Sign, Symptoms and Laboratory Diagnosis Of HIV Infection - Do I have HIV infection Or Dengue Viral Infection? -

This Article has been written in response to the following question asked by a visitor

"Hi I'm 21 y/o Six months ago I started to become sexually active w/ only one man. After 2-3 weeks of becoming sexually active, I experience a chill,fever-high fever-, sweating, eye pain, muscle pain and rashes-at my back, arms, legs, stomach. I had a blood test for Dengue-Blot test- and the result is positive(that time there is a dengue outbreak in my country). And now I'm paranoid, there is HIV epidemic here in my country is it possible that the cause of what I experienced before is HIV, not dengue? Is it possible to have a dengue false negative test? What is the difference between the testing of HIV and dengue?"


Read out the Following text, Conclusion is given at the end.

Symptoms Of Acute HIV, That is After infection:  (Bold/italic symptoms are present in the patient)

1. Fever

2. Rash

3. A headache

4. Loss of appetite

5. Swollen glands

6. Achy muscles

These symptoms usually disappear after a week or so. People who experience these early symptoms don’t experience any other signs of infection for a few years.

Other Common Symptoms of HIV infection

Usually, it takes about 8 to 10 years to notice symptoms of AIDS. (Hence These are not important in the above case )These symptoms are,

1. Persistent, difficult and painful enlarged lymph nodes.

2. Excessive fatigue

3. Weight loss

4. Seizures and lack of coordination

5. Mental symptoms like confusion.

6. Frequent fevers

7. Night Sweats

8. Chronic or persistent diarrhoea

9. Nausea, abdominal cramps, and vomiting

10. Genital sores

11. Thrush and mouth lesions

12. A rash of flaky skin

13. Stiffness in joints

14. Bone pain

15. Blurred vision

16. Short-term memory loss

17. Repeated viral or fungal infections.

18. Coma

Early Signs and Symptoms Of Dengue Infection: 
Dengue is an acute illness of sudden onset that usually follows a benign course with symptoms such as

1. a headache,
2. fever, 
3. exhaustion, 
4. severe muscle and joint pain, 
5. swollen glands (lymphadenopathy), 
6. and rash. 
7. The presence (the "dengue triad") of fever, rash, and headache (and other pains) is particularly characteristic of dengue. 
8. Other signs of dengue fever include bleeding gums, severe pain behind the eyes, and red palms and soles.

Hence:- If we consider symptoms only, it is concluded that the patient has an acute dengue infection. 

NOW:

The Second Question Is it possible to have a dengue false negative test?  Yes, it is possible. It depends on the quality of instrument used, the proficiency of the technician and pathologist and above all it depends on the quality of sample and presence of antibodies (if the method of testing depends upon the presence of antibodies, antibody formation takes 3 months to appear in the blood after infection)

Moreover according to a study;

Dengue blot test is a dot enzyme immunoassay which detects the antibodies to dengue virus of all types (1 to 4). The result of the test can be obtained after three hours. In the management of dengue hemorrhagic fever confirmation of diagnosis should be made at an early stage. This requires a test which is highly specific, highly sensitive and quick. To determine the usefulness of dengue blot test in diagnosing dengue hemorrhagic fever, this study was carried out in 319 patients who were clinically diagnosed as dengue hemorrhagic fever at Yangon Children Hospital. They were tested for both blot test and the standard test of haemagglutination inhibition (HI). Blot test was positive in 304 patients out of which only one is negative for HI test (True positive 303 false positive 1). Out of 15 patients who were negative for blot test 10 were positive for the HI test (True negative 5, false negative 10). This test was found to be highly sensitive (sensitivity 96

), and specific (specificity 83

).The positive predictive value was 99.6

but the negative predictive value was only 33.3

3rd Question is: What is the difference between the testing of HIV and dengue?

The most common, cost-effective, and accurate method of diagnosing HIV infection is via a blood test that looks for antibodies to HIV. Antibodies are the body's reaction to HIV and other foreign substances. Other methods that can be used are rapid HIV antibody tests that use blood, saliva, or urine. The Food and Drug Administration (FDA) approves all of the above methods.

But antibody formation takes 3 months. Therefore it is not possible to detect antibodies immediately after infection.

Another very effective and accurate method of detecting HIV infection is PCR. PCR will detect the viral DNA and give an accurate result. 

The clinical laboratory findings of dengue fever include 

• low levels of white blood cells (leukopenia)
• low levels of platelets (thrombocytopenia)
• often, an elevated level of the enzyme serum aminotransferase.

The diagnosis of dengue fever is usually confirmed in the laboratory by serologic tests on blood samples from the patient. (In very technical terms, this is done by antigen-detection ELISA or PR-PCR during the acute phase of the disease or by IgM ELISA or paired serology during the recovery phase of dengue fever).

During the acute phase of the illness, the dengue virus that causes the disease can also be readily isolated from the patient's bloodstream. but It is difficult to detect HIV in the acute phase as compared to dengue.

Conclusion: 

In the end, my personal opinion is that the patient has most probably a dengue infection. as there was dengue outbreak at that time and symptoms are closer to dengue. moreover, if the platelets and WBC count in a blood test are low it strongly suggests that the patient might have got a dengue infection. Doctors can add their opinion in comments if they want to:

PCR is a highly accurate and specific test which can detect HIV infection but it is costly. and HIV takes time to affect the individual physically.

DR. Adil Ramzan.