Infectious HIV/AIDS
July 17, 2025

Newly Diagnosed HIV with High Viral Load and Low CD4 Count Despite Multiple Prior Negative Tests

Gender: Male
Age: 42

Case at a Glance

A 42-year-old male with a history of recurrent infections and chronic gastrointestinal issues presented with vertigo and tinnitus. Routine HIV screening revealed positive results with a viral load of 39,000,000 copies/mL and CD4 count of 60 cells/μL, despite multiple negative HIV tests over the preceding 7 years.

Patient's Story

The patient has a long-standing history of immune weakness, frequent respiratory infections, and multiple allergies. He had been undergoing regular HIV screening through occupational health programs and during hospitalizations since 2014, with consistently negative results. In 2023, he developed severe chronic diarrhea leading to a diagnosis of inflammatory bowel disease (IBD) after colonoscopy and endoscopy. Most recently, he presented with acute vertigo and left ear tinnitus, prompting admission for neurological evaluation.

Initial Assessment

The patient appeared chronically ill with complaints of dizziness, weakness, and confusion. Physical examination revealed mild hepatomegaly and lymphadenopathy on ultrasound. Laboratory findings showed slightly decreased lymphocyte count but otherwise normal complete blood count and liver function tests. The discrepancy between his current advanced HIV status and multiple prior negative tests raised questions about testing accuracy or recent seroconversion.

The Diagnostic Journey

HIV testing timeline: 2014-2015 (hospitalized for allergic asthma, HIV negative), 2016-2022 (annual occupational screening, consistently negative), 2018 (hospitalized for food poisoning, HIV negative), 2022 (COVID-19 related testing, HIV negative), 2024 (multiple hospitalizations for IBD workup with 4 separate HIV tests, all negative), November 2024 (IBD follow-up, HIV negative), June 2025 (current admission for vertigo, HIV positive). Additional testing ruled out tuberculosis, hepatitis B and C co-infection.

Final Diagnosis

Newly diagnosed HIV infection with advanced immunosuppression (AIDS-defining CD4 count <200 cells/μL). The high viral load and low CD4 count suggest either acute HIV infection with rapid progression or potential issues with prior testing methodology.

Treatment Plan

Immediate initiation of combination antiretroviral therapy (cART) with close monitoring of viral load and CD4 count response. Prophylaxis against opportunistic infections given the low CD4 count. Continued management of inflammatory bowel disease with coordination between HIV and gastroenterology specialists. Investigation into the cause of recent neurological symptoms.

Outcome and Follow-up

Patient education provided regarding HIV transmission prevention and treatment adherence. Regular follow-up scheduled for viral load and CD4 monitoring. Specialist consultation recommended to investigate the discrepancy between current HIV status and multiple prior negative tests. The patient was counseled that rapid progression to low CD4 counts can occur in acute HIV infection, which may explain the clinical presentation despite recent negative tests.

About HIV/AIDS

Infectious Condition

Learn more about HIV/AIDS, its symptoms, causes, and treatment options. This condition falls under the Infectious category of medical conditions.

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Medical Disclaimer

This case study is for educational purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment. Always consult with qualified healthcare professionals for medical guidance.