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Use Of Biopsy to Identify/Rule Out HIV Infection

Jul 28, 2002

Dear Dr Holodniy - just repeating a previous question. I'd really appreciate your advice.

Patient initially presented 2 1/2 weeks post possible exposure with submandibular, inguinal and axillary lymphadenopathy - submandibular has gone but rest persist as well as swelling behind knees and thrush. Re timing his has had no recurrent exposures - last was just over 6 months ago

When he first came to the surgery post exposure he was also suffering from systemic symptons including weight loss and night sweats as well as mild sore throat.These have all gone.

He has tested -ve HIV 1/2 by Elisa out to 6 months, -ve P24 antigen as well as undetectable on bDNA and RNA PCR. I have also tested for EBV mononucleosis, CMV, tuberculosis, toxoplasmosis, syphilis and Hep B - however no readily diagnosable cause. He has consistently had an increased lymphocyte count.

My question is can a bioposy of the lymph nodes be used to identify or rule out HIV infection? I have no experience of this.Is this something you would recommend in this scenario?Is further testing warranted?

Apologies for the long question but I am not clear what is best to do with this patient and he remains very anxious.

Thanks very much

Response from Dr. Holodniy

Although HIV infection does have certain characteristics that can be identified in lymph nodes there would be no reason to use such an invasive test to confirm a diagnosis that can be accomplished with blood tests.

Pityriasis Rosea and HIV
is 188,000 a high viral load does this mean aids

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