Jul 24, 2001
Dear Dr. Little, I am an ER physician in Chicago. I had a patient that tested negative by EIA, western blot, pcr, and viral culture a year past last possible exposure. But he continues to experience oral signs and symptoms. His oral symptoms resemble that of necrotizing periodontitis. I know that this is usually a sign of severe immunosuppression. But is it possible that he has been infected with a rare subtype not picked up by current tests? His exposure was in Lithuania, and I know that subtype B is not the dominant type there? Could you offer any further advice? Thank you for your help.
Response from Dr. Little
First - very sorry for the delay in answering your question. Regarding testing for rare subtypes - I believe that the available HIV EIA tests all detect non-B subtypes within the M group quite well. On my quick look on the web, I found that subtypes B, C, and D have been identified in Lithuania. The problem is with the non-M group strains - these are group O and N. Group N isolates are vanishingly rare, so I would not worry about these. Group O (for genetic "outliers") are quite uncommon, but less is known about their natural distribution since HIV strains designated group O are not consistently detected by currently licensed EIA tests for HIV-1. Most of the goup O infections have been described in Cameroon or countries bordering Cameroon. Unless your patient has an exposure to someone from this region, I think that group O infection is quite unlikely.
For your patient - I would start with his CD4 cell count and ratio. If it is abnormal (low), then you might want to pursue other immunodeficiency disorders. If you do want to pursue work-up of group O HIV infection, there are subtype-specific serologic techniques (ie. peptide-based enzyme immunoassays) which are available for this purpose. You could contact your state public health department for advice about who/where these tests are done in your state. Good luck.
How off schedule is off?
Resistance/Clinical Trials Question
- What's The Difference Between Mouth Ulcers And Herpes Simplex 1?
- What Kind Of Doctor Should I See For Hpv?
- What Is The Difference Between Herpes Igg And Igm?
- What Happens If Genital Herpes Goes Untreated?
- Does Vinegar Dry Up Genital Herpes?
- Time Frame After Contracting Herpes Before It Shows Up On An Std Test
This forum is designed for educational purposes only, and experts are not rendering medical, mental health, legal or other professional advice or services. If you have or suspect you may have a medical, mental health, legal or other problem that requires advice, consult your own caregiver, attorney or other qualified professional.
Experts appearing on this page are independent and are solely responsible for editing and fact-checking their material. Neither TheBody.com nor any advertiser is the publisher or speaker of posted visitors' questions or the experts' material.