Question:

I am an intern who got stuck while trying to place a central line in a severly ill patient during a code (which the patient did not survive). The patient was cachectic, had very poor prior healthcare, and on this hospitalization was diagnosed with systemic CMV, HSV II encephalitis, and pulmonary Aspergilossis, with some questionable acid fast bacilli on staining - many of the Aids deficining conditions. His WBC count was only 1 and his absolute lymphocyte count 0.1x10^9. This patient was also on high dose steroids for a diagnosis of Lupus for the past 1 year for elevated Anti native doublestranded DNA titers (140-240 on repeat tests).

After getting stuck we sent off the basic labs: Hep C Ab - negative, and Hiv1 Ab - negative using the Genetic Systems HIV-1 PLUS O EIA (which I think is a 3rd generation test), and HIV2 Ab- negative. Therefore no PEP was started. However I am now very woried about the possibility of a False negatie in late stage HIV, especially given the patient 's poor immunological and immunosuppresed status. Patient had never had HIV RNA or CD4 testing done, but had had 2 more HIV serologies done within the last year which were negative (one in June 2007, and one in Aug 2006 during which times he had a similar WBC profile).

My question is how common is seroReversion in end stage AIDS patients, and the likelyhood of that being the case with this patient given his 3 different HIV negative serologies at 2 different institutions? Are my fears justified or should I just move on? BTW - I'm way past the PEP window now , this incident happened 16 days ago. Thanks for your help.

Answer provided by:

Donna Sweet, M.D., MACP
Professor of Internal Medicine
University of Kansas School of Medicine - Wichita

The negative test in this patient that was done last year indicates that this person was not infected and could not have been in late stage disease to serorevert. Seroreversion is rare and occurs only in someone with very advanced, late stage disease. I do not feel that you are at risk from this exposure.

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