Dear Dr Holodniy, your response to a question regarding Idiopathic CD4 depletion syndrome has prompted me to ask for your opinion re a Patient under my care

He had a significant HIV risk exposure 15 months ago but is repeatedly negative on serology and undetectable on DNA PCR and bDNA. However his CD4 count has been over the last 12 months in the 220-295 range and trending down.Malignancies and other immune system risk factors have been ruled out. Is the medical community sure that such occurences are ALWAYS CATEGORICALLY NOT related to HIV infection? He has asked me what would happen if his CD4 falls below 200 and he develops opportunistic infections, and whether I would see if his immune system responded to HAART. This is a very difficult area. My question is whether we can be absolutely sure in the presence of a HIV risk exposure and a low and declining CD4 count that the syndrome is not HIV related or whether in rare cases individuals whether due to their immune response or the strain of the virus are not picked up with current tests.

Your personal opinion would be very much appreciated

Best Regards

The cases to date have not shown any HIV-1 infection. However, cases have demonstrated OIs, when CD4 counts are low. I would strongly suggest OI prophylaxis as one would do with AIDS or cancer associated leucopenia.