RNA tests have never been approved as a standalone test or at 28 days being conclusive. There are no tests marketed or sold to give a conclusive negative test result earlier than 3 months post exposure.

Offline JohnD99

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Re: My Story - HIV Exposure and PEP
« Reply #9 on: March 11, 2012, 08:37:36 pm »
Allow me to just put this one more way before I go:

I would rather have 98% reassurance at 28 days, than ZERO assurance for 3 months.

I can always go get the antibody test at 3 months for good measure, and recommending that to people makes total sense.

Telling them that their PCR at 28 days isn't sufficient, reliable, or is useless - is wrong.

Offline RapidRod

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Re: My Story - HIV Exposure and PEP
« Reply #10 on: March 11, 2012, 08:39:40 pm »
How many times does it have to be explained to you that it is not approved to be a standalone test nor can it give a conclusive test result by itself?

http://www.cdc.gov/globalaids/Resources/pmtct-care/docs/TM/Module_6TM.pdf
Page 11
#4
  In an adult, a positive HIV antibody test result means that the person is infected, a person with a negative or inconclusive result may be in the “window for 4 to 6 weeks but occasionally up to 3 months after HIV exposure. Persons at high risk who initially test negative should be retested 3 months after exposure to confirm results

UK Fourth Generation  Testing
http://www.bhiva.org/documents/Guidelines/Testing/GlinesHIVTest08.pdf
Post testing
Page 11
The need for a repeat HIV test if still within the window period after a specific exposure should be discussed. Although fourth generation tests shorten the time from exposure to seroconversion a repeat test at three months is still recommended to definitively exclude HIV infection.
« Last Edit: March 11, 2012, 08:41:31 pm by RapidRod »

Offline Andy Velez

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Re: My Story - HIV Exposure and PEP
« Reply #11 on: March 12, 2012, 08:47:38 am »
We're not here to argue with you. Rod has given you very reasons as to why we continue to follow the 3 months CDC recommendation and specifically why the PCR is not a stand alone reliable result at 28 days.

Of course you're free to make your decision.

Like I said we're not going to argue with you about this. You've made your opinion very clear. I will warn you that if you return with more combative commentary you will very quickly find yourself getting a Time Out from the site.
« Last Edit: March 12, 2012, 08:49:25 am by Andy Velez »
Andy Velez

Offline JohnD99

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HIV and SEVI Enhancement
« Reply #12 on: March 15, 2012, 08:48:46 pm »
Hi Andy and Ann!

Was doing some research today and was wondering if you guys had ever heard of this.  In summary - the presence of semen can enhance the infectiveness of HIV by literally hundreds of times. 

Naturally when i read this, my head almost exploded.  That's quite a scary statement.  I have spent the afternoon reading the relevant studies (you can see the main one here:  http://hal.archives-ouvertes.fr/docs/00/66/38/92/PDF/1742-4690-7-55.pdf )

However I have failed to find a single "real life scenario" discussion about this issue.  In other words, what exactly does this mean to the various ways in which people have sex?  Right now we know things from the available data, such as "Receptive Anal is the highest risk act".  And "insertive vaginal is the lowest risk".  And "Oral sex carries little to no risk".  We've had people write those laymans terms phrases for us based on all the very highly technical studies that have done research. 

But what about this issue?  I have found only one discussion paper which alludes to these studies about "SEVI" and it stated that its relevant only to an HIV+ male inserting into an HIV negative female.  Male to Female transmission.   

The implication there is that the fibrous pieces which are formed when combining semen and the HIV virus are only formed within an HIV+ male.  However this study clearly states (Figure 2B, and explanation on the page before that) that they took regular semen, and mixed it with hiv virus, and *instantly* it became infective 5, 10, 50, 100 fold times .... Figure 2B shows that after 5 minutes it had gone up 200 times, and by 5 hours it was nearly 1,500 times more infective. 

This implies that an HIV negative male can insert into an HIV+ female and ejaculate, creating a highly infective environment for *himself*.  Especially if he inserts a second time while his semen is still in there. 

My question to you guys is this:  Have you heard about this study?  Have you heard any reliable discussion on what scenarios are affected by its findings?  Is it truly just an HIV+ male to Female risk? 

This just seems like such a huge new bit of research that it should be wildly discussed.  One might even say "If you dont cum inside a female who is HIV+ you reduce your risk by 100,000 times compared to if you did!"

Thanks.

J

Offline RapidRod

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Re: HIV and SEVI Enhancement
« Reply #13 on: March 15, 2012, 09:24:38 pm »
Please do not start a new thread every time you have another question or thought - regardless if you think your questions are related to each other or not. It helps us to help you when you keep all your thoughts or questions in one thread and it helps other readers to follow the discussion. Additional threads will be merged.

If you cannot find your thread, click on the "Show own posts" link in the left-hand column of any forum page, under your name.

Offline Ann

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Re: HIV and SEVI Enhancement
« Reply #14 on: March 16, 2012, 05:30:11 am »
John,


I've merged your new thread into your original thread - where you should post all your additional thoughts or questions. It helps us to help you when you keep everything in one thread. It doesn't matter how long it has been since you last posted in your thread or if the subject matter is different.

If you need help finding your thread when you come here, click on the "Show own posts" link under your name in the left-hand column of any forum page.

Please also read through the Welcome Thread so you can familiarize yourself with our Forum Posting Guidelines. Thank you for your cooperation.





This implies that an HIV negative male can insert into an HIV+ female and ejaculate, creating a highly infective environment for *himself*.  Especially if he inserts a second time while his semen is still in there. 


Seriously? It sounds to me like you're putting a chicken in the oven and serving up a pork roast.

Just because something happens in vitro doesn't mean it's going to happen in vivo. If what happened in vitro worked every time in real life, we would have had a micorbicidal gel by now that would protect women against hiv in cases where men refuse to wear condoms. We've been working on microbials for years now will little real life success, despite some fantastic in vitro results.

The implications of this study have nothing to do with you, unless there's something you haven't been telling us about and you've been the recipient of unprotected anal intercourse.

You were never likely to end up poz following two unprotected encounters with a woman with such a low viral load. You've taken PEP, and this means you're more likely to win a multi-million dollar lottery this weekend than you are to go on to test hiv positive.

Earlier in this thread you were looking for testing short cuts, but unfortunately they do not exist. Sure, a negative PCR result might give you peace of mind, but ANY PCR result must be confirmed with antibody testing at the approved time for a conclusive result. Don't shout at us about it, that's just the way it is.

Ann

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HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline JohnD99

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Re: HIV and SEVI Enhancement
« Reply #15 on: March 16, 2012, 02:45:04 pm »
Never shouted, Ann.  Just waved the scientific data in the air frantically.   :D

I totally respect how you guys run this site.  I too run a social networking health site, and my rules are there for a reason.  If you've instituted rules to match the CDC recommendations, then there's a reason.  Liability is one thing that plays a big role in the types of things I can recommend to my users. So I understand.

Fortunately, the various HIV specialists out there, have begun adopting "shortcuts" for testing (gosh you made that sound so bad LOL) ... and they've recommended PCR at 10 days.  It's becoming a pretty common practice for obvious reasons.  If the virus is there 28 days after you finish the meds, there's every reason to believe you will progress to infection.  If its not there 28 days after suppression has stopped?  There's no reason to believe you will spontaneously create the virus and become infected.  I also waved the data in their general direction and have told them I'll wait at least 28 days for the PCR.  10 is just too adventurous for my preferences.

Thank you for the helpful and funny response to this SEVI question.  I actually contacted the researchers involved, and they did confirm my suspicions.  A male ejaculating into a HIV+ female could create a highly infectious environment that is 100+ times greater than it otherwise would have been.  This is new research, so it hasn't really hit the airways yet.  However your point is quite good - in vitro versus in vivo is significant.  They've failed to create gels which prevent infection for a reason.  The researchers also confirmed that a circumcised male would likely need lesions or mucosal trauma for this to affect him.  Uncircumcised however is a very different story.  As a side note, he confirmed that urinating after sex does absolutely nothing to prevent HIV infection.  In 10 years I had a misconception about that one! 

I am at 5 weeks post-exposure.  1 week off the PEP meds. 

Tested negative on an antibody test today (way too soon, I know).  But I had been dealing with countless HIV related symptoms at about 7 days post exposure that were filling my mind with concerns of PEP failure.  Fever, Sore Throat, Night Sweats, Macropapular Rash, and glandular irritation.  I am thankful that 5 weeks later, I am negative, which means those things were just medication related.  Now I can embark on the wonderful journey of waiting to see if the PEP *fully* worked. 

As a side note, I wanted to ask something once again outside the box a bit.  I have been dealing with marked inflammation all over my skin surface, since day 7 when the rash appeared.  The day it appeared it was a pretty severe skin reaction to the medications, and i had to use both topical and oral benadryl to stop it.  My doctor confirmed that Kaletra and also AZT can have serious inflammatory effects on the body and skin.  In fact AZT has been shown to cause Lymphoma and cutaneous inflammation in long term use.  Likewise, short term use in one study caused noticeable system-wide inflammatory response that took corticosteroids and 6 months of no meds, to eliminate.  This feels like what I have been dealing with.  For about 4 weeks now, in the evenings, my skin feels scaly and hot.  Its not scratchy, but extremely tender. Feels like a sunburn all over my body.  There is no redness, but if I scratch myself, that red mark?  Stays there for about 25 minutes.  Much longer than normal  There is definiely some sort of lingering inflammation going on, and it is making me extremely uncomfortable.  I am considering hitting the docs office to run a CBC and liver / pancreas / kidney tests.  Have you heard of any such reactions from the meds in your time here?  I expected it to go away after I discontinued, but it has remained. 

Thanks again. 
« Last Edit: March 16, 2012, 02:52:25 pm by JohnD99 »

Offline jkinatl2

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Re: HIV and SEVI Enhancement
« Reply #16 on: March 16, 2012, 04:32:48 pm »
We actually go a bit above and beyond the CDC website when it comes to a lot of the information on this site. CDC, being above and beyond all else a governmental agency, tends to err on the side of caution to the point of not updating their databases nearly as often as we would like.

I know of one state, Massachusetts, that has lowered the testing window to six weeks. Thanks to implementing state of the art testing in all of its facilities. Other states, like North Carolina, use NAT testing which processes batches of samples to expedite the process and detect HIV far earlier. Other states in the US are not as well funded, and therefore the window stands at three months.

As far as PCR testing, same applies as the above. In SOME areas, especially metropolitan ones in the US, I can absolutely endorse that process (despite my lingering concerns about freaking people out with a false positive). Also, while the price for this test (which is still not universally available) HAS gone down a lot, it's still a ways from cheap - certainly no match for the rapid ELISA or combo testing.

Seeing as how a lot of folks come onto these forums from areas of the US which are decidedly NOT HIV friendly, small towns and rural areas and the like, we will keep to our established "party line" regarding what is still considered alternative testing until such time as the tests are A) prevalent, B) as cheap as other tests, and C) universally state of the art, with the same rate of false positive results as other testing.

And of course I was simply referring to the US when I mentioned that. Obviously in some other parts of the world those tests are still rare, often antiquated, and hideously expensive.  If you decide that the PCR test is one you are comfortable with, and if you don't think you will double or triple dip into the world of HIV fear and testing up until and including a three month "all clear," then go for it. In my experience on these forums, you would be the exception to the rule in that regard.

Insofar as the presence of semen and HIV, forgive me for being skeptical until at least a couple of long-term studies come out confirming this. Like HIV treatment, what works like a miracle in the lab, or in simian study, rarely bears out in real world testing. I've been dealing with this far too long to latch onto each and every new development with eagerness and fervor. I require duplicated studies, by different researchers, with first tiered peer review.

I'm a cranky type of science nerd like that.

As far as your meds go, I have intimate experience with AZT. And though it might take some time to get it out of your system, a month will not likely place you at risk for extended inflammatory issues or lymphoma. And the risks involved with corticosteroids tend to seriously outweigh the benefits here - I have intimate experience with those as well.

Of course no one is stopping you from running liver tests and the like, but I think that's a bit of overkill myself. It might take a few weeks for your body chemistry to hit normal again.

And though you mentioned symptoms (we don't address them on this site as they remain essentially meaningless except in the case of SEVERE ARS syndrome - which would likely land you in a hospital anyhow) I will say I would be extremely shocked, given your lower risk event (the insertive partner in a vaginal exposure is at far lower risk) AND PEP to see a positive result.

While I appreciate the zeal in which you plow through the science, I hope it does not morph into something that can make you crazy. In my roughly ten years on these forums I have seen highly intelligent, rational, science-minded folks degenerate into feces-flinging simians within the space of three postings. I'm always startled when that happens.

*modified for typo
« Last Edit: March 16, 2012, 04:36:38 pm by jkinatl2 »
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Offline JohnD99

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Re: HIV and SEVI Enhancement
« Reply #17 on: March 16, 2012, 05:39:14 pm »
Thanks for the post.  No worries.  I have been at this for over 15 years now.  I work in the medical field and run a health related support site that is nearly identical in structure and flow.  Totally different topic.  Unfortunately my personal behavior hasn't matched my knowledge, and that's where I am ashamed.  Very unfortunate that I find myself in this position at all, given all that I know about the disease.

I am still trying to (casually, and leisurely) determine what is causing my neck to feel hot when I bend it.  My scalp to feel tender and inflamed.  My back to feel scaly and sensitive when I squeeze my shoulder blades together.  My inside elbows to feel irritated and inflamed just because I bend my arm closed.  And my armpits - which are the ongoing center of irritation and periodic itching.  And why all of this increases at night, when I am tired.  Even as I write this I am laying on a couch, on my back, with a laptop on my chest, and my neck being bent forward and overlapping on itself is making it feel "Hot" and irritated. 

I actually enjoy researching this stuff.  So wheras you guys might be used to freakout sessions from people who google too much, my posts are moreso a "project" and educating of myself. 

Doing some looking, the closest I can find is something called DSP.  Distal Sensory Polyneuropathy.  It can be caused by the antiretroviral medications.  Just like everything else, it has levels of severity.  Mine is mild compared to what it could be.  But the symptoms fit quite well.  And you are probably correct, that it will take some time for my body to "calm down" after the meds are gone.  Keep in mind, that first day - day 7 on meds - my entire body went bezerk with redness and skin inflammation ... i was unable to sit down without feeling on fire all over.  This is just an ongoing residual effect of that.  I kept it at bay during treatment by taking benadryl at night time.  Whatever it is, its definitely a neuro-related condition.

As for Liver and CBC and Kidney tests - they are advised for anyone who does PEP.  In fact my doctor was supposed to run them a week into PEP and determine if I was having any hypersensitivities or toxicities.  So im running them now.

J

Offline jkinatl2

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Re: HIV and SEVI Enhancement
« Reply #18 on: March 16, 2012, 06:06:04 pm »
Honestly? In my years on this forum dealing with PEP issues I have never been informed of the process of running liver tests after PEP. Thanks for educating me.
"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

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Offline JohnD99

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Re: HIV and SEVI Enhancement
« Reply #19 on: March 17, 2012, 02:33:41 pm »
Not sure if you're being sarcastic or sincere.  As I mentioned above, my doctor failed to run the recommended tests at the 2 week mark, so I am doing it afterwards because it wasn't done during, and I continue to have problems.  I try to be thorough.  If I didn't have these personality traits, I never would have found out within 8 hours that my partner was HIV+ and gotten myself on PEP meds so quickly.  I am thankful, and I dont fault myself for my tendency to be proactive with my health.  I may just have saved my own life. 

The monitoring of Liver, Renal, and full CBC is recommended due to toxicity risks even with short term administration.  CDC alludes to it, and numerous other sites specify what's recommended:   

Toxicity and Drug Interactions of Antiretroviral Agents

Persons receiving PEP should complete a full 4-week regimen (3). However, as a result of toxicity and side effects among Health Care Personnel (HCP), a substantial proportion of HCP have been unable to complete a full 4-week course of HIV PEP (15--20). Because all antiretroviral agents have been associated with side effects (Table 3), the toxicity profile of these agents, including the frequency, severity, duration, and reversibility of side effects, is an important consideration in selection of an HIV PEP regimen.

http://hab.hrsa.gov/deliverhivaidscare/clinicalguide11/cg-301_occupational_pep.html
"For patients taking PEP, adherence assessment and evaluation of any side effects should be included. At 2 weeks, blood testing (e.g., CBC, creatinine, liver function tests) should be done for patients on a 28-day PEP regimen to monitor for PEP toxicity, as indicated by the particular ARV regimen."

http://www.healthunit.org/professionals/exposure_blood/Managing-Exposures-Blood-Borne-Pathogens.pdf
"If HIV PEP therapy is started, drug toxicity monitoring including a complete blood
count, renal and hepatic function tests should be completed initially, at week 1, and again 2 weeks after the patient begins taking the medications. If toxicity is suspected, the treating physician should consult with an infectious disease specialist."

http://www.nursingcenter.com/prodev/ce_article.asp?tid=962884
"Get PEP for HIV in accordance with CDC guidelines. Start the prophylaxis medications within 2 hours after exposure. Make sure that you're being monitored for symptoms of toxicity."

Just from the 1st page of Google.


Offline Andy Velez

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Re: HIV and SEVI Enhancement
« Reply #20 on: March 17, 2012, 02:36:20 pm »
Are you aware this is not a chat forum?

It is for when members have specific concerns about which they want a response.

Just thought I'd mention that.
Andy Velez

Offline JohnD99

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Re: HIV and SEVI Enhancement
« Reply #21 on: March 17, 2012, 02:52:48 pm »
Andy, why do you sound annoyed again.  I am not familiar with the term "chat forum".  As per about 10 thousand other threads, people come here to discuss their situation.  And they continue to post updates, as the weeks go by.  I am not having casual chit chat.  I am responding to your partner's comment calling into question post-pep toxicity testing.   

Maybe you dont understand the incredible value of threads like this, when people search Google.  I have landed on your site countless times because particular search terms I typed landed me here, right in the middle of a thread where a person was documenting his progress from PEP through final testing.  Not just asking a question and going away. 

Admittedly, he usually has to wade his way through a ton of snarky responses telling him to stop posting and go away, but I have found myself thankful, and even laughing a little when they ignore the unnecessary comments and continue to post.  It may piss you guys off, but the questions they ask - if someone chooses to actually be helpful and answer them - have proven to be invaluable.  Is that "Chat" ?  Or is someone just documenting their progress and getting information and support?  Is that not the purpose of this forum?

I would like you to take a look at the thread by Brighton88.  That is an example of a thread that helped me immensely.  He asked questions, *and* documented his experiences.  "Chat".  Yet even he was told numerous times to stop bugging you guys. 

As I have mentioned several times.  I run a site almost identical to this.  And after years and years, I eventually find myself irritated with well-intentioned users too.  Often times I speak down to them, or speak to them as if they are retarded.  I see that in a lot of posts on this forum as well.  An exhaustion.  And a very short fuse when it comes to patience.  And I get it - believe me.  Its called "burnout".  The topic of my forum is a different medical condition, but I have gotten to the point where I am so sick of the topic that I don't even like looking in my own forum sometimes.  Seeing the thread titles and reading the comments is just an endless repetition.  If you have gotten to that point with this forum, my advice is to step away for a bit and take a break.  I have had to do the same thing.  If after 4 posts from someone, you find yourself scolding them and being snarky and irritated towards them, this is a big sign.

You're right.  This forum is not a "chat forum".  Its a place people come to ask questions, and tell their story, and document their progress.  If that wasn't your intention for this forum, I can tell you from an outsiders viewpoint - those are the most helpful threads.  Not the ten thousand threads of people asking if they got HIV from an ice cream cone.

I actually came here today to post an update, and instead was met with a snarky comment which I felt the need to respond to.  If you're going to pull out a person for "chatting" - address the person who initiated it.  (jkinatl2).

Offline jkinatl2

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Re: HIV and SEVI Enhancement
« Reply #22 on: March 17, 2012, 03:32:40 pm »
Quote
I actually came here today to post an update, and instead was met with a snarky comment which I felt the need to respond to.  If you're going to pull out a person for "chatting" - address the person who initiated it.  (jkinatl2).


There was no snark intended. But the condescending tone of your posts today have made me keenly aware that few good deeds go unpunished. I was actually trying to go above and beyond the call of duty and discuss your situation like an intelligent adult.

I respectfully withdraw from further conversation with you. Best of luck with your PEP and testing.



"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

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Offline Ann

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Re: HIV and SEVI Enhancement
« Reply #23 on: March 18, 2012, 08:58:03 am »

Honestly? In my years on this forum dealing with PEP issues I have never been informed of the process of running liver tests after PEP. Thanks for educating me.


Some places do, some places don't. Most don't.

I know someone here on the Rock who did PEP and they had him in every single week during PEP for a complete CBC, chem panel and liver enzyme panel, as well as rapid hiv tests. The CBCs, chem and liver panels always came back in normal ranges and his rapid tests all came back negative.

This was obviously overkill in the extreme and to be honest, I think they were trying to punish him for knowingly having unprotected intercourse with a poz person. Despite the fact that he was extremely unlikely to have been infected following a one-off vaginal encounter.

He tested conclusively negative at three months post-PEP. He more likely than not would have had the same result without PEP. I can say this with absolute confidence because he was put on PEP nearly a week later, not within the 72 hour guideline. (Another reason why I think his experience had more to do with punishment than it had to do with any actual concern for his hiv status.)

John, I am increasingly at a loss as to why you come here. You seem to know it all - so why bother to ask us? I acknowledge that Rodney was very rude to you when you first turned up and that is being dealt with. However, whatever replies you get, you refute to one extent or another and as I'm sure you know from your experience elsewhere, it gets tedious. Those of us who are authorised to answer questions in this forum have a combined nearly 100 years of hiv prevention knowledge and experience - and you have what, a month?


Admittedly, he usually has to wade his way through a ton of snarky responses telling him to stop posting and go away, but I have found myself thankful, and even laughing a little when they ignore the unnecessary comments and continue to post.  It may piss you guys off, but the questions they ask - if someone chooses to actually be helpful and answer them - have proven to be invaluable.  Is that "Chat" ?  Or is someone just documenting their progress and getting information and support?  Is that not the purpose of this forum?

I would like you to take a look at the thread by Brighton88.  That is an example of a thread that helped me immensely.  He asked questions, *and* documented his experiences.  "Chat".  Yet even he was told numerous times to stop bugging you guys.


People get warned about excessive posting when they keep asking the same questions over and over and over again. There are only so many ways we can correctly answer the same question. We're not a hand holding service in this section of the forums and we never will be. We do not offer psych counselling - which is what many are looking for - it is far outside our remit.

We ONLY offer transmission, prevention and testing information. This information is actually very simple and there's no need to go on and on about it to any one single poster. If we can't get through to them in a few posts, chances are we never will. Also, we will cut someone off who goes on and on about symptoms. Symptoms are essentially meaningless when it comes to hiv diagnosis.

At the end of the day, if you don't like the way this forum is run, there are other forums out there.

Here is the take-away point for you as I see it:

You are highly unlikely to end up poz over this insertive vaginal encounter, PEP or no PEP. However, you do need to test at three months post-PEP to make certain.

Despite the suppositions presented in the SEVI study you cite, thirty years of hiv epidemiological studies have shown us that hiv is more difficult to transmit from a woman to a man. I cannot see the results of this one study changing that. The study is useful in other regards, but not in the regard you are applying to it.

There's nothing more we can tell you. You need to test at three months following your last dose of PEP - and we fully expect you to test hiv negative.

Ann
« Last Edit: March 18, 2012, 09:01:14 am by Ann »
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Offline JohnD99

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Re: HIV and SEVI Enhancement
« Reply #24 on: March 23, 2012, 02:20:07 pm »
Hi everyone - hope you're doing well.

I wanted to ask a question I haven't been able to find a clear answer on.  I am confused why the CDC recommends a 6 week post exposure antibody test when someone has taken PEP meds.  That would be 2 weeks post-PEP.

Ann - you tackled a similar question from someone awhile ago because Dr. Bob from TheBody also recommended this test, but referenced the "PEP Guidelines" as being the source of it.  Commenting that the CDC actually recommends the 3 month and 6 month in addition.  I am not sure if its the CDC but this 6 week test does seem to be recommended across the board. 

Can you clarify for me what you think their logic is on this?  And why they would think, under any scenario that the results from such a test would be relevant?

Due to a freakout session, I buckled and tested negative on a 5 week post exposure antibody test, but felt that it held absolutely no value for how my future tests will turn out.  It just gave me peace of mind for a lot of ARS symptoms I thought i was having a week after exposure, on PEP meds.

Thank you.
« Last Edit: March 23, 2012, 07:19:16 pm by JohnD99 »

Offline JohnD99

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Re: HIV and SEVI Enhancement
« Reply #25 on: March 28, 2012, 10:52:10 pm »
Thank you Ann.  Did you get my private message a couple days ago?  I dont see it in my sent items.

Unfortunately I am not doing well at all.  I went on Monday (14 days after finishing PEP) to get my RNA pcr test done.  When I woke up that morning something was seriously not right.  I was extremely nauseous.  Could not even put my morning eggs into my mouth without gagging. 

Guzzled a lot of water as that usually helps me wake up and feel energetic, but I felt very uncomfortable.  My body felt tingly and weak.  I decided to get my ass to the draw station and get the test done. 

After the test, as I was driving home, I had to stop at the post office and ended up in line.  Within about 5 minutes, I felt overwhelmingly ill.  I got very hot, and my muscles in my legs felt weak and drained.  I had to leave the post office and go sit in my car.  And that is when it really hit me.  It felt like a wave of pure weakness washed over my head, down the back of my neck, and through all my muscles. 

It felt exactly like when I had Mono 10 years ago.  Hadn't felt that extreme fatigue since, and it was very familiar.  My head was hanging low in as I sat in my car just destroyed with weakness and fatigue.  My head was also aching up the back of it.  Felt swollen and achy.  My lower back muscles (lumbar) were both just painfully achy.  It felt like it was coming over me like a ton of bricks.

The sensation was that of very fast, and harsh onset of Flu.  I knew I wasn't doing this to myself.  I was ready to have a good day and get a lot of errands done.  But this just took over.  I cancelled all my plans and drove home.  I am alone right now, and realized at this moment that if ARS was kicking in at day 14, right on queue, that I would need to be with friends or family to deal with it.

I raced home, phoned my dearest friend in Arizona, and literally threw together my bags full of clothes.  Ibuprofen had been giving me relief from a lot of the discomfort I'd been feeling (swollen glands, etc).  So I popped another 600mg ibuprofen for the flight.  Just to get me there.  Within 30 minutes i was drenched.  I dont know if I had a slight fever and the ibuprofen "broke" it or what, but as this continued powerful fatigue continued to intensify, I was now also dripping in sweat so much that it was coming off my forehead onto the floor. 

Within a few hours, as the ibuprofen kicked in, things seemed to begin to calm.  My glands seemed to relax, but the fatigue remained somewhat noticeable.  By the time evening came and the Ibu wore off, my was still experiencing that Flu-like creepy crawly fatigue, and strong nausea. 

Dramatic story I know.  But that feeling that came over me was so strong, and so uncomfortable that I needed to get somewhere before it hit. 

ARS?  I have no idea.  Everyone seems to be so confident that my PEP didn't fail.  But since monday I have struggled with fatigue that just will not go away.  Back and muscle aches that just wont stop.  and feeling so incredibly "flu-like" that its noticeable.  I can't create this stuff.  No matter what anyone says.  I was hungry and wanted those eggs!  but i almost puked when they went in my mouth.  I didn't "psychosematic" that into existence. Something is very wrong with my body.

Anyways that's where I am at now.  The RNA test is supposed to be done by tomorrow or Thursday.  So i will know once and for all whether or not this experience is indicative of presence of HIV.  I thank God that RNA tests exist so that the psychological torture, which is very much neglected by a lot of people in the medical industry, can be addressed.  Either PEP failed, or it didn't.  All the statistics say its near impossible.  But people do sometimes get struck by lightening.

I guess I will update tomorrow when the results come back. I  hope you are right Ann.  But I am not hopeful.  I can't even walk through the drugstore and back out to the car right now without feeling like I need to go lay down.  Something is going on.  Also hope you got my PM.  It was an apology ... to you and everyone here for being so difficult on the forums.  This has been the most upsetting 6 weeks of my entire life.  the first four on drugs that made me feel like I was dying, combined with the fear that i would end up dying if they didnt work ... it does a number on your mind...  I haven't handled it well and I have been a bit of a blowhard.  I truly apologize to everyone.

Offline JohnD99

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Re: HIV and SEVI Enhancement
« Reply #26 on: March 29, 2012, 11:12:19 am »
Would a Hep B vaccine shot a week before starting PEP meds affect the PEP regimen at all?

Just trying to think of why this might have failed.

I also mistakenly was taking milk thistle, which I now know interacts with kaletra :(

Lastly, though it's a stretch, I drink a gallon of water a day.  Purely for fitness and health reasons.  I am concerned I was flushing the drug out of my system every day.


Offline Matty the Damned

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Re: HIV and SEVI Enhancement
« Reply #27 on: March 29, 2012, 02:36:46 pm »
Would a Hep B vaccine shot a week before starting PEP meds affect the PEP regimen at all?

Just trying to think of why this might have failed.

I also mistakenly was taking milk thistle, which I now know interacts with kaletra :(

Lastly, though it's a stretch, I drink a gallon of water a day.  Purely for fitness and health reasons.  I am concerned I was flushing the drug out of my system every day.

You think too much and, frankly, you're a bit of a drama queen.

HBV vaccination will not affect the outcome of an HIV PCR RNA test. Nor will drinking water or taking tincture of milk thistle or monkey glands or decoction of she-oak or any other nonsense patent medicine.

Like the others I believe that you will test negative at the close of the PEP extended window period.

I won't even go into the symptom stuff, I assume you've read what we said to others on this subject.

MtD

Offline JohnD99

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Re: HIV and SEVI Enhancement
« Reply #28 on: March 29, 2012, 11:17:51 pm »
Quote
You think too much and, frankly, you're a bit of a drama queen.
You talk too much, and, frankly, you're a bit of a dick. ;D
As always, 20% rude comments, 40% misreading, and 40% helpful content.

If I didn't "think too much" I would never have gotten on PEP in the first place.  I would have been like every other simple minded dolt who comes here and asks if you can get HIV from an ice cream cone.  Those are the people who end up acquiring HIV in the situation I had.  Because they "didn't bother to learn".  Im thankful I think too much.  It may have saved my life.  And that's not being dramatic.  Its a fact. 

Quote
HBV vaccination will not affect the outcome of an HIV PCR RNA test.
Learn to read more closely.  The question was whether the HBV vaccination a week prior to PEP would have affected the effectiveness of the PEP medications.  I didnt ask if it affects the result of the PCR test.

Quote
Nor will drinking water or taking tincture of milk thistle or monkey glands or decoction of she-oak or any other nonsense patent medicine.
Once again that isn't what I asked.

And please educate yourself, because you are misinformed.  Milk Thistle (as well as St. Johns Wart and other various herbal supplements) is listed as a drug interaction with Kaletra.  I learned this as a side effect of being a drama queen who thinks too much.  And researches too much.

Just one of many pages on the topic:

http://www.thebody.com/Forums/AIDS/Fatigue/Q181203.html

"Regarding interactions with HIV meds, we are concerned, because milk thistle, like garlic supplements, can interact with the same liver-enzyme system (Cytochrome P450 3A4) responsible for metabolizing some HIV drugs, such as Kaletra (lopinavir/ritonavir). This interaction may alter the amount of Kaletra in the bloodstream and thus lead to problems. Consequently the bottom line on milk thistle, for me, is that for this supplement, like so many others, the potential risks outweigh the potential benefits. "

« Last Edit: March 29, 2012, 11:26:30 pm by JohnD99 »

Offline Matty the Damned

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Re: HIV and SEVI Enhancement
« Reply #29 on: March 30, 2012, 12:13:05 am »
You talk too much, and, frankly, you're a bit of a dick. ;D
As always, 20% rude comments, 40% misreading, and 40% helpful content.

If I didn't "think too much" I would never have gotten on PEP in the first place.  I would have been like every other simple minded dolt who comes here and asks if you can get HIV from an ice cream cone.  Those are the people who end up acquiring HIV in the situation I had.  Because they "didn't bother to learn".  Im thankful I think too much.  It may have saved my life.  And that's not being dramatic.  Its a fact. 
Learn to read more closely.  The question was whether the HBV vaccination a week prior to PEP would have affected the effectiveness of the PEP medications.  I didnt ask if it affects the result of the PCR test.
Once again that isn't what I asked.

And please educate yourself, because you are misinformed.  Milk Thistle (as well as St. Johns Wart and other various herbal supplements) is listed as a drug interaction with Kaletra.  I learned this as a side effect of being a drama queen who thinks too much.  And researches too much.

Just one of many pages on the topic:

http://www.thebody.com/Forums/AIDS/Fatigue/Q181203.html

"Regarding interactions with HIV meds, we are concerned, because milk thistle, like garlic supplements, can interact with the same liver-enzyme system (Cytochrome P450 3A4) responsible for metabolizing some HIV drugs, such as Kaletra (lopinavir/ritonavir). This interaction may alter the amount of Kaletra in the bloodstream and thus lead to problems. Consequently the bottom line on milk thistle, for me, is that for this supplement, like so many others, the potential risks outweigh the potential benefits. "



Whatever. If you really knew as much as you think you do you wouldn't be in here asking us for advice.

Your questions have been answered and I have better things to do than bandy words with some narcissistic "wall of text" know-it-all.

Ta-ta,

MtD

Offline Andy Velez

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Re: HIV and SEVI Enhancement
« Reply #30 on: March 30, 2012, 09:18:50 am »
John, name calling i.e. "you're a bit of a dick" is not permitted here. Don't do it again or you will find yourself getting a Time Out or banned.

If you have a problem with someone's comments then send a complaint to the moderators for the matter to be addressed.
Andy Velez

Offline JohnD99

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Re: HIV and SEVI Enhancement
« Reply #31 on: March 31, 2012, 02:48:10 pm »
Andy.  Dont ignore the initial name calling, while scolding me for my response.  That kind of obvious double standard, is a clearly inconsistent, and unfair enforcement of rules.  I didnt appreciate the insanely offensive comment from RapidRod to my first post, mocking me for making a mistake that may have cost me my life.  You suggest reporting a post.  Well I did.  Did you or anyone do anything about his post?  Nope, its still sitting right up there at the top.  Reporting posts does nothing, becuase Rod is your buddy, and apparently offensive comments from buddies are okay.  Just not from anyone else.  I didnt appreciate the name calling of "DRAMA QUEEN" immediately above.  But most of all I dont appreciate you completely ignoring both of those and scolding me.  Seriously ...

I have sent about 10 different friends here to read threads on this site, and across the board, all of them have commented how rudely the worried well are spoken to on here.  I dont know if you guys operate in a vaccuum and arent aware of how you all sometimes come across, but from regular, outside individuals, the reputation of how caustic people are here, is getting around.  And quite honestly i dont need to be spoken to that way by any of you.  I've been nothing but polite, and swallowed my pride out of respect, while getting very little respect in return.

A rule everyone on here should learn:  If you cant say something nice, dont say it at all.

And if you're a moderator, dont scold someone for RESPONDING to an insult.  On what planet is that reasonable moderating?

Im quite honestly done with this web site.  I know you guys are struggling with HIV.  And on that level I feel for you and the daily struggle you go through.  But I have come to the honest to God conclusion that - just as you ban worried well's from posting in the HIV forums, I believe HIV positive individuals should not be allowed here.  You are all dealing with a real, and horribly difficult daily situation.  For you to come to the "Well" forums and try to give helpful advice, is a contradiction.  You're just going to be annoyed and irritated with all the silly uneducated people who are afraid they have HIV.  That can't be anything less than upsetting for you.  And it shows in how you all talk to the people here, and how you treat them.  The people who moderate this forum should be educated individuals without HIV.  People who actually have the patience to 'coddle' the "drama queens" rather than INSULT them.  And moderators who dont put up with insults of any kind to "worried well" people ... rather than moderators who actively participate in those insults, and protect their "buddies" who do more insulting.

Thats my input on this forum.  HIV+ people should not be providing support here.  I just believe its an added burden that you guys dont need to deal with.  In fact, on one site yesterday I saw an HIV+ moderator yell at a worried well and accuse her of "Flaunting her negative results".  This is a perfect example of what I mean.  I dont fault her for feeling that way.  But she should not be camping out in the worried well forums at all.  She's not going to handle it well.  And I dont expect her, or you guys, to handle it well.  You've got a lot on your plate. 

But stop being rude to people on here.  Im out.  Ban me if you like.  There is nothing worse than seeking support and having insults in response, and feeling afraid to even go back and look at your own thread. 

For those who may come here in the future seeking help, who may have gone through what I jus went through - my RNA test came back negative.  So .. unlike what the moderators here will tell you ... several *DOCTORS* have told me 14 days post pep meds a negative QUALITATIVE RNA test (down to 30 copies) is 95%+ conclusive that there is no HIV virus in my body at all. 

I will still test the antibody test at 3 months to be sure.  But dont let anyone, anywhere, no matter how long they've been working with HIV, make you feel stupid for wanting a pcr test sooner, and dont listen to them when they tell you that you can't have 90%+ peace of mind if you wait the proper number of days and then get a PCR test.  Nobody should have to sit for 4+ weeks taking debilitating, toxic drugs, while worrying that they are going to be infected with a deadly disease, only to be told they then have to wait another 3 months to have *ANY* peace of mind that the drugs worked.  Im sorry but that kind of prolonged mental torture is not only dangerous to the body, its dangerous to society.  Proponents of PCR testing aptly point out that the weeks after exposure (or PEP meds) are the most highly contagious weeks on earth, and the VAST MAJORITY OF NEW HIV INFECTIONS occur during those weeks.  Getting PCR testing to identify infection before antibody tests show positive is a HUGE method for reducing new HIV infections.  That's a fact.

And yes Matty the Damned, I do know my stuff.  Sorry if correcting your misinformation annoyed you, but that says more about you as a person than anything else. 

Someone needs to make a web site for the worried well, run by the worried well.  People who care, and understand the mental anguish, and treat people who are going through it, with respect.

Over and out.
« Last Edit: March 31, 2012, 02:58:39 pm by JohnD99 »

 


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