Your Advice Would Be Really Appreciated
Nov 22, 2002
Dear Dr Little, this is a repeat of a previous question that I sent you. I understand from previous postings that you are an expert in primary infection and thus I would very much appreciate and value your opinion on this case. I work with HIV and infectious diseases in the Department of Virology at the Pasteur Cerba Institute in Paris. We have an unusual case: 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, especially in regard to the T-cell results which clearly are abnormal although from my experience the low absolute is a function of the low WBC and the CD4 is normal.
Thankyou very much for your time
Dr Jean-Dominique POVEDA, MD
Response from Dr. Little
I agree with you completely - I do not think the patient is HIV infected. Although not common - low CD4 cell counts (with normal CD4/CD8 ratios) have been described in otherwise healthy individuals. I cannot see any justification for further HIV work-up for the original presentation. Good luck.
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