Staph infection and HIV

Question

Hello Doctor,

I would like to start off by thanking you for all the information and insight you provide via this website. It has been a great source of knowledge and sometimes even inspiration for me over the past couple of years.

I tested positive for HIV almost exactly 2 years ago (May 17th 2004). Given my initial lab results, syptoms, and my sexual history back then, my doctor and I believe that I was diagnosed immediately after seroconverting. After the initial boost in viral load (>100K) in my very first set of numbers, my numbers have remained great. In fact my viral load dropped to 1,500 copies just 3 motnhs after my diagnoses/seroconverting. My most recent set of labs (March 2006) were: CD4 - 664; percentage at 34, and virtal load at <150 copies. In fact, for the past 18 months my viral load count has remained at <400 copies - and from what I understand, termed undetectable.

However, I am concerned because it seems that I caught a staph infection. I saw my doctor today who immediately upon seeing my boil (on my left butt cheek - no less), diagnosed it as such. He put me on both an oral antibiotic and a topical antibiotic. We talked about how this infection is related to HIV. He said that given my excellent lab numbers just 2 months ago (listed above), this staph infection is not HIV related and that this type of infections would not necessarily be rare among the general population (non-HIV+). He said that in fact, the infection could have gotten much more severe had I not had a strong immune system as I do now. Can this be true? I am slightly freaked out, but remind myself that my lab numbers over the past 18 months have been excellent.

He did not take a culture of the infected area. He did lance and dress it and gave my instructions on how to do this myself at home for the next 10 days (along with taking the antibiotics). Should I go back to get a culture of it to see if it is drug-resistant? Or, should I wait a few days to see if it gets better with the medication? How does this affect my current HIV status? Will it put a strain on my immune system?

I would apprecaite any insight you can provide. Thanks again.

Answer

Although I always like to get cultures of these kinds of infections, both to confirm the diagnosis, but also to get the antibiotic susceptibility testing to insure I am using the right antibiotic; it is highly likely this is a MRSA infection (methicillin resistant staph aureus). It is a very common community acquired skin infection and is spread by skin to skin contact, or contact with contaminated gym equipment, etc. Although it has been reported with increased frequency in HIV infected people, it occurs commonly in people without HIV infection. Unlikely a culture at this late date will yield anything if if is getting better. If it is not, it may signal that the antibiotics you were given are not working in which case a culture would be required to get the right one on the next go round.