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Tuberculosis again and again - can it mean HIV +
Jun 19, 2000

An Indian male of 30 years of age suspects that he could have been infected by HIV. The series of events that followed are as follows :

1. He had an unprotected physical relation (for about a month or so) with a female (not a prostitute) in March 1994.

2. He suffered from Tuberculosis in September 1995 and was under medication until August 1996. That is when he suspected that he must have been infected. So he got himself tested for HIV (ELISA for HIV 1 and 2) once in November 1995 and again in February 1995. Both the results were negative.

3. The Tubercolosis lapsed in March 1997 and he was under medication until June 1998. During this period he got the RTPCR done for HIV 1 only once on 17th October 1997 and later on 12th June 1998. The results were again negative.

4. In the mean time he read somewhere that there are some strains of HIV which do not get detected by ELISA or RTPCR. He also read that the CD4 and CD8 counts are low when when a person is infected. So he got himself tested on 31st January 1998 (while on medication for Tuberculosis) and the counts were -- CD4 was 345 and CD8 was 220. The doctor said that it could be because of the medication that he was taking at that time.

5. He is again suffering from Tuberculosis now and is under medication since May 2000. However his HIV status taken recently is still negative.

6. He suffers from dry cough very frequently. It seems to be some allergy related to dust and pollution as the cough subsides when he is at home or away from the pollution.

Please note that he has never again had any physical relation with anybody after that incident.

Now the questions are : 1. Does his suffering from TB again and again mean that he is HIV positive ? 2. Do low CD4 - CD8 counts indicate that he is infected by some other strains of HIV which could not be detected by ELISA and RTPCR ? 3. Are there any other tests which he can undergo now to ensure 100% that he is not infected by HIV or any of its strains ?

Awaiting your response to these queries.

Thanking you in anticipation.

Response from Dr. Feinberg

TB is a clue for HIV infection because they commonly occur together, but you can have TB (including relapsed TB) without HIV infection. His tests are repeatedly negative, which is reassuring. There are some strains that are not diagnosed readily by the standard tests, but these are primarily strains from West Africa and other non-Western locales. You don't say where are this exposrue took place, so it is hard to give you a definitive answer.

blotches on the skin...KS?
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