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Sunday, August 31, 2014
My daughter has been diagnosed with mono/Epstein Barr twice in the last two years. She also has recurrent yeast infections and occasional night sweats but no weight loss. They always run a CBC and mono spot which come back positive. Should I be worried about an HIV infection?
The correspondent is describing a very specific clinical scenario, and he or she is not providing all the details. I will try to provide a helpful answer with the information provided, but my best advice is to consult an infectious diseases specialist with expertise in virology. Then, and only then, all the details, questions and test results could be placed in the right framework. I will intercalate commentaries within your question for sake of clarity.
`Epstein/Barr My daughter has been diagnosed with mono/Epstein Barr twice in the last two years.`
You do not provide information about the symptoms your daughter has been having. What has prompted the diagnostic work up? Epstein Barr infection is, like all other Herpes Viruses, a life-long infection. Once you become infected, which is a rather common occurrence in adolescence and early adulthood (close to 70% of all Americans infected), you remain infected all your life. Usually, the patient becomes symptomatic i.e. ILL early after initial infection, but the symptoms tend to disappear after some months. Only with severe immunosuppression, like after a bone marrow or solid organ transplant, would Epstein Barr virus reactivation be a problem. It is noteworthy that immunosuppression related to advanced AIDS does not commonly cause Epstein Barr reactivation. There is a poorly defined condition called chronic Epstein Barr infection, in which the symptoms of anemia, fatigue, enlarged lymph nodes become chronic or recurrent, along with high titers of antibodies against Epstein Barr virus.
`She also has recurrent yeast infections and occasional night sweats but no weight loss.`
Recurrent yeast infections in a young woman are not all that uncommon. Yeast infections are not a feature of Epstein Barr virus infection, and are not necessarily related to immunosuppressive conditions like AIDS. Other health problems i.e. diabetes, use of antibiotics, may cause yeast infections. Also, otherwise healthy women may have bothersome, recurrent yeast infections.
`They always run a CBC and mono spot which come back positive.` `A mono spot measures a non-specific antibody against horse red cells. While this mono-spot test is quite reliable in the right clinical scenario, it also has false positives and false negatives. It may be necessary to perform anti Epstein Barr specific antibodies to better document the diagnosis and stage of disease.
`Should I be worried about an HIV infection? `
You can always argue that any individual with a non-typical and difficult to define illness deserves to have an HIV test. I have very little information about the overall symptomology of your daughter, so I can not say that she must have an HIV test or she should not have one. In case of doubt, it is simpler to perform an HIV test and take that diagnosis out the picture. The problem, however, centers around the fear, stigma and guilt around HIV infection/disease. Such diagnostic considerations can only be discussed in a candid, face to face interview.
I hope this can be of help
Francisco Gomez, MD
College of Medicine
University of Cincinnati