A typical case of HIV infection

Posted on November 12, 2015 by drtan

Not every case of HIV infection follows the textbook but sometimes it does.


This is the story of Mr. V. Most doctors will find this story dull because of its predictability. However, I thought of sharing this to show everyone that sometimes, only sometimes, the textbook gets everything right.


Mr. V migrated to Singapore many years ago and was working for a construction company. He visits Thailand very often usually for a short holiday to get away from the hustle, bustle and stress of Singapore.


Songkran is his favourite time to visit Thailand. He loved having to put his mobile phone and wallet in a ziplock bag and getting drenched out in the streets ofBangkok.


When inBangkok, he would occasionally smoke some Crystal Meth and very occasionally even snort some Cocaine. But he never went overboard and always made sure he was clean before coming back to Singapore. He could easily go for months without any drugs and so he really did not consider himself an addict.


When he did do drugs, he never liked to do them alone. He always had at least 1 person (always a sex worker) and sometimes even 2 sex workers doing drugs with him. Mr. V enjoyed sex with both men and women.


This year as usual, Mr. V went up toBangkokfor a short holiday during Songkran. He decided that he wanted to snort some Cocaine. So he engaged the services of 2 lady sex workers and bought himself a small amount of Cocaine.


They all went back to his hotel room and started their party. According to Mr. V he did only a very small amount of Cocaine. Only 2 thin short strips. Soon after, the women with him wanted more drugs. They brought with them some Crystal Meth. Instead of smoking it, they wanted to shoot themselves up. Mr. V was initially reluctant but after some persuasion, he agreed. They shared the same needle and syringe and started shooting themselves up with Crystal Meth.


As Mr. V started to get high he began “fingering them vigorously” (his words, not mine) and ended up having unprotected sex with 1 of the women.


3 weeks later after that event, Mr. V developed a high fever. His temperature was persistently above 38.5˚C even though he was taking Paracetamol regularly. 3 days after the fever came on, he started having a severe sore throat. A day after that, a rash broke up over his face and upper chest. His colleagues saw the rash and became very concerned. They literally forced him to see a doctor even though Mr. V insisted that all he needed was a few days of rest.


One of Mr. V’s colleagues was a patient of mine and encouraged him to see me. Nobody suspected that he had anything more than a viral sore throat.


When I saw Mr. V, he actually looked very healthy. He did not appear ill at all. He was slightly flushed from the fever and his rash looked very much like that of an allergy. He told me he felt fine and everyone was making too much of a big deal out of all of this. When I examined him I found his body temperature was 38.7˚C. The back of his throat was covered with large painful ulcers and there were multiple swollen lymph nodes on his neck the size of cherries.


“Have you had any risky sexual encounters lately?” I asked.


“Why do you ask doctor? You think this is an STD?” Mr. V replied.


“Well”, I said “The ulcers could be Herpes. But the problem is symptoms of STDs and even HIV are very similar to other viral infections so it is very hard to tell. If there was a risky encounter we may think of running some tests.”


“I was in Thailand about 3 weeks back. Nothing particularly risky. I visit Thailand quite a lot. Last year I had a full STD check including HIV and it was all OK.” Said Mr. V.


“Was what happened 3 weeks back risky?” I asked.


“Hahaha! Doc! I can’t tell you! I don’t want to get into trouble. You have to record all this down right?” Mr. V said.


“Yah. OK, you don’t have to tell me but why don’t we run some tests just to be sure.” I suggested.


Mr. V agreed and we conducted a bunch of tests including the rapid HIV Combo test. As the story goes, the test turned positive.


As it turned out, Mr. V had a rather aggressive strain of HIV. By the time we measured his viral load, it was more than 100,000 copies per ml of blood. His CD4 cell count had also dropped to below 350 and his CD4 ratio was only 13%.


Mr. V continued to see me for treatment. Within a month of starting HAARTs, his viral load fell to an undetectable range. His CD4 cell count continued to drop for the first few months but eventually stabilized and started rising again.


Mr. V was also tested positive for Syphilis which we treated.


Over these month, he slowly got more comfortable talking to me and realised that telling me his whole medical history was not going to land him in hot soup with the Singapore authorities. Bit by bit, the story that you see above came out.


I have really not come across a HIV case as typical as Mr. V. He had all the risk factors and all the symptoms. The silver lining to this is Mr. V did not lose hope. He stuck with his treatment and is now back to full health. He still visits Thailand. Although he does not tell me directly, I have a sneaking suspicion he still occasionally does some drugs and engages some sex workers.