HIV is a highly inflammatory (figuratively) subject, even without any spark it is as hot as Mbeki being asked about African incompetence, or HIV itself.
Today we will limit our discussion to two inflammatory (immunologically) neurological diseases that when you do get in association with HIV, does get lots of doctors and their misdiagnosed patients into hot water.
These are acute inflammatory polyradiculoneuropathy (AIDP) and polymyositis. The trap is in the immunologically inflammatory nature of these diseases that essentially makes them improve as your CD4 deteriorates.
The advantage that we have is that HIV gets to be clinically diagnosed (potentially) much earlier when CD4 count is higher than normal. This unfortunately gets lost in the frequent misdiagnoses of this as end stage disease to be avoided at an interventional level, or AIDP polymyositis without HIV association at all (probably less criminal and I should not judge this as I am biased) We pass the unfortunate patient prematurely to the priest with disastrous consequences.
Acute demyelinating polyradiculopathy and polymyositis is only a good point to start, and that says nothing about those I have left out, e.g optic neuritis, up to and including flu syndrome at seroconversion stage, etc.
You need to be relatively average as a doctor to be able to diagnose either, but I find that time after time doctors see the client who can’t walk and assume that this is because the HIV is progressed so far that it is now end of the road.
Most get packed with their terminal vows diarized in case the priest is late and are send home to die, only to find that they recover to an extent that anybody who read the original notes can’t begin to comprehend.
What happens is that some of these inflammatory diseases we treat using immunosuppressive drugs and therefore with time the HIV disease with the associated lower CD4 count improves the inflammation.
This as we said earlier improves the inflammatory disease part and like magic he or she regains enough power to walk.
Bless the lord, we proclaim.
The patient next meets the doctor in town and we claim miracles happened when the diagnosis was wrong in the first place. The HIV in the meantime worsens and infection spreads like wild fire as he celebrates his new found freedom in the bedroom.
This potentially missed time when we could have treated both the primary disease and the associated inflammatory disease is lost in situations when time is of the essence.
Think of all the people your patient is going to infect before he gets the immunosuppressive disease part (say TB) when we normally start asking for HIV tests.
There will be more added to this earlier phase of HIV when the immune system is in the inflammatory or raised immunoglobulin phase as doctors improve and we hope for the sake of sub Saharan Africa that they do so quick.
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