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Advice re Unusual Case
Nov 7, 2002

Dear Dr Frascino,

I work with HIV and infectious diseases. We have an unusual case that I wanted to get your professional opinion on. Male patient, 27 yrs, presented with seroconversion type illness/symptons 2 weeks post possible exposure in October 2001. Repeatedly negative out to 12 months using HIV 1/2 serology that is also tuned to be sensitive to type O and N. Additionally -ve on bDNA 3.0 and Pro-Viral DNA. The DNA is an in-house test using two sets of primers specially designed to detect all sub types of HIV 1 infection. At 6 months post exposure patient was told that he was HIV -ve. However he has independently had his T-cells tested using a private lab and has returned with the results. 1st set of labs taken 7 months post exposure as follows; CD4 - 345 Cd4 - 36 CD4/CD8 = 1.2 WBC - 2500

2nd set of labs taken 10 months post exposure CD4 - 328 Cd4 - 35 CD4/CD8 ratio = 1.1 WBC - 2520

Following psycholgical assessment of patient and subsequent psychologists reccomendation we have repeated serology at 12 months and performed seminal fluid viral load (both negative) in order to get patient to mental closure on this. In my view HIV infection has been conclusively ruled out. However would very much like your opinion on whether you agree.

Thank you for your time

Response from Dr. Frascino

Bonjour,

Je suis d'accord que votre client est HIV seronegatif, bien sur. Les examens de laboratoire sont concluants.

OK, I'm sure your English is much better than my French, so I'll switch to my "langue maternelle." Your patient does have 2 sets of laboratory reports showing low CD4 cells. First off, was the "private lab" reliable? You might want to run your own T-cell subset analysis to see if you get the same results. If persistently low T-cells are confirmed, I'd recommend sending your patient to an immunologist. There are a wide variety of conditions that can result in low CD4 counts, aside from HIV. There is no doubt that you have ruled out any possibility of HIV, so that really is no longer in the differential diagnosis. The immunologist can run a more sophisticated series of T-cell markers to find out if there is an isolated loss in a particular subset. Other immune diagnostic tests may also be warranted, including functional assays.

Je suis desole que ma reponse est en retard.

Amicalement,

Dr. Bob


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