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Simultaneous TB HIV transmission
May 30, 2006

Dear Dr,

I would sincerely appreciate an answer to this question. If a person was simultaneously infected with tb and HIV would they definitely produce an antibody response to both? This is my story. I am the mother of an 11 year old and 7 1/2 year old. Three years and two months ago, at a mall, my daughter who was 4 at the time was exposed to a high risk person's blood. After my daughter started eating a bagel, I noticed a small amount of blood on it. She was not bleeding at all, so we returned to the store where we spoke w/ the person who gave it to her. He did not know where the blood came from (no visible cuts) and he had used the automatic cutting machine to cut it instead of a knife. I called the pediatrician who was not concerned about the event and instructed me to forget about it. Exactly, three weeks later my daughter came down w/ a fever, fatigue, sore throat. (like nothing she ever had before-no nasal symptoms) She was tired for about a week. Her sister was sick a few days before w/ a fever and cough. (She recovered quicker). On the second day of symptoms, I brought her to the pediatrician who tested her for strep (negative). I insisted she test her for HIV so she did an antibody test and p24 antigen test (both negative). I decided to see an infectious disease doc who did a DNA PCR & Elisa 2 1/2 months after the incident. (negative) At this time I also brought my daughters for physicals and they both had tb tests which were negative. We followed up w/ a 6 month ELISA (negtive). I went to another ID specialist to get a second opinion, 10 months after the incident. She did a HIV DNA & RNA test)(none detected, under 50), Hep C antibody & RNA test(both negative), t-cell count (CD4=1636, CD4%= 46%, CD8=603, CD8%=17% CD$/CD8 = 2.71), and a CBC that was normal except her mean platelet volume was a little low. Fast forward, three months, my daughter needs an updated physical for kindergarten. I bring her to the pediatricain who does the physical and gives another PPD test which is completely negative (no mark at all). This is 1 year after the incident. Six months later, my older daughter needs her physical for school and a tb tests shows her at 14mm. The pediatrician reccommends a retest three months later. We return and the PPD now measures 20mm. My younger daughter is tested (the one exposed to blood) and shows a 12 mm induration. I test and show a 18mm induration. We all have chest x-rays, my daughter's are clear but mine shows a few calcifed granulomatas in my lower right lobe. We go back to the ID specialist who prescribes 9 months of INH for all three of us. He does not see a correlation b/ my daughters exposure to blood almost two years before b/ her PPD the year previous would have been positive if related. FOr my piece of mind, 32 months after the exposure to blood, he ran another series of RNA PCR, HIV1/2 ELISA and t-cell count. (all negative and t-cells CD4= 1715, CD4%= 51%, CD8= 605, CD8% = 18% and CD4/CD8= 2.83. The puzzling part of this is how we were exposed to tb. We don't have household help. Close relatives were all tested. My children or myself never had any symptoms. Could my younger daughter have had a case of extrapulmonary tb that was not detected. My daughters use the same toilet (always pee on the seat), bathe together, etc. Could she somehow have exposed her sister and myself. I know this whole sceanrio sounds crazy but I don't know how to put this to rest. I keep thinking that somehow she was exposed to TB/HIV at the same time and her little body was unable to react to both. Is there anything else I can do to prove that she is unifected with HIV. I am desparate. I don't want to bring her to another doctor but I am terrified that someday it will show up out of nowhere and had I got her help earlier she would be able to have a greater chance. I apologize for this longwinded version but I wanted to clearly represent all the facts. Please advise what you think may have possibly happened and anything else that I can do.

Sincerely,

Desperate MOM

Response from Dr. Wohl

There is no need to do "anything else ... to prove that she is un-infected with HIV." Your daughters are both HIV un-infected. That HAS been proven. You were exposed to TB and depending on where you live that may not be that uncommon. It has nothing to do with anything else you describe.

The medical advice you have received seems right on. I would suggest you drop the idea regarding HIV infection as it is clearly not an issue for your daughter, finish the TB medication as directed and move on.

DW



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