thrush= disease progression?

Question

Hello Dr. Feinberg,

I've been trying to get answer to this for months, but no luck. A bit frustrating in light of the some of the questions answered.

Can you please help?

Supposing a friend has oral thrush one month after a risky exposure. I understand that oral thrush is a good indicator of HIV progression which is why I'm not sure I understand why he is experiencing thrush during the acute stage. He does not have any other symptoms that generally come along with the acute infection stage(fever, headache) except for occasional loose bowels.

Is this common in your experience?

The person is healthy person but has had HSV2, Dengue fever, and mono as a kid. Could he not have enough in his immune reserve to fight HIV. Could it be possible, even though he is healthy in general(no cancer or life threatening illness)and did not have many of the symptoms during he acute infection stage, that the CD4 levels could get to 350 or below in only one month, or during the acute stage?

In what cases would oral thrush present itself during the acute stage? Is HAART still recommended for these patients even if they have a decent Cd4 count(700) and a reasonable vL?

There is so much data on thrush as an indicator of the late stage of HIV infection, but not much on thrush during the acute stage.

thankyou so much in advance.

Answer

There is no perfect, all-encompassing answer to what acute retroviral syndrome may consist of. Typically, it is a mono-like illness that can be complicated by the types of problems that are seen in more advanced disease (like thrush or even PCP) if the person's T cells drop to low enough levels. I think it's probably uncommon to have thrush but no other symptoms as part of ARS. The past illnesses described in your email should not by themselves cause an inadequate immune response.