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HIV Testing
Apr 17, 2001

I know you do not like these type of questions, but I hope you could give me some insight on my condtion.

During the past 3 months I had drenchig night sweats which subsided then I lost 10 lbs. the second month during the third month the lymph nodes in my groin had pain like the were buring but were not hot to touch and were not swollen. After the nodes quit hurting I gained my weight back.

Just six months ago I had been dignosed with Nuro Cardio syncope by at tilt table test.

I visited my GP and we had a CBC and HIV test. The Hiv test was negative and my WBC was 10.0 RBC 4.6 all other items were normal. I felt like HIV infecetion was out of the quesiton until I read about Hiv subtype n.

I went back to my GP and told him 3 years ago I had unprotected sex with a woman from Cammeroon W. Africa. He then order an HIV 1 & 2 test and did another CBC with CD4 count. I guess he was worried as well as I that I could have contracted a rare subtype? HIV test was negative, CD4s were 1176 WBC was 9.5, 75polys 15lymps 8monos 2bas. The Red count was 4.6 14 He 43 Hct, Sed rate was 2. I ask him for a referal to an infectous disease doctor and he wouldn't grant my request.

Can an infectious disease doctor rule out Hiv subtype N. I have ask for a Western Block test but my GP said I didn't need it.

Should I go ahead and see and Infectious disease Dr. I under stand from reading the report on subtype N that it dose not infect CD4 cells, is this true?

I hope you can give me some good advice so I can put my mind at ease.

Response from Dr. Little

Sorry for the delay in getting back to you. While I am not an expert on subtypes N and O, I will do my best with your question. First, I am sure that your physician was not particularly worried because all of your tests were normal and infection with either of these Non-M type viruses is very uncommon in the US. As far as referral to an infectious diseases doctor, I cannot adequately advise without taking a complete history myself, and I do not know a great deal about "nuro cardio" syncope - though I have no reason to think that any form of syncope would have an overlapping symptom profile with that of typical HIV infection. Regarding the tender lymph nodes, fever, and weight loss, there are a whole host of other causes (some serious, some not) which could have caused your symptoms and have gone away without specific intervention. While I cannot really advise you on whether you should see a specialist, I think that the odds that you have a rare HIV subtype are very low. If your HIV 1/2 antibody test is negative, I would agree that a western blot is not worth doing. However, if you do pursue testing, you are correct that standard HIV 1/2 assays may miss types N and O infection. It is my understanding that HIV type-specific peptide assays are needed for subtypes N and O. There are two newer HIV 1/2 EIA tests (the Abbott Plus and the Ortho Enhanced) which have some track record at detecting subtype O infection. One of these more specialized tests would be necessary to rule out infection more definitively if this is what is decided. Good luck.

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