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CD4 EBV Scared to Death
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CD4 EBV Scared to Death

I am Moose23: 31 year old hetersexual male.

From April 2009 to June 2009 I experienced recurrent pharyngitis with exudate three times. August 2009 developed suspected bacterial pneumonia with night sweats. October 2009 again developed pharyngitis. H. Influenzae was the culprit. I responded to antibiotics each time. Bloodwork indicates a recent EBV reactivation. IgM and VCA and EBNA antibodies detected.  Throughout none of the above infections did I develop a fever.

I have had a decade long history of mild candida albicans issues.  

I had negative HIV testing by NAT in March 2009 (via blood donation), and most recently, via HIV-1/2 EIA AB with reflexes October 2009.  NOTABLY, in April of 2009, my first sore throat occurred the day after making out (including some limited digital-vaginal stimulation with a healing cut on my finger) with a girl. She also woke up with swollen lymph nodes, but felt better after a couple of days and did not get sick again - her HIV status is unknown.  

My most recent blood work indicates a CD4+ count of 335, a CD8+ count of 238, a helper/suppressor ratio of 1.38, and an absolute lymphocyte count of 846 (ref. 850 – 3900).  I ended a short course of prednisone and Nasacort AQ 8 days before the blood work was performed.

My immunoglobulin levels, while on steroids, were at the lowest levels of the normal range, with a notable IgG4 deficiency of 1.5 and a low IgM of 36.  My IgA was normal at 162. Overall, my IgG serum level was 742, within the normal range, and my IgG1 subset was at 382 (low=normal).

My obvious concerns are HIV, CVID (and the accuracy of the ELISA test), any differential diagnoses that come to mind. My girlfriend gave blood two weeks ago and I presume she is negative (she also gave blood in March 2009), and another possible exposure has tested negative this month (& outside 3 month window).

HIV? Cancer? Transient Immunodeficiency? Thanks for your help, I am scared to DEATH.
Tags: CD4, HIV, ebv, CVID
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239123_tn?1267651214
Welcome to the HIV forum.  The answer to this question is easy and -- despite the length of the question -- brief.  The HIV test results prove with 100% certainty you do not have HIV.  Combined immunodeficiency disease and EBV do not alter the reliability of HIV test results, so that's not a concern.  The sole focus of this forum is prevention of HIV, which you do not have.  Therefore I have no comments about the other possible diagnoses that you discuss.  All I will say is that I believe you are overreacting to a situation that carries little if any long term serious health consequences.

Good luck--  HHH, MD
4 Comments
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Thank you Dr. for the reassuring advice.  My only follow up is my concern that there are numerous reports on the Internet that suggest that person with CVID may not be able to produce a sufficient antibody response to HIV infection to produce a reactive ELISA result. My immunoglobulin levels are definitely low and so I worry that I could be a delayed seroconverter. My recent in vitro mitogen/anitigen stimulation showed normal mitogen responses, and normal tetanus toxoid response, but decreased responses to candida and NO RESPONSE to PPD.  Just wondering whether these factors, based on interenet reports, suggest that my recent ELISA test was either a false negative or otherwise unreliable.  I won;t bother you anymore but I truly am worrying myself to death,
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I know you are extremely busy Dr. Handsfield, but I would deeply appreciate a response to my preceding comment.  I have not been able to find a single source on the internet that explains in any convincing details the circumstances under which a suspect immunoglobulin profile and possible T-cell defect (e.g., no response to in vitro stimulation with PPD) could render an HIV-1/2 EIA AB with reflexes test worthless at six months post exposure.  I would deeply appreciate some clarification and appreciate your work immensely.

moose23
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239123_tn?1267651214
"...there are numerous reports on the Internet that suggest that person with CVID may not be able to produce a sufficient antibody response to HIV infection to produce a reactive ELISA result":  No, there are not -- at least not from medically reliable sources.  I am unaware of such reports in the scientific literature, and I suggest you pay no attention to assertions by nonprofessional postings about their personal experiences.  Advance chemotherapy and near terminal cancer might interfere with HIV test results -- and even those are theoretical, with few if any actual cases.  No other medical conditions of any kind, and no medications, are known to interfere with the reliability of HIV testing.

You are obviously having trouble accepting the reality that you clearly do not have HIV.  Most likely your immune system is entirely normal.  It is time for you to accept the reassurance you have been given here and probably repeatedly by your own providers.  I also suggest you stop having any tests of your immune function.  These sorts of evaluations are almost always wastes of money, time, energy, and emotion.

That will be all for this thread.
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