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possibly optimistic situation
Jan 5, 2004

Hello Dr. Wohl

I insist you read this even if it is a little off topic or sounds all too familiar. It is actually a unique situation. I'm a 37 year old woman who had an oral exposure some 2 years and 8 months ago that resulted in swollen salivary glands and tonsils, nausea, and quite a bit of weight loss. At the onset of the symptoms (around 2 weeks after exposure) I tested positive on an HIV viral load test (it wasn't a high viral load, but above undetectible). After the symptoms became less harsh, yet still, somewhat a chronic problem, I began testing undetectible on viral load tests, and also always test negative on elisa. Because of this, the positive viral load was retroactively deemed a false positive. But to this day, I continue to gradually lose weight on the scale no matter how much I eat, and my salivary glands are still always swollen and tender and tonsils still enlarged. I test negative for everything else any doctor can think of. I know we are not supposed to think this way, but I suspect that because of the route of transmission, there is some sort of virus (maybe HIV) being held at bay in my tonsils and salivary glands, and this is somehow signaling my body to breakdown because it needs the extra energy to feul my glands and help them keep this virus out of my blood and other tissues. But when my tonsils finally tire out, this virus will enter my blood and begin causing problems. This is when I may begin to test positive for HIV. Had my intestinal tissues been exposed rather than my throat glands (as is more normally the case with HIV infection), maybe I would have tested positive already. I think a prudent measure would be to have the mass or fluid in my salivary gland removed, and my tonsils as well. My glands seem not able to win this battle on their own. What are your thoughts?

Response from Dr. Wohl

I have not heard of localized HIV infection where the virus enters the body but does not take advantage of all the appetizing CD4 cells swimming by. HIV is very good at circulating widely via our immune cells and these cells traffic through our glands.

False positive HIV viral load tests happen and are almost always low level. If HIV was wreaking so much havoc on your body I would have expected your body to make some antibodies against it. If you have truely swollen glands, I think a biopsy is reasonable and may point to what is really going on. Sorry, if that was not much help. DW



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