Advice re Unusual Case

Oct 21, 2002

Dear Dr Boyle,

I work with HIV and infectious diseases. We have an unusual case that I wanted to get your professional opinion on. 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.

Thank you for your time

Response from Dr. Boyle

It sounds like the patient has been thoroughly evaluated for HIV and that there is absolutely no evidence of infection. I would agree that at this point HIV infection has been effectively ruled out.