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Complicated case ( Neutropenia & CD3 and CD4 isn't in the normal range ) Please help
Mar 27, 2014

Dear Doc David ,

Please answer me this time as your opinion means a lot to me and i need to weak up from this bad dream.

I am male , 29 years , from Middle East.

I had unprotected vaginal sex with sex worker 3 months ago and i don't know her HIV status.( i was very drunk and i don't know how i did that )

Symptoms:

After 4 weeks i had a Sore throat for 8 days, after 7 weeks till now :night sweat every night , loss appetite , loss weight till now( 9 kg). After 10 weeks : a flue for only 3 days with a fever of 38 after 12 weeks : diarrhea for no reasons (9 days and then went for 3 days and came back for 3 days) and 3 small red dots in each hand. and i feel always fatigue.

During my window period i took extacys pills twice, 1 time haf of tramadol 1.25 pill trying to go out of anxiety and it this doesn't work at all.

Please note that before this accident i was in a good health and i wasn't the one who get sick usually.

Tests did with result days : ( may be 3rd generation i don't know exactly)

80 days : HIV antibody ( non reactive 0.12) 90 days : HIV antibody ( non reactive 0.24) 110 days : HIV antibody ( non reactive )

I went to a doctor ( not HIV doctor as in my country it is very difficult to meet HIV doctor ) he ask me to do a full blood picture and here came another new surprise with the result on the 91 day

Hemoglobin: 14.9 Haematocrit(pcv) 42.5 RBCs count 5.47 MCV : L 77.7 MCH : 27.2 MCHC : 35.1 RDW-CV: 12.0 PLAtelet count : 370 Total LEUCOCYTIC COunt : 4.7

Differential leucocytic count: Neutrophils: 35.7 % 1.69 Lymphocytes : 48.1 % 2.28 Monocytes : 10.1 % 0.48 Eosinophils : 5.7% 0.27 Basophils: 0.4% 0.02 **** ( comment: RBCs show mild microcytosis .Relative LYmphocytosis.Relative Monocytosis.Absolute Neutropenia)

After 2 weeks i went to another doctor ho ask me to do another full blood picture witch come back with the following result.

Hemoglobin: 14.9 Haematocrit(pcv) 42.5 RBCs count 4.9 MCV : 84.3 MCH : 28.2 MCHC : 33.5 RDW-CV: 12.0 PLatelet count : 338 Total LEUCOCYTIC COunt : 3.8

Differential leucocytic count: Neutrophils: 47%. Lymphocytes : 45 % Monocytes : 3 % Eosinophils : 1% Basophils: 2% staff 2%.

( comment: Count is normal limits for age and sex except for ABSOLUTE NEUTROPEMIA . Platelets are normal.)

and then he ask me to do Lymphocytes ( CD4 and cd8 ) test and the result was :

Lymphocytes 39.9 % Comment :( immunophenotyping of peripheral blood cells shows that about 40 %of cells are lymphocytes. 46.9%of these lymphocytes are CD3 positive T-cells(N:53.1% - 84.3%) CD4 is expressed on T-cells by 65.7 % (N :27.0 - 53.0%) CD8 is expressed on T-cells by 26.6% (N: 13.0% - 40.0% ) CD4/CD8 ratio = 2.5 (N: 1.0 - 3.5 )

after all this tests the doctor told me that i am not an HIV case but he asked me to retest at 6 months for HIV and for CD4 and CD8.

My questions is :

1- what does the Cd3 , CD4, CD8 test mean in my case ??why CD3 and CD4 aren't in the normal range ?? It that mean that my body trying to defense a virus ??

2- Does my full blood picture, Neutropenia & Total LEUCOCYTIC COunt : 3.8 can cause a late antibody production?? it is a kind of per-existing immunity disorder ?? ( keep in mind i never went to hospital )

3- Should i retest again at six months ?? or 90 days is conclusive in my case ?

4-Why many of HIV experts told that 90 it's conclusive and others doctors says 6 months and actually there is some cases witch tested positive after 6 months on the internet ??

4 - Does ANXIETY can make me loss 8 kg in 3 weeks (about 10 % of my all weight), and have diarrhea for about 9 days ? ! and night sweats for almost 1 month ( keep in mind i read "ARS SYMPTOMS vs. ANXIETY" article http://www.medhelp.org/user_journals/show/326070/ARS-SYMPTOMS-vs-ANXIETY but also there is a percentage that this it s a real ARS symptoms and is not the Anxiety. and regarding my Sore throat for 8 days i am sure of it as at this time i wasn't thinking about being infected of HIV !!

Sorry for my long question but please have a look for all my case , and try to response to my question in details as much as u can ,as i need a bottom line for this situation.and i need to get back to my normal life.

Good bless you and help you in supporting people and helping them.

Thank you and best regards.

Response from Dr. Wohl

I think your HIV tests are correct and you are not infected. Most people seroconvert from HIV negative to positive within 12 weeks after infection. The rest do so by 24 weeks. Older antibody tests were less sensitive and back then there was no HIV RNA (viral load) or p24 testing. With these, the testing becomes basically fool proof.

Your labs are not abnormal. Some of the numbers are just out of the range of normal but normal typically means on standard deviation, that is where about 68% of people will fall. That means many normal people will have values outside these ranges.

None of the results indicate HIV.

For security and peace of mind get tested at 6 months and when this returns negative feel convinced you are not infected.

DW



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