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STDs  (Expert Forum)
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Reactivated CMV and Early HIV Infection (Specialist Needed!!)
Answered by
H. Hunter Handsfield, M.D. -
University of Washington Seattle - WA
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MedHelp Member's Question

Reactivated CMV and Early HIV Infection (Specialist Needed!!)

by CuriousGeorge1234, Apr 01, 2006 12:00AM
Dear Dear Dr. Hansfield:

I had an unprotected encounter with two former girlfriends in Dec. 05: Ex-girlfriend 1 on Dec. 5, 05 and Ex-girlfriend 2 on Dec. 23, 05.  Ex-girlfriend 1 had two negative ELISA tests on Jan. 24, 06 (7 wks after the encounter) and Feb. 14, 06. (10.14 wks after). Ex-girlfriend 2 had one negative Oraquick HIV 1 & 2 Rapid Blood Test on March 13, 06 (12 wks after).  I have known both for over 7 yrs, and I feel that they were very low risk (i.e. have been in long-term monogamous relationships, not prostitutes, non-IV drug user, ect) I’m left puzzled!!!



I have been to several doctors as a result of my symptoms that started on Jan. 16, 06  (i.e. 10 lbs weight loss of muscle and fat in 2 mths, constant mouth sores, 4 incidents of night sweats, small itchy bumps on side, 3 days with chills, no fever > 99.0, no diarrhea, 1 wk of swollen lymph nodes all over and pain in muscles, 2+ wks w/ fatigue, constant dry nose & headache, & intermittent burning sensation of left hand. Initially, my family doctor ran a CBC and several STD tests without any definitive “poz” results. He didn’t recommend other evaluations since the symptoms, according to him, were not symptomatic of ARS more like another illness.  I requested a referral to an ID that ran 2 CBC tests, EBV, ELISA, and CMV.  I received the following results over the past 3 mths:  



CBC

·       Jan. 9, 06: AST 46, ALT 61, WBC 6.4, Neutrophils 55, Lymphs 36; Neutrophils (ABS) 3.5, Lymphs (ABS) 2.3

· Feb. 3, 06: AST 30, ALT 65, WBC 11.4, Neutrophils 67, Lymphs 25; Neutrophils (ABS) 7.6, Lymphs (ABS) 2.9

· March 3, 06: AST ?, ALT ?, WBC 11.2, Neutrophils 63.6, Lymphs 28.5; Neutrophils (ABS) 7.2, Lymphs (ABS) 3.2



CMV/ EBV

· Feb. 10, 06: EBV AB VCA, IGM < 20 (Negative); EBV AB VCA, IGG 95 (Positive > 19); CMV AB, IGM < 0.9 “Equivocal” (Negative < 0.8); CMV AB, IGG 16.3 (Positive > 1.0)



Other tests

· Jan. 23, 06: HCV (Negative), HIV-1 ABS (Negative), HBsAG (Negative), Hep B Core AB, IGM (Negative), HIV-1 ABS-EIA (Negative), Hep A AB, IGM (Negative); HCV AB (Negative)  (Ex-girlfriend 1 @ 7 wks/ ex-girlfriend 2 @ 4.5 wks after encounter)

· Jan. 30, 06: Amplicor HIV-1 RNA PCR- undetectable viral load; (range < 400 copies to 750,000 copies/ ml  (ex-girlfriend 1 @ 56 days/ ex-girlfriend 2 @ 40 days after encounter)

· Feb 10, 06: Diagnosed with Strep Throat

· Feb. 20, 06: Oraquick HIV 1 & 2 Rapid Blood Test: Negative (ex-girlfriend 1 @ 11 wks/ ex-girlfriend 2 @ 8.57 wks after encounter)

· Feb. 27, 06: Oraquick HIV 1 & 2 Rapid Blood Test: Negative (ex-girlfriend 1 @ 12 wks/ ex-girlfriend 2 @ 9.57 wks after encounter)



The ID said that I didn’t have HIV or any life threatening, so he didn’t recommend any follow up appointments. (Considering the negative CMV/EBV test, strange HIV-like symptoms, the last 3 CBCs w/ high WBC & increasing ABS lymphs, I was puzzled that he didn’t offer any follow up after 4-6 mths!



Questions below...
Doctor's Answer

by H. Hunter Handsfield, M.D., Apr 01, 2006 12:00AM
I am not going to address your concerns, for several reasons:  1)  I cannot begin to digest all that information; even trying to do so, and coming with a possible diagnosis or recommendations, would come too close to practicing medicine online.  2)  You have been to several doctors.  In that circumstance my opinion, on top of theirs, would be useless. 3) On quick scan of your risks, symptoms, and lab results, it is clear that no STD or HIV is responsible, and this forum is strictly limited to STD/HIV issues.  4) Based on your username, I believe much of this is a repeat performance.  5) Finally, see the forum rules about word limits.  I'm not even going to look at the continuation of your questions in the comments section.



I suggest you continue with your current provider(s); or if unsatisfied with their expertise, ask for referral for yet another opinion.



I will not carry on a dialog; this is my last comment in this thread.



HHH, MD
Member Comments (4)

by CuriousGeorge1234, Apr 01, 2006 12:00AM
Unfortunately, I live in a mid-size town with limited medical specialists within a 3-hour radius, and he is the only ID available and hasnt been in practice long  I’m very saddened to say that he didn’t give me much explanation of the CBC results or the CMV results!!! He was very rushed during our conversation.



Also, I’ve noticed several yellow small pellets from the tonsils folds and intermittent mouth sores that healed quickly.  I had some blood from sinuses when I blew my nose. An ENT doctor said I had a sinus infection, stress-related sores, and tonsilloths (concretions) that doesn’t indicated anything overtly alarming.  Also, he noticed numerous very small pink or slightly flesh-colored bumps on the hard palate. I can feel them on my tongue, but they are not obvious at first glance.  He said it could be petecrie, not thrush, but he hasn’t seen anything like this before in 7 years of practice.    



1. Do you recommend visiting a major city to for a better ID evaluation; closest is Atlanta, Jacksonville, or Orlando? Do you recommend anyone?

2. Is there a correction with the changes of WBC, Neutrophils, Lymphs and decrease of CD4 counts?

3. The drastic changes in my CBC labs are the result of HIV, CMV, EBV, or all of these?

4. What caused elevated liver enzymes? What are AST and ALT?

5. Considering the CMV and EBV tests, do the high titers indicate reinfection, reactivation or chronic infection?  How recent are these infections?

6. If someone had exposure to CMV or EBV, would ARS reactivate these viruses?

7. If so, does pre-existing CMV quicken the AIDS diagnosis since the patient already has an opportunistic infection.  How can I mitigate rapid progression to AIDS?

8. Are the listed symptoms typical for EBV, CMV, or HIV? Which?

9. What does “Equivocal” mean in the CMV IGM test?

10. How does Erythematous Candida manifest in early stages?

11. I read ARS symptoms occur 2-20 days or 2-8 weeks after contact in these threads.  Which scenario have you witnessed?

12. Is the Oraquick HIV 1 & 2 Rapid Blood Test reliable since it takes only a drop of blood for the test?

13. Since the 2 girls and I had negative tests, including my RNA PCR test during the 2nd week of the onset of symptoms, is an HIV negative diagnosis definitive? Should I get another test at 4 or 6 months?

14.    In your experience, does an HIV-infection person ALWAYS have viral loads > 400 per ml during early symptoms/ ARS before antibodies are created?



I sincerely appreciate your response! I live in a very small community with few HIV or STD-related health issues. People say the truth is difficult, but not as difficult as uncertainty!



I’m a heterosexual, never used drugs, and only had 2 sexual partners in the 3 past years.  



With warm regards, George

by raphlo2, Apr 01, 2006 12:00AM
What is your deal dude? Go see a counselor.

by carnageofthepast, Apr 01, 2006 12:00AM
To: CuriousGeorge1234