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Antibodies of opportunistic infections
Oct 1, 1996

I am Hiv-positive, recently infected, with normal CD4 counts, healthy and asymptomatic, on no medication.I know from some analysis years ago that I give positive also to Mantoux test forTB, to citomegalovirus and to toxoplasmosis antibodies. I am vaccinated against Hepatitis B.The fact that I have antibodies against TB, CMV, HBV and toxoplasma means anythingregarding future progression into aids?I have heard both types of opinions. One, that it is likely that those viruses,now "dormant" in my body, will reactivate if I progress to aids. Two, that preciselyhaving those antibodies already present will prevent those diseases from appearing.I would like to hear your opinion.Thks

Response from Dr. Cohen

Let's deal with one test at a time:

The positive Mantoux test for TB: This means that you have been exposed to tuberculosis. It means that there somewhere in your lungs, there are a few tuberculosis bacteria that are being effectively contained by your immune system. However, as your CD4 cell count falls, your immune system could fail to control the infection, and you could develop active tuberculosis. People with positive skin tests for TB (the usual test is the PPD), or people who have EVER had a positive skin test, even if they don't now, should receive prophylaxis against tuberculosis. That consists of one year of isoniazid (INH), which will kill the bacteria and prevent you from getting sick.

The positive antibody against CMV (cytomegalovirus): This is extremely common in the general population, and especially among HIV-infected people. It means that at some point in your life, you were exposed to CMV. It means that you, like almost everyone else with HIV, will be at risk for CMV disease when your CD4 count is less than 50. Although at this point, prophylaxis against CMV is not routinely recommended, that may change in the future, and people with low CD4 counts and positive CMV antibodies will be the ones who receive prophylaxis.

The positive antibody against Toxoplasma: This means that at some point you have been exposed to Toxoplasma gondii, the parasite that causes toxoplamosis. As with TB and CMV, it means that somewhere you have that organism in you, and it is being contained by your immune system. When your CD4 count falls below about 100, there is a good chance that your immune system would no longer be able to contain the organism and you would develop toxoplasmosis (usually a brain disease). There is now prophylaxis for such people-- either TMP/SMX (Bactrim or septra) or a combination of dapsone and pyrimethamine, which is given when the CD4 count falls below 100.

The vaccination against hepatitis B: This should protect you against hepatitis B infection, provided your CD4 count was high enough when you received the vaccine to be able to respond to it.



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