I think you have more evidence against HIV1/2 than in favor.
1. By history, he has a single possible transmission event via the transfusion 40+ years ago.
2. No evidence of viral replication on either HIV 1/2 viral load.
3. Despite low absolute CD4 count, he has leukopenia and his CD4% is normal suggesting that he doesn't have selective depletion of the CD4s.
And even assuming he is positive on antibody, he has no viral load, so he is not transmissible; so we don't have to tackle the question of starting ARVs or not.
I would say a work-up should focus heavily on his hematologic/immunologic life. Does he have a history of frequent infections? Does his CBC have disruptions in multiple cell lineages or just lymphocytes? How has the blood cell count looked over time? Is it dropping or has it been stable for his whole life? Is he taking any meds associated with leukopenia?
Physical exam focused on the lymphoid tissues, looking for hepatosplenomegaly, inflammation of the joints, rash, thrush.
For labs, I agree with the HIV 1 & 2 proviral DNA for peace of mind. I would also check a peripheral blood smear. ESR. CRP. And probably flow cytometry.
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Francis Matuszak
Miami Lakes FL
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Original Message:
Sent: 05-25-2022 10:58
From: Michelle Moore
Subject: Is it HIV-2 or false positive?
Hi! I have 64 yo cis M w/ Parkinson's, HTN, leukopenia thought to be d/t ethnicity (already saw Hem/onc in 2021), and h/o HBV infx resolved. Recent ED visit for hip fracture. He is originally from West Africa, moved here about 20 years ago. H/o blood transfusion 1980 but identifies as Muslim and only having had 1 lifetime sexual cis F partner. No h/o IVDU. Wife is HIV negative. HIV-1 VL undetectable. HIV-2 VL undetectable. CD4 is 155, %33. Repeat HIV supplemental ~3 weeks later is still positive. Do I call this false positive and work on discovering what's causing the cross reactivity? Any ideas on further work up? Do I send him back to Heme? Goes back and forth frequently to West Africa to visit family.
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Michelle Moore
Chicago IL
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