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Recurring salmonella and hiv

Nov 10, 2013

Hi doc,

My grandpa just got out of the hospital after having symptoms of severe food poisoning, and were waiting for the results of the stool culture to see if its salmonella. Heres some background info before I get to the question - he has been living with HIV for over 25 years and especially thanks to the advancements in medications he has overall been very healthy. I dont know his initial labs, I just know that for the past ten years or so he has consistently had a CD4 above 500 and an undetectable viral load (there were a few blips though) and is now on Atripla. Not sure what meds he was on before Atripla. However, in 2008 (not sure how he got it) and 2006 (might have been related to the tomato recall) he had nearly-fatal incidents with salmonella cases. What was really frustrating was how aggressive the salmonella was and how it took a TON of antibiotics to treat it because the 2008 and 2006 strains were resistant to ampicillin. His doc talked about how hiv infected individuals are more likely to have a resistance to ampicillin, but is there a specific reason for this?

I imagine that age is definitely a factor (hes 71) in how his body responds to intestinal bugs but I thought recurring instances of salmonella is a sign of AIDS. Is it common to have recurring salmonella infections in hiv infected individuals who are in the normal range of cd4 counts? thank you

Response from Dr. Holodniy

Although it is hard to quantify over time, the number of invasive cases of salmonella infection in HIV infected people has decreased, although some studies have demonstrated that the average CD4 count has increased from < 100 to > 300 on presentation, even in the presence of HIV treatment. The number of antibiotic resistant strains has also increased over time and this is not just in those with HIV infection. So, given his age and current CD4 count, it would not be inconsistent to see a salmonella infection. However, there are many moving parts here. Salmonella is known to evade the immune system and thus, people can become carriers (even in those without HIV infection). Unless the isolates were saved and could be studied, it is hard to know whether his infections are all new events or recurrence with the same strain.

CD4 count dropping with stable %ratio
Undetected or less than 20 and detected?

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