HIV, low CD4 count, and Crohn's Disease

[argentinedoc]

I am a heterosexual male and I had unprotected sex with 3 female partners in South America last year between early June and late July.  Two of these encounters were one nighters and the third was my girlfriend at the time.  I moved back to the States in August and went for an HIV test at 3, 5, 6, and the most recent one last week at 8 to 9 months.  Starting in September I developed Eczema.  From October to January I had very vague flu like symptoms.  I never had a temperature above 100

[H. Hunter Handsfield, M.D.]

Good grief.  Can you say "hairsplitting"?  What difference do you see between my "virtually" and your quote of "for all practical purposes"???

Take that sort of anxiety-driven business over to the HIV Support forum, not here.

[Pumpkinseed77]

A related discussion, Low CD4 count would not effect seroconverion time? (CHEMO PATIENT ASKING) was started.

[H. Hunter Handsfield, M.D.]

I knew that was one of your concerns.  I intended to address it in the opening line of my response: "Your negative HIV test results indicate with virtually 100% certainty that you did not acquire HIV in Africa--regardless of your Crohn's disease...."

No drug or medical condition is known to alter the reliability of HIV testing or to delay seroconversion.  Immunosuppressive drugs in large doses (e.g., cancer chemotherapy) are always cited as possibilities, but to my knowledge there are no data to show it's really a problem. The only clear exception I know about is HIV therapy itself; when HIV post-exposure prophylaxis (PEP) is unsuccessful, it may delay seroconversion.

I am unaware of specific data on Crohn's disease or the drugs used to treat it. But to my knowlege you have no worries on that score.

HHH, MD

[daveedo]

Doc, why do you refer to multiple negative tests out to 9 months as only 'virtually certain' to be conclusive? You have repeatedly stated that for all practical purposes no one takes longer than 13 weeks, let alone 9 months!

[argentinedoc]

Thank you.  I totally forgot to ask the one question that was the entire reason of my posting.  This is not a follow up, if, or but question but rather something I completely left out.  The one thing that was bothering me about having Crohn's and due to its nature of being an autoimmune disease is the following: could an autoimmune disease actually prolong the incubation period of a disease such as HIV, resulting in a longer window in which a person would build enough HIV antibodies to test positive?

[H. Hunter Handsfield, M.D.]

Your negative HIV test results indicate with virtually 100% certainty that you did not acquire HIV in Africa--regardless of your Crohn's disease, CD4 count, or any symptoms you may have. Every symptom you describe is caused more frequently (by far) by things other than HIV.  Normal people's CD4 counts vary quite a bit; HIV is not the only cause, and your test results show it is not the cause in you.

My bet is that the ID doc already assured you in strong terms that you don't have HIV.  The best help I can give is to suggest you continue care with that provider and discuss your fears with him or her.  If you have done so and been reassured, yet your fears persist, you need to consider professional counseling to figure out why you cannot shake your unreasonable anxieties.  I suggest it out of compassion, not criticism.

Good luck--  HHH, MD