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"Not a Question from Worried Well": F/U Question

Feb 26, 2013

Dear Dr. Wohl,

Thank you for answering my question posted on 29 Jan 13. You suggested me to have a CD4+ count to rule out my symptoms suspicious of caused by any opportunistic infection. Actually I have it done on 17 Nov 2012 and the results: WBC: 6.3k/uL, Lymphocytes: 1972/uL (31.3%), CD4: 746/uL (37.8%). Yet I did another panel of tests on 20 February 13 and the results are: P24 & Antibody: negative, HIV-1 RNA: not detected <100 IU/mL, WBC: 4.3k/uL, Lymphocytes: 1668/uL (38.8%), CD4: 605/uL (36.3%).

The CD4 count is below the normal level on the test (ref. value: 720-1440). Is it possible that the WBC/Lymphocytes/CD4 counts to be dropped/fluctuated by that amount for a HIV- person? As I am still having all the symptom, particular the weird pain behind the sternum and epigastric, is it possible that a person with CD4 count of 600+ to have esophageal candida? What conclusion can be drawn by having those tests' results?

Regards. Chan

-----------------------------------------------------------------Not a Question of Worried Well Jan 13, 2013 Dear Dr. Wohl, I had multiple unprotected exposures with around 15 girls in the last 8 years (rough estimation). I didn't know their HIV status. Most of them I just had 1, 2, or several casual sexual encounters, and 3 of them I developed a few months' relationships. My last unprotected exposure was on mid-August 2012. I became aware of my HIV status since late-September 2012. With severe upper abdominal pain radiated to the back, I was diagnosed with chronic gastritis and esophagitis on 19 Sept 2012. After that, I have been developing weird neural pain (tingling, numbness, burning) on my upper back and chest, and it is persistent and worsening until now. I had a whole body PET scan to rule out malignancy on last Oct. And then every symptom coming up are pointing to HIV/ AIDS. I have white coated tongue with tingling feeling. I have persistent night sweats. And I become aware of my numerous raised warts on my shoulder, trunk, and abdomen which I firstly supposed to be caused by continuous sun light over the years. I have a bean-shaped lymph node under my left mandible. However, I don't have fever and obvious weight loss, and my appetite is normally good. Then I have multiple Duo combo and PCR RNA tests, and all the results are negative. Is it absolutely conclusive if I had negative Duo combo plus PCR RNA after 3 to 4 months of my last exposure? Due to my multiple risky exposures in the past years, I'm worried of complicating the disease's diagnosis and/or progression and the possibilities of developing rare/virulent/recombinant/superinfected/rapid progressing viruses or other unusual circumstances (e.g. highly exposed seronegative) that the antibodies and viruses are not detected by the tests. Is there anything I can do to completely rule out HIV infection? Is that viral replication can be restricted in only mucosal tissues or lymphatic system, but not necessarily in the blood plasma? Apart from the tests of the plasma, is having biopsy possible to rule out highly suspected but seronegative cases?

Thanks, Chan

Response from Dr. Wohl

Why not get a CD4 cell count? You have had so many tests and evaluations done but this simple test will reveal all. If your CD4 cell count is normal, there is no way you have HIV as the cause of your symptoms as it is reduced immunity that leads to the opportunistic conditions you fear.


Response from Dr. Wohl

The CD4 cell counts are quite good, do not indicate AIDS and are not any where near the level that would lead to opportunistic conditions like thrush. Congratulations, you are very HIV negative. DW

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