Lost and Found: Misdiagnosis of AIDS-Related Bone Marrow Suppression As Neutropenic Fever and Benign Ethnic Neutropenia in a Patient With Congenital HIV.

Neutropenia is a relatively uncommon but notable secondary effect of HIV infection. While the various hematopoietic effects of HIV and AIDS are well-described in the literature, high-quality evidence directly linking neutropenia with mortality in HIV-infected patients remains limited. The multifactorial etiology of neutropenia complicates its diagnosis, particularly when it occurs secondary to HIV. We present the case of a 35-year-old African American male with congenital HIV, who presented with severe neutropenia accompanied by a fever in the context of untreated HIV. The initial differential diagnosis was broad, including benign ethnic neutropenia (given the patient's African American ethnicity), tuberculosis (given the potential for anti-tuberculosis therapy to cause neutropenia and its commonality as a co-infection in HIV patients), sepsis-related neutropenia, and AIDS-related bone marrow suppression. However, through further workup, it became apparent that HIV-related bone marrow suppression ultimately led to pancytopenia. This case highlights how HIV patient non-adherence to antiretroviral therapy (ART) and hematologic abnormalities complicate the diagnosis of hematopoietic abnormalities from HIV. It also discusses how vertical transmission and abrupt ART discontinuation create a new phenotype of HIV patients with delayed presentations of AIDS-related complications. This patient's presentation also provides insight into the consequences of untreated HIV following the self-discontinuation of long-term HIV management therapy due to low healthcare literacy and loss of follow-up. The patient's clinical course, laboratory findings, imaging studies, and treatment outcomes are discussed, emphasizing the need for timely diagnosis and a multidisciplinary approach to care while exploring potential barriers to care in different social contexts.

Depression among Youth Living with HIV/AIDS.

Depression and human immunodeficiency virus disease are common co-occurring conditions among youth living with human immunodeficiency virus/AIDS. Depression serves as a risk factor for contracting the disease and for nonadherence to medications and adherence to safe sex practices. Although new infections are decreasing nationally, subpopulations of youths continue to have the highest rates of new infections, specifically ethnic and sexual minority youths. Depression contributes to poor health outcomes for youths with human immunodeficiency virus disease. Evidence-based psychotherapy and pharmacotherapy for depression are effective treatments. Integrated care with medical and mental health provides the best care for this population of youth.

Late ELISA Testing in Infants Born to HIV-Positive Mothers.

We present the case of a young boy who was born to a human immunodeficiency virus (HIV)-positive mother and originally found to be uninfected. Evidence-based guidelines were followed regarding the mother's prenatal and infant's postnatal care, including the avoidance of breast milk. HIV DNA polymerase chain reaction qualitative tests were obtained at birth, 6 weeks and 4 months, and were all negative. He also received 6 weeks of prophylactic zidovudine. Despite these measures, his health began to decline at 17 months of age and antibody and serology tests performed at this time confirmed HIV infection. Guidelines no longer recommend routine antibody testing at 18 months of age to confirm the absence of infection in exposed infants with a record of negative virology in the first year of life. Based on this case and others we propose that this test be added back to the national guidelines for the early detection and prompt treatment of HIV infection in infants born to HIV-positive mothers.