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PCP Diagnosis Despite Negative HIV Test Result
Sep 30, 1997

My boyfriend tested negative for HIV five weeks ago. Last week while away on business he suddenly became very ill with a high fever and dyspnea. A local doctor after taking chest x-rays diagnosed him with bacterial pneumonia and prescribed him an antibiotic. However, the doctor said he should see his regular intern in New York because the x-ray showed a bilateral diffuse interstitial infiltrate that may be something other than bacterial and the doctor also thought it strange that my boyfriend was not producing phlegm or coughing. After the New York intern examined him and looked at the x-rays he diagnosed him with PCP. The doctor, knowing that he was a sexually active gay man, told him his HIV result a month ago was probably a false-negative. The doctor a took t-cell test, PCP test and an HIV test and took him off the antibiotics and put him on Bactrim and Prednisone. Three days later the nightmare ended when the results of his tests showed that his t-cell count was normal, his PCP test was negative, and his HIV test was negative AGAIN. The doctor said he was relieved and that his anomalous pneumonia had cleared up nicely. Do you think it was irresponsible and impetuous of this doctor to communicate such an ominous diagnosis to my boyfriend and change his medications before he had seen the test results? How common are false-negative results for the HIV test?

Response from Mr. Sowadsky

Hi. Thank you for your question. A false negative HIV test beyond 6 months from a possible exposure to the virus, would be extremely rare. An HIV test shows positive by 6 months after infection, and usually remains positive for life. PCP (Pneumocystis carinii pneumonia), and other opportunistic diseases, do not usually begin until an average of 10 years after infection. When a person has an AIDS related opportunistic disease like PCP, they would continue to test HIV antibody positive. False negative HIV tests under these circumstances would be extremely unusual.

In some persons in the very late terminal stages of AIDS, they may once again test HIV negative on an antibody test. This would occur if the immune system becomes so damaged, that it could no longer produce antibodies anymore. But let me stress to everyone that this would only occur in the very late terminal stages of AIDS. It however does not occur very often. It would NOT occur in persons with early HIV infection, nor in the majority of persons with the full blown disease.

This incident proves that one CANNOT make a diagnosis of HIV infection or AIDS without laboratory confirmation. A physician cannot determine the cause of most illnesses without doing laboratory tests. Many doctors think that if a Gay man has symptoms like pneumonia (or symptoms similar to that of other opportunistic diseases), they commonly assume that the illness is probably due to AIDS. This is a very dangerous assumption, as is shown in your boyfriends situation. Nobody (not even doctors) can assume a person has AIDS without laboratory testing.

If you have any further questions, please feel free to e-mail me at "nvhotline@aol.com" or call me at 1-800-842-AIDS (Nationwide). I'm glad to help!



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