Swollen Parotid Gland And HIV FEAR!

[billynotime]

Dear Dr,

I have been dealing with a swollen left parotid gland for six months now. Iv been to an ent who tested my blood for sorjins (neg) and sent me for an mri of the gland. my lab report reads as follows.

Findings
A skin marker was placed over the region indicated by the patients corresponding to the ankle concern, which was superficial to the posteraspect of the left parotid gland.

No Mass lesions are seen related to either parotid gland. No abnormally large malignant appearing cervical lymphadenopathy is seen. Small foci of enhancement are seen in both parotid glands, the largest 6 mm x 3 mm in size in the tail of the left parotid gland, unlikely to be of a clinical significance, probably representing focally prominent vessels or small intraparotid lymph nodes of no clinical significance. follow up study in 6 months time can be considered for further evaluation if clinically warranted.

OK here goes This is my six month testing and i will list the whole thing. Please let me know what you think the more people the better. My main concern is the rna by pcr because im affraid of delayed antibody response. I also have a lump under my left ear that a ent dr said is indicative of hiv before running any tests. All tests were done at Labcorp on 6/13/09 entered on 6/14/09 and reported on 6/16/09 at 3pm. I only put what i could fit.CBC ok

RNA Real Time PCR (Graph)
HIV-1 RNA By PCR
                    Less than 48 copies/ml, Hiv1 RNA not detected

                    The reportable rangs for this assay is 48 to 10,000,000 copies hiv-1 RNA/ml

Log10 hiv-1 RNA                                                        log10copy/ml
                       unable to calculate result since non-numeric result obtained for component test.

  HIV 1/O/2 ABS Negative

OK now come the questions?

1. Were my tested returned to quickly to be real.

2. At six months is it possible to have a neg eia and rna by pcr.

3. Does my parotid gland problem look like it could be hiv related.

[Edward W Hook, MD]

I will summarize my interpretation of the tests you mention and then address your questions.  The bottom line however is that your tests, taken six months following your exposure show that you do not have a swollen parotid gland, nor do you have lymph node swelling in your neck.  In addition, your tests show for sure that you do not have HIV and the other tests listed here are normal.  Thus, from what I can tell from your questions and the information you provide, HIV is not and should not be a concern for you. As for your specific questions:

1.  I cannot figure out why you would ask these questions.  HIV tests taken at any time more than 8 weeks are totally reliable. the idea of late seroconversion is an urban myth.  The results were returned by the lab once the tests were complete.  This too is appropriate.

2.  No, believe the test results. You do not have HIV.

3.  As for the parotid gland "problem", you need to discuss that with your doctor.  I suspect he or she mis-spoke when they raised this issue of HIV with you.  Your MRI shows that your parotid gland is normal.

Bottom line- nothing in this post suggests in any way that you need to be concerned about HIV.  EWH

[billynotime]

This is the complete blood test. as it was given to me word for word.

CBC with Differential/Platelet
wbc 4.3 Range 4.0-10.5
rbc 4.64 Range 4.10-5.6
hemoglovin 14 Range 12.5-17
hematocrit 40.3 Range 36-50
mcv 87 Range 80-98
mch 30.3 Range 27-34
mchc 34.8 Range 32-36
rdw 13.7 Range 11.7-15
platelets 328 Range 140-415

****Please note reference interval change****
Neutrophils 60 Range 40-74
lymphs 28 Range 14-46
monocytes 9 Range 4-13
eos 3 Range 0-7
basos 0 Range 0-3
Neutrophils (Absolute) 2.6 Range 1.8-7.8
Lymphs (Absolute) 1.2 Range 0.7-4.5
monocytes (Absolute) 0.4 Range 0.1-1.0
eos (Absolute) 0.1 Range 0.0-0.4
Baso (Absolute) 0.0 Range 0.0-0.2

RNA Real Time PCR (Graph)
HIV-1 RNA By PCR
                    Less than 48 copies/ml, Hiv1 RNA not detected

                    The reportable rangs for this assay is 48 to 10,000,000 copies hiv-1 RNA/ml

Log10 hiv-1 RNA                                                        log10copy/ml
                       unable to calculate result since non-numeric result obtained for component test

Antinuclear antbodies direct                   Negative

RPR
    RPR                                                 Non Reactive

Sedimentation Rate-westergren                   1                                  mm/hr          Range 0-15

Panel 162222
  HIV 1/O/2 ABS-ICMA
  HIV 1/O/2 Abs index Value                     <1.00                                                   Range <1.00
                                           index value: Specimen reactivity relative to the negative cutoff.

HIV 1/O/2 Abs, Qual
                                          Non Reactive

[billynotime]

Dear Dr Hook,

The first and second ent that i saw both said that my parotid gland is swollen. The first saw it on a sestimebi scan before i even said anything about the lump. In fact i wasnt even concerned about it until he said it was indicative of hiv. This is why i was scared. I also have low vitamin d and from what i have read lowers your immune system. This is why i was concerned about the late antibodies. As far as the pcr and antibody both being neg at the same time it would be impossible to have hiv at six months past exposure. Correct? I thank you for your quick response and will not ask further questions past this.

1, Neg PCR and EIA at the same time would be impossible if someone had hiv correct?

2, If the gland is swollen which it has to be because i have had a lump there for six months that i have noticed.

3. What do you think about the vitamin d thing?

[Edward W Hook, MD]

1.  Correct.  You do not have HIV.
2.  You need to talk withthe ENT who ordered your MRI. The MRI report you provided shows no abnormality in your parotid gland.  Thus this conflict needs to be ressolved by the examiner and person who ordered the test.  I have not examined you but I cna read the report you provide which found nothing abormal about your parotid gland.  I do not doubt that there is a lump there but the MRI suggests it is not abnromal.
3.  Low vitamin D is not a major rsik factor for HIV.  The most common causes of low vitamin D are not enough dietary intake and not enough sunlight.

Hope this helps.  EWH