Distinguishing immunosilent AIDS from the acute retroviral syndrome in a frequent blood donor.

BACKGROUND: There are seven reports of "immunosilent AIDS" in which there was a lack of development of anti-HIV for more than 6 months. Thus, when a frequent blood donor presented with clinical findings highly suggestive of overt AIDS, there was concern that he may have had a prolonged immunosilent infection.

CASE REPORT: A 24-year-old man who had donated blood six times in the previous year was diagnosed as having AIDS; he presented with fever, nausea, vomiting, diarrhea, weight loss, and oral candidiasis. The anti-HIV enzyme immunoassay was positive, the Western blot was indeterminate (gp160 only), the CD4+ count was 174 per mL, the HIV polymerase chain reaction was positive (2.8 x 10(6) copies/mL), and the HIV p24 antigen assay was positive. Twelve components from previous donations had been transfused, and 2 units of fresh-frozen plasma were still in inventory. Repeat donor testing 57 days after donation indicated seroconversion with a positive anti-HIV enzyme immunoassay, a positive Western blot, a negative HIV p24 antigen assay, and a positive test for HIV by polymerase chain reaction (89,000 copies/mL). Both units of fresh-frozen plasma tested negative for HIV by polymerase chain reaction. Four transfusion recipients had died, and the remaining eight are anti-HIV negative with >6 months' follow-up.

CONCLUSION: The donor had an unusually severe acute retroviral syndrome and presented with findings that were difficult to distinguish from overt AIDS.