Question

Hi Dr Moyle

My questions are about my 28 year old friend. Last March (2007) my friend had a negative HIV test. In July he fell ill with a severe throat infection, because of this episode, he was put on the waiting list for a Tonsillectomy. He had this in september 2007 and was discharged home, however, after a couple of days of being at home, he started bleeding (and like most people who have Tonsillectomy's he had got an infection) and had to be readmitted in order to go back in to theatre. Whilst he was in theater he had a blood transfusion. On his discharge they told him to see his Doctor and have routine bloods done because his WBC was low. He had this done and was never called back, so he assumed that it was ok. I understand that an overwhelming infection can cause your WBC's to decrease??? In around Jan/Feb 2008 he noticed enlarged lymph nodes, he saw a Doctor who requested a HIV test. In March 2008 he got the result that he was HIV positive, he was referred to the HIV clinic straight away and at the end of april 2008 he had his first set of bloods back. His CD4 was 240 and his viral load was 49000. He has no coinfection. He has lost weight but this has not been dramatic. He has also suffered with very very mild dermatitis on his face and scalp. His partner had a test and also tested positive, his first set of blood results were really good and he has no signs or symptoms at all. My friend has to go back to the HIV clinic in 8 weeks for his second lot of blood results. My questions are: Is it possible that the severe throat infection last year was when my friend seroconverted, especially because his WBC's were low when he had his tonsillectomy? Or did he go through seroconversion when his lymph nodes came up at the beginning of this year? Either way, the fact that his CD4 is so low, does that mean he is progressing fast, or could his CD4 come back up on it's own because the infection cannot of happened no more than a year ago? Finally, the fact that my his blood results are worse than his partners, does that indicate that he has had it longer, and passed it to his partner?

Thank you for your time x

Answer

Sore throats, and mononucleosis (glandular fever)type symptoms (fever, rash, fatigue, enlarged lymph glands, low white cell count) are common around serocoversion and may persist for several weeks. CD4 may drop substantially and recover over the subsequent 6 months. More dramatic seroconversion illness may be associated with faster subsequent progression of HIV. I am never sure that looking back at things helps much. Who infected who and when is a pointless game of recriminations about the past and does not deal with the problem at hand and the future. Seroconversion occurred bewteen March 2007 and March 2008. Different people progress with CD4 decline at different speeds so CD4 cell counts don't tell any story about how long somemone has had HIV. The CD4 may come up on subsequent testing after a period of good health so at present it is hard to judge what will happen next. His Dr will provide the best individualised guidance. Best of luck for the future and thanks for supporting your frineds regards Dr Moyle