HIV and ID Observations

An ongoing dialogue on HIV/AIDS, infectious diseases,
all matters medical, and some not so medical.

October 13th, 2012

More Questions from “ID in Primary Care” Course

Some additional excellent questions from the course:

  1. For someone who has had 3 doses of hepatitis B vaccine but does not have the antibody, should we just go ahead and give another 3 shots?
    A:  (Per vaccine guru Howard Heller):  The guidelines say to just go ahead and give another 3 shots but if the initial series was many years before then I usually give one booster dose and recheck antibody level 2 weeks later. If there is a robust response then I stop. And always consider the possibility of and screen for chronic infection as a possible reason for why the patient did not “respond” to the first series of shots.
  2. If someone has a history of receiving 2 doses of MMR but they do not have antibodies, do you just give them one dose of MMR or 2 doses?
    A:  If they have documentation of the 2 previous doses or if their history is very reliable, then one dose. If there is any doubt about the reliability, then give 2.
  3. My patient had a positive HIV ELISA, and an indeterminate Western blot. What should I do next?
    A:  As I wrote here, you must exclude acute HIV infection with an HIV RNA (viral load). And if that’s negative, it also would make sense to exclude HIV-2 with a differentiation assay. If both are negative, then it’s a false positive ELISA. Would repeat again in a month just to make sure.
  4. How long is a person contagious with shingles?
    A:  When the lesions are crusted over, there’s no further viral replication and the person is no longer contagious.
  5. Can a person get mononucleosis twice?
    A:  They can only get EBV-related mononucleosis once, but other infections that can mimic acute EBV mono include CMV, toxoplasmosis, and HIV.
  6. Why do people think you look like Paul Farmer? You have a much stronger resemblance to Steve Buscemi.
    A:  Umm … Thank you… or not? (Above image with permission of www.mattleese.com.) Just in time for Halloween!

Categories: Infectious Diseases, Medical Education, Patient Care


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HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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