Premium
Distinguishing immunosilent AIDS from the acute retroviral syndrome in a frequent blood donor
Author(s) -
Kopko Patricia M.,
Calhoun Loni,
Petz Lawrence D.
Publication year - 1999
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1046/j.1537-2995.1999.39499235670.x
Subject(s) - seroconversion , medicine , polymerase chain reaction , immunoassay , immunology , vomiting , nausea , virology , diarrhea , antibody , gastroenterology , biology , biochemistry , gene
BACKGROUND: There are seven reports of “immunosilent AIDS” in which there was a lack of development of anti‐HIV for more than 6 months. Thus, when a frequent blood donor presented with clinical findings highly suggestive of overt AIDS, there was concern that he may have had a prolonged immunosilent infection. CASE REPORT: A 24‐year‐old man who had donated blood six times in the previous year was diagnosed as having AIDS; he presented with fever, nausea, vomiting, diarrhea, weight loss, and oral candidiasis. The anti‐HIV enzyme immunoassay was positive, the Western blot was indeterminate (gp160 only), the CD4+ count was 174 per mL, the HIV polymerase chain reaction was positive (2.8 × 10 6 copies/mL), and the HIV p24 antigen assay was positive. Twelve components from previous donations had been transfused, and 2 units of fresh‐frozen plasma were still in inventory. Repeat donor testing 57 days after donation indicated seroconversion with a positive anti‐HIV enzyme immunoassay, a positive Western blot, a negative HIV p24 antigen assay, and a positive test for HIV by polymerase chain reaction (89,000 copies/mL). Both units of fresh‐frozen plasma tested negative for HIV by polymerase chain reaction. Four transfusion recipients had died, and the remaining eight are anti‐HIV negative with >6 months' follow‐up. CONCLUSION: The donor had an unusually severe acute retroviral syndrome and presented with findings that were difficult to distinguish from overt AIDS.