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Hiv Subtype E


unlucky1

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Thanks, I hope you're right but I'm pretty sure I have a viral infection that has affected my immune system.

Even if so, HIV is neither the only nor (based on history and symptoms) the most likely. Mononucleosis and lymphogranuloma come to mind.

Indeed, I would be a bit happier if my symptoms were that of dengue fever; sounds mad but HIV still has so much stigma and it's the most preventable serious disease in the world, which makes many people's first reaction 'what an idiot' and, in the west 'I didn't know he was gay'.

Mono is unlikely due to me being late 30s and that the lymph pains started in the groin rather than neck illustrating that this is likely a sexual infection.

Anyway, it does seem to be more transmittable female to male in Thailand plus the idea that prostitutes (disguised prostitutes or bargirls) wouldn't use condoms was completely new to me. In the West the girls are aware of HIV and always insist.

Only since I got back have I discovered the trend for barebacking. It was me that initiated condoms all the time with the girl I was with and I thought that was weird too. At one point I said 'where's the condoms' and she said 'up to you' that great Thai phrase.

There is no HIV explosion through prostitution in countries such as the UK, Germany and Holland and there needn't be one in Thailand.

There's clearly a lack of education and some fuc_ked up individuals who are insisting that the poor girls don't use condoms.

I came to Thailand knowing a couple of friends had settled down with girls here, one a bar girl one a girl who worked in a hotel. Only came cos I got a cheap flight.

I had a quick scan of a tourist info site that said there was a 100% condom programme and that Thailand was an example of how to tackle HIV (I didn't know it was years out of date).

I had never heard of a male who has been infected with HIV other than gays or Africans and when a UK doctor told me last year the 1/1500 stat I thought that's why.

Anyway, that's me. I made a series of fatal errors but I was well intentioned - I never had full sex without a condom but did have 4 unprotected moments.

I'm not dissing Thailand but it's a place where one is less likely to get away with silly mistakes.

Cheers

Get treatment! Seriously!

Not HIV treatment but psych treatment! All this drama cannot be good for your mental health. Therapy should help you out but will take some time. However, since psych meds are often only a stopgap way to manage symptoms it would appear that therapy is your best bet.

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I don't know about anyone else but I think some of the responses should be removed as they appear to be mocking OP in a most unfair way. For sure, he has some tropical bug, and may be feeling confused, depressed, agitated, and anxious to varying degrees. Like many I'm a bit puzzled that he should be so anxious about HIV but when we're ill we don't think straight, do we?

My own brush with said lurgy led me to reflect on 'immunity' and more specifically that being human means we are not as invulnerable as we might like to think we are. Thus at the risk of sounding boring: willywellies all round as mandatory.

Geriatric's post is masterful, thanks a real education which confirms what I had felt intuitively.

I did a bit of googling as a result of an earlier posting on the subject of variant A/E, and research by the John Hopkins Institute came up time and again. According to researchers the study suggests that A/E leads to faster disease progression.

I'm assuming that they eliminated the possibility of there being something genetic in Thais, faster disease progression simply through living in the tropics, prevailing quality of life, environment, and life style issues. But I've got a feeling that might be being kind.

Being neither a scientist, or scholar I can only say that IMHO what I saw on the net seemed rather lacking in rigour and somewhat assumptive. I think if we started with an honest examination of reported figures we might find that the mystery is partly or wholly solved, but again this is just my feeling.

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I don't know about anyone else but I think some of the responses should be removed as they appear to be mocking OP in a most unfair way. For sure, he has some tropical bug, and may be feeling confused, depressed, agitated, and anxious to varying degrees. Like many I'm a bit puzzled that he should be so anxious about HIV but when we're ill we don't think straight, do we?

My own brush with said lurgy led me to reflect on 'immunity' and more specifically that being human means we are not as invulnerable as we might like to think we are. Thus at the risk of sounding boring: willywellies all round as mandatory.

Geriatric's post is masterful, thanks a real education which confirms what I had felt intuitively.

I did a bit of googling as a result of an earlier posting on the subject of variant A/E, and research by the John Hopkins Institute came up time and again. According to researchers the study suggests that A/E leads to faster disease progression.

I'm assuming that they eliminated the possibility of there being something genetic in Thais, faster disease progression simply through living in the tropics, prevailing quality of life, environment, and life style issues. But I've got a feeling that might be being kind.

Being neither a scientist, or scholar I can only say that IMHO what I saw on the net seemed rather lacking in rigour and somewhat assumptive. I think if we started with an honest examination of reported figures we might find that the mystery is partly or wholly solved, but again this is just my feeling.

I'm not sure about the disease progression part but from what I've found I do think the 1 in 1500 chance of catching it from an infected person doesn't sound right. If the NHS in the UK are gonna tell people that they should caveat it by saying if there's an STD and a high viral load present the odds change.

I don't mind anyone saying 'it's all in the mind' and that I had 'stupid unprotected sex' which I did.

From the outside I can see how you'd think the former, some people are hypochondriacs but I've not even been registered with a doctor for the past 6 years. My attitude to HIV and anyone who had 'stupid unprotected sex' also used to be a bit judgemental.

I'm a laidback guy believe it or not. Hopefully I'll get better (the neuropathy and lymph pains are real and still occuring) and test negative at 6 months.

If not I'll take the pills and live as long as I can - I enjoy hill-walking n mountain biking and will continue to be cool.

Over and out till December, be lucky.

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I don't know about anyone else but I think some of the responses should be removed as they appear to be mocking OP in a most unfair way. For sure, he has some tropical bug, and may be feeling confused, depressed, agitated, and anxious to varying degrees. Like many I'm a bit puzzled that he should be so anxious about HIV but when we're ill we don't think straight, do we?

My own brush with said lurgy led me to reflect on 'immunity' and more specifically that being human means we are not as invulnerable as we might like to think we are. Thus at the risk of sounding boring: willywellies all round as mandatory.

Geriatric's post is masterful, thanks a real education which confirms what I had felt intuitively.

I did a bit of googling as a result of an earlier posting on the subject of variant A/E, and research by the John Hopkins Institute came up time and again. According to researchers the study suggests that A/E leads to faster disease progression.

I'm assuming that they eliminated the possibility of there being something genetic in Thais, faster disease progression simply through living in the tropics, prevailing quality of life, environment, and life style issues. But I've got a feeling that might be being kind.

Being neither a scientist, or scholar I can only say that IMHO what I saw on the net seemed rather lacking in rigour and somewhat assumptive. I think if we started with an honest examination of reported figures we might find that the mystery is partly or wholly solved, but again this is just my feeling.

I'm not sure about the disease progression part but from what I've found I do think the 1 in 1500 chance of catching it from an infected person doesn't sound right. If the NHS in the UK are gonna tell people that they should caveat it by saying if there's an STD and a high viral load present the odds change.

I don't mind anyone saying 'it's all in the mind' and that I had 'stupid unprotected sex' which I did.

From the outside I can see how you'd think the former, some people are hypochondriacs but I've not even been registered with a doctor for the past 6 years. My attitude to HIV and anyone who had 'stupid unprotected sex' also used to be a bit judgemental.

I'm a laidback guy believe it or not. Hopefully I'll get better (the neuropathy and lymph pains are real and still occuring) and test negative at 6 months.

If not I'll take the pills and live as long as I can - I enjoy hill-walking n mountain biking and will continue to be cool.

Over and out till December, be lucky.

You are tortureing yourself for no reason. Yes what you did was risky, but the tests state you are negative. Consult with medhelp.c0m and you will find tons of information there. Most doctors & the literature supports/suggests that a negative test at 6 weeks is in the Ninety percentile accuracy. Plus, you never mentioned developing a rash, fevers etc within 2 weeks of contact.

Thank god for a negative test... do another test if you have to, but I would bet all my money, every stang, you are negative.

move on and be happy

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I'm a laidback guy believe it or not. Hopefully I'll get better (the neuropathy and lymph pains are real and still occuring) and test negative at 6 months.

If not I'll take the pills and live as long as I can - I enjoy hill-walking n mountain biking and will continue to be cool.

Over and out till December, be lucky.

There are something like 1,500 known human pathogens plus countless other diseases that arise in the absence of a pathogen (cancer, autoimmune etc). Your symptoms really don't fit with HIV.

If you are unhappy with your docs diagnostic/treatment regime - change him!

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I'm no doctor, but, in the light of the negative HIV test you might explore the possibility of diabetes as some of the symptoms you mentioned sound like what I experienced before getting diagnosed as diabetic type 2. (fatigue, neuropathy comprising of pins and needles, burning feet, pains in hands and feet).

Just a thought but some symptoms could point to diabetes and others to something else.

Whatever the problem is, good luck.

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First, for anyone reading this, if you aren't already aware of it, there is alot of HIV subtype-e in Pattaya as well as the north of Thailand. The situation is alot worse than what you may be seeing on the surface. As far as bars in pattaya testing their employees, it takes 3 months for HIV to show up on tests, and those first 3 months are when its most contagious so bars testing them means nothing. You don't hear about the guys who catch HIV because most people aren't going to go around talking about it after they find out they have it, they just disappear. I just want to warn people to take caution when out there and keep in mind that rubbers do break so there is no such thing as protection. Just do a google search for "Subtype-e germany" and you will find a post on another forum from a man a few years ago who did in fact catch subtype-e and posted about it on the internet to ask a "doctor" questions about it. I would just advise anyone going out there for romance or a good time to try to find a thai partner who doesnt work in the "industry" out there(I know most people will disagree with me on this and say theres nothing to worry about), although sometimes its hard to tell....

I was with a girl in Thailand once. Same thing happened to me except I did wear a rubber but was with her for a month and it constantly broke so its just like I wasnt wearing one...anyways....I got home in the USA and had the flu...looked up HIV symptoms and instantly started freaking out. I then talked myself out of it and convinced myself I didnt have it. A few weeks or a month or so later I got athletes foot for the first time in my life, flaky skin all over (especially my arms), sore throat, peripheral neuropathy (I would wake up in the middle of the night sweating and couldnt feel my feet at all. I would have to jump out of bed and try to walk around), enlarged lymph nodes under my chin(not noticeable but I could feel them) and one in my groin and I was sleeping majority of the day for no reason. I had just read about all this stuff the week before so I was recognizing all the signs as HIV. I went to the doctor and asked him what he thought and it turned out that this guy was a volunteer doctor in Pattaya before he got a job in USA (American doctor but I guess went over there for whatever reason) and he took a look at me, felt my lymph nodes in my neck and groin, looked at the back of my throat (said he saw white stuff, and I was reading about candida online although it didnt appear that I had that), and told me that he was sure I had HIV based on patients he had seen in Thailand. I was freaking out again and so he sent me to the local hospitals emergency room (I dont know why, I guess because he thought they could get the results back faster or not)...It had been 1 month since I had returned home from Thailand. So I go to the hospital and they test me but say they wont get the results back for a week(they tested for everything, not just HIV). So I have to wait this week and then a week later I go to another doctors office (who the hospital referred me to for my results) and everything came back negative. I got home and then started reading more about this window period and how some people go 6 months before it shows up on a test as positive..A few days later my entire leg went numb and really scared me so I went back to the doctor (the one the hospital referred me to). She looked at me and was convinced that I was making myself sick with anxiety. I didnt understand why my leg would go numb like that. So she told me to come back to her in 2 months for another test because at 3 months it should be reliable. So 2 months go by and I go back for the test. Negative again. I just cant believe it because all the original symptoms presented as HIV(and during the window period when the symptoms would have showed up) and I was in a high risk area and my rubber broke....it just all made sense. So I test again at 6 months.. Negative. By this time Im thinking I dont have it and maybe it was all in mind. 3 months go by and my face begins to get flaky and red. Im thinking its just dry skin like what was on my arms (although my arms werent red, just flaky) so I start using a moisturizer and it doesnt help. I google the type of flaky skin I have and the areas that are red and 2 things show up, Rosacea and Seborrheic Dermatitis, both of which are common in people with HIV. So now im freaking out again and go for another somewhere else....Negative. Now I know I dont have it. I went to the doctor and its Rosacea. Athletes foot, skin conditions on my face, peripheral neuropathy, flu like symptoms the first few weeks after infection....all of these are symptoms of HIV....but they are also symptoms of Anxiety. Each one of these things is caused by Anxiety as well. Im stuck with Rosacea for the rest of my life since both SD and Rosacea are chronic and Im a pretty good looking confident young guy and its made me not want to go outside for months. I got rid of the flaking but I have yet to get rid of the redness on my face which just keeps getting red. I got rid of the athletes foot though. Im 26 years old and nobody in my family has ever had SD or Rosacea and I have never had flushing in my face or blushing before and they say that both SD and Rosacea are thought to be hereditary and people who flush/blush are more prone to it. I dont believe I would have developed any of these problems if I had not worried about HIV so much and gone through so much stress over it, which lowered my immune system and allowed all these organisms/factors to take control. I learned alot about subtype-e over the course of a year. #1 you would not be having symptoms now of anything if you contracted it 5 months ago. You are barely out of the window period and 99% of people test positive at about 3 months. All those symptoms ARE symptoms of advanced HIV and you would not have advanced HIV so soon. You arent even 1 year out so your symptoms are definately not from HIV. The average life expectancy is 7 years without treatment(compared to 10 with subtype-b ) and I believe the ones who die at 5 years are malnutrioned etc. I also think that the only reason it is 7 years, isnt because the strain is deadlier, it's because thais have smaller body mass than westerners and its been proven with subtype-b that people with lower body mass are more prone to it advancing into AIDS. The life expectancy of subtype-e while taking medication is the same as subtype-b 18-25 years. Anxiety can cause all kinds of serious conditions, but skin infections and sore throats and peripheral neuropathy are very common and I experienced all of these, so try not to stress out about it. Ask your doctor to prescribe you ativan to get over the inital stress.

Edited by ConfusedFarang
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Thanks, I hope you're right but I'm pretty sure I have a viral infection that has affected my immune system.

Even if so, HIV is neither the only nor (based on history and symptoms) the most likely. Mononucleosis and lymphogranuloma come to mind.

Indeed, I would be a bit happier if my symptoms were that of dengue fever; sounds mad but HIV still has so much stigma and it's the most preventable serious disease in the world, which makes many people's first reaction 'what an idiot' and, in the west 'I didn't know he was gay'.

Mono is unlikely due to me being late 30s and that the lymph pains started in the groin rather than neck illustrating that this is likely a sexual infection.

Anyway, it does seem to be more transmittable female to male in Thailand plus the idea that prostitutes (disguised prostitutes or bargirls) wouldn't use condoms was completely new to me. In the West the girls are aware of HIV and always insist.

Only since I got back have I discovered the trend for barebacking. It was me that initiated condoms all the time with the girl I was with and I thought that was weird too. At one point I said 'where's the condoms' and she said 'up to you' that great Thai phrase.

There is no HIV explosion through prostitution in countries such as the UK, Germany and Holland and there needn't be one in Thailand.

There's clearly a lack of education and some fuc_ked up individuals who are insisting that the poor girls don't use condoms.

I came to Thailand knowing a couple of friends had settled down with girls here, one a bar girl one a girl who worked in a hotel. Only came cos I got a cheap flight.

I had a quick scan of a tourist info site that said there was a 100% condom programme and that Thailand was an example of how to tackle HIV (I didn't know it was years out of date).

I had never heard of a male who has been infected with HIV other than gays or Africans and when a UK doctor told me last year the 1/1500 stat I thought that's why.

Anyway, that's me. I made a series of fatal errors but I was well intentioned - I never had full sex without a condom but did have 4 unprotected moments.

I'm not dissing Thailand but it's a place where one is less likely to get away with silly mistakes.

Cheers

Hi there Unlucky,

Read your post and was struck because I have exactly the same symptoms you describe since I ended up with one of the working girls in Bankok in April.

I had a condom rupture and have been sick for the past 5 months...sore throat...swollen glands....tingling and burning in hands an feet....fatigue....problems concentrating..mouth ulcers....you name it...I even convinced myself that I got hairy leukoplakia in my mouth...also have 4 ELISAs done so far ...all negative out to five months.....cbc normal except for slightly elevated liver enzymes...but no hepatitis...nothing....it's strange. HIV specialist sent me home saying you got nothing......I don't know what to believe....here in Europe they all think as a hetero you run pretty much no risk....I also heard that subtype thing about thailand and don't know what to think....maybe it's really just stress and extreme anxiety and some other bugs the girls carry around....keep me updated how your story ends:-) thumbs up and all the best!!!

Cheers

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Hello

I've had a series of symptoms that can't be anything else other than HIV since I had 3 unprotected moments with 1 girl and 1 unprotected moment with another in Thailand in May / June. I also went down on both as a London doctor told me that you can't get it from oral sex.

I realise you have to be diagnosed before you can say for sure but I've had 2 x extreme allergic reactions to insect bites, fatigue, night sweats, neuropathy comprising of pins and needles, burning feet, pains in hands and feet, persistant sore throat, shooting pains in lymph nodes in groin and armpits. I've also had a fungal infection on my big toenail, most of which has come off now.

It's a complete nightmare to say the least - it was my first trip to Thailand and I stayed with a girl for a few days so stupidly ended up trusting her a bit plus the fact that the longer I'm with someone the more scope for mistakes. When she started saying 'make babies' I got a bit carried away.

I had friends there so didn't do much research pre trip - also a doctor in London last year told me the chances of a man contracting HIV from a women is 1/1500 which made me a bit too complacent.

Anyway, the doctors in the West don't seem to know so much about subtype E. They all dish out very positive stories which I suppose is their job in a comforting / 'try not to stress the patient out' kind of way.

Does anyone on the forum know of life expectancy with subtype E?

I know untreated it is just 5-7 years on average but just trying to work out what the situation may be with treatment.

I'd also be interested to hear if anyone has had similar symptoms to me - the doctor at my latest test told me 'you've not got HIV because the symptoms you've got are symptoms of advanced HIV' which isn't very reassuring.

Thanks very much

A highly suspisious post your doctor told you you must have HIV by your symptoms.Why didn't he test you :o

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With the swollen lymph nodes, get tested for LGV/chlamydia. There are lots of false negatives on the piss test, so don't rely on it. Do not under any circumstances use Cipro or Levaquin to treat it, as they DO NOT WORK against this class of organisms.

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With the swollen lymph nodes, get tested for LGV/chlamydia. There are lots of false negatives on the piss test, so don't rely on it. Do not under any circumstances use Cipro or Levaquin to treat it, as they DO NOT WORK against this class of organisms.

sound advice :o

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Some have mentioned the fact that working girls are tested for hiv in Pattaya.

I wouldn't count on it because like many things in Thailand there is an amount of show but beneath that not much substance.

Many girls do not get the test especially girls who are attached to beer bars in Pattaya and don't receive a salary and even those that do could easily get falsified documents.

I believe the rate of HIV in Thailand amongst sex workers is much higher than many punters imagine.

Many Thais with HIV will do nothing whilst in the non symptom period and just pretend it is not there.

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With the swollen lymph nodes, get tested for LGV/chlamydia. There are lots of false negatives on the piss test, so don't rely on it. Do not under any circumstances use Cipro or Levaquin to treat it, as they DO NOT WORK against this class of organisms.

I got NSU and was given the wrong antibiotics for them in Pattaya. The BKK Pattaya said I had chlamydia then gave me drugs that are suppose to be for gonorrhea (this is what I was told by the hospital in London when I returned) so the Doctor in London put the gomorrhea pills in the bin and gave me 2 strong antibiotics to clear up the NSU.

I'm hoping that the antibiotics messed up my immune system a bit which led to the alleargic reactions to moosquito bites then some other kind of non HIV complication led to the neuropathy, night sweats, loss of appetitie, fatigue, painful lymph nodes, persistant cough etc

I might come back to Thailand for the 6 month test as tests there are primed for subtype E

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With the swollen lymph nodes, get tested for LGV/chlamydia. There are lots of false negatives on the piss test, so don't rely on it. Do not under any circumstances use Cipro or Levaquin to treat it, as they DO NOT WORK against this class of organisms.

I got NSU and was given the wrong antibiotics for them in Pattaya. The BKK Pattaya said I had chlamydia then gave me drugs that are suppose to be for gonorrhea (this is what I was told by the hospital in London when I returned) so the Doctor in London put the gomorrhea pills in the bin and gave me 2 strong antibiotics to clear up the NSU.

I'm hoping that the antibiotics messed up my immune system a bit which led to the alleargic reactions to moosquito bites then some other kind of non HIV complication led to the neuropathy, night sweats, loss of appetitie, fatigue, painful lymph nodes, persistant cough etc

I might come back to Thailand for the 6 month test as tests there are primed for subtype E

antibiotics don't mess up your amune ststem, and if your hiv positive you'll test positive anywhere in the world , theres no "priming for subtype e

Edited by Sheryl
insults removed
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With the swollen lymph nodes, get tested for LGV/chlamydia. There are lots of false negatives on the piss test, so don't rely on it. Do not under any circumstances use Cipro or Levaquin to treat it, as they DO NOT WORK against this class of organisms.

I got NSU and was given the wrong antibiotics for them in Pattaya. The BKK Pattaya said I had chlamydia then gave me drugs that are suppose to be for gonorrhea (this is what I was told by the hospital in London when I returned) so the Doctor in London put the gomorrhea pills in the bin and gave me 2 strong antibiotics to clear up the NSU.

I'm hoping that the antibiotics messed up my immune system a bit which led to the alleargic reactions to moosquito bites then some other kind of non HIV complication led to the neuropathy, night sweats, loss of appetitie, fatigue, painful lymph nodes, persistant cough etc

I might come back to Thailand for the 6 month test as tests there are primed for subtype E

Mr not so bright,antibiotics don't mess up your amune ststem, and if your hiv positive you'll test positive anywhere in the world , theres no "priming for subtype e.........where did you study medicine................shish :o

PCR tests have primers for subtype E in Thailand. The antibody tests should pick up all infections but the window period is longer for subtype E.

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Hi there Unlucky,

Read your post and was struck because I have exactly the same symptoms you describe since I ended up with one of the working girls in Bankok in April.

I had a condom rupture and have been sick for the past 5 months...sore throat...swollen glands....tingling and burning in hands an feet....fatigue....problems concentrating..mouth ulcers....you name it...I even convinced myself that I got hairy leukoplakia in my mouth...also have 4 ELISAs done so far ...all negative out to five months.....cbc normal except for slightly elevated liver enzymes...but no hepatitis...nothing....it's strange. HIV specialist sent me home saying you got nothing......I don't know what to believe....here in Europe they all think as a hetero you run pretty much no risk....I also heard that subtype thing about thailand and don't know what to think....maybe it's really just stress and extreme anxiety and some other bugs the girls carry around....keep me updated how your story ends:-) thumbs up and all the best!!!

Cheers

Cheers mate, I will do - let me know how you get on too

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"neuropathy comprising of pins and needles, burning feet"

This is not a symtom of hiv but rather a side effect of potent medication which you are not recieving. It wont go away and probobly the culprit is Diabetes. Stop googling and get a full blood workup now

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What a worry wart you are mate.

I had a friend who was banging his girlfriend for four and a half years not knowing she was HIV positive and he tested negative so the chances of catching something in a one off situation must be huge.

YOu are worrying yourself literally sick for nothing i reckon.

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您可以帮我翻译一段文字吗----",我们感染了病毒,这个病毒从感染的途径,病程,症状全部和HIV一样,但是由于测不出抗体,正规医院不开具处方,我们中的很大一部分人,都私自搞抗HIV的药,由于这些人的钱不是一样多,就存在有钱的人能买到3种药联合治疗,没钱的就只能买一种或二种药进行自己口服,当然服用药后,每个人效果持续时间是长短不一的,但是吃一种药去治疗这个病毒,药效是最短的只有几个月药物就没有用了,有的吃2种药可以保持2年的药效,我有十万美金,我想给家人和自己一个完整的鸡尾酒疗法,但是在中国政府却不给我们自费买,很苦恼.我们中的部分人已进死去,部分人将面临死亡,有的人的CD4只有200到300."--非常感谢 以上所说 都是真实的心声 希望有懂汉语的 朋友帮着分析下 我经过2个月的检查 我的CD4下降了100多

Edited by HELP123
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IIR his original post correctly, which was also a bit muddled, HELP123 is a guy who believes he has HIV. He can't get the meds in his native China because the docs there do not diagnose and medicate until a certain threshold of viral load or something. He wants to buy the proper meds for HIV here in Thailand.

I suspect -although it was not so stated in his original message in a way I could decipher- that he believes he has the subtype E and that the Chinese tests are not detecting it properly. I seem to recall him not wanting to be diagnosed in China anyway due to the discrimination against those so diagnosed. Can anybody help him? I am sadly out of date on my HIV knowledge, as I have had no real reason to keep up on it, and it does change rapidly.

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Thanks, cathyy. If he were here in BKK or even the States I could point him in the right direction but I am unable to assist him in China. However, even in the US if you don't meet certain viral load burdens nor low enough Cd4 levels most MDs won't prescribe HIV meds to patients.

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