“HIV/AIDS: Candidiasis of esophagus?”
The patient is a 31 year old bisexual woman. She is 5’7” and weighs 104 lbs. She has a history (7 years) of oral thrush and UTIs. Recently, Ketoconazole and Nystatin were unsuccessful in treating oral thrush. An endoscopy and biopsy confirmed Candidiasis of the esophagus. The doctor suspects Candidiasis of the lungs. Her prior sex partners include bisexual men and an IDU. She is at least one year past risky sex exposures. She has had rapid HIV tests (Bioline, Orasure, Insti, Alere) for saliva and blood. The rapid test results are sometimes negative and sometimes positive. Her HIV 1 & 2 Antibody (4th Gen) Test (blood) result was negative. Is she probably HIV negative or positive? Could HIV antibody levels be too low to always produce a reactive result? Could HIV have mutated into a form that tests may not detect? Does she have any risk of being infectious towards sex partners? Is she considered to have developed AIDS?
Female | 31 years old
Medications: Diflucan
Conditions: Candidiasis of esophagus
5 Answers
InfectiousDiseaseSpecialist|InfectiousDiseaseInfectiousDiseaseSpecialist
Ronaldo Supena
Infectious Disease Specialist
HIV POSITIVE; HIV antibody could be too low;No; She is infectious towards sex partners. Yes
Cornelius Van Dam
Infectious Disease Specialist
Re the HIV test the 4th Generation test is highly sensitive for recent infections 2 weeks in. It is highly unusual for Candida to infect lungs in a person without immune compromised. I would recommend that she see infections disease consultant to go over her case closely
I think the evidence is that she does not have HIV infection. She seems to have an immune deficiency as invasive Candidiasis is very unusual. Three tests would help: an HIV RNA PCR assay (to see if she might have HIV), T-cell subsets to check her cellular immune status, and immunoglobulin subsets. There are other immune deficiencies.
G. Dickinson
G. Dickinson
Not qualified to answer HIV questions …she sounds HIV positive to me
She is likely HIV negative, but it should be confirmed with an RNA test - sometimes called a viral load. It measures the actual virus in the blood. Also ask for a CD4 cell count - a measure of immunity. Finally, consider other immune disorders. Your doctor will help with that.
Thanks for the question!
Thanks for the question!
