Now diognized with lymph node TB

[abcfrmindia]

Hello Doctor,

Sorry to pester you again. In our previous conversation, you had mentioned that there was no risk in the massage activities that I had encountered, and there is no need for testing / worry about any STD. After this episode, I have never ventured out for any massage or any kind of sexual activities.

However, since last one month, I have a swollen lymph node (supraclavicular) on the right side of the neck. Doctor ordered for a CBC and "Quantiferon TB Gold" blood tests. The TB test has come positive. Today, I had a needle biopsy and the doctor who did the biopsy also said she strongly suspects this to be TB. Now I am really shattered. After googling on Lymph node TB, I got to know that TB (especially the lymph node TB) is most common in the HIV positive ppl. Now I am extremely scared and loosing hope. Request your sincere advise on the situation at the earliest.

Also, please let me know how common is it to acquire TB if a person is HIV+ve for 10 months.


Thanks

[abcfrmindia]

A related discussion, Rapid and CMIA (antibody only) negative after 1 year 2 months - is this conclusive was started.

[H. Hunter Handsfield, M.D.]

Even after a positive lymph node biopsy, it is normal medical practice to do surgery to remove the node.  The biopsy probably did not collect enough tissue to culture the TB bacteria and test it for the best drugs to use for treatment.  

I have no patience with not getting tested for HIV (or for any other serious health condition) for fear of the result.  It isn't the test that gives someone HIV -- you have or you do not.  If you do, you have to know in order to get lifesaving and life-extending treatment.  Think how unfair it would be to your daughter and your family for you to die 20 years earlier than necessary because you had this silly fear and didn't get treated.  Anyway, when people delay testing and finally do it, anxiety declines -- even if the test is positive.  Having a clear answer is less stressful than all the worry about it.

Also, it is 100% confirmed medical standard worldwide that everyone with TB gets tested for HIV. Everyone, no exceptions.  Discuss it with your doctor; she will agree. (You could print out this thread as a framework for discussion.)

So just do it.  Do not delay.  If you like, return with a follow-up comment to let me know the HIV test result. But anything else you post until then will immediately be deleted without comment.

[abcfrmindia]

Thanks a lot Doctor for your response and assurance. The ENT specialist called me and told that the Needle Biopsy results show TB. However, she said she would need to do a tissue biopsy (and take some amount of lymph node tissue) for further study. I am not sure why the doctor is suggesting tissue biopsy again when the needle biopsy has already indicated TB.

With your answer above, I got some hopes again. On your comments regarding "any past unrecognized risks", I would like to let you know that the only risks that I have had is with the massage parlour experience that I have detailed in the question few months ago and a handjob experience that I had in 2008 (which was also discussed in this forum previously). Other than these two, I have NEVER had any other type of sexual exposure out of my monogamous relationship with my wife.

With a beautiful daughter and a religious family network, I am really scared to get tested. Considering the risk that I had with the nude massage (detailed in the forum few months ago), and the symptoms that I am going through at this point of time, please could you suggest if there is any possibility of contracting HIV.

Also, please let me know if there would be any other symptoms that are seen in an HIV co-infected person who has lymph node TB.

[H. Hunter Handsfield, M.D.]

Welcome back to the forum.

I'm sorry to hear of your tentative diagnosis of tuberculosis; I'm sure it's upsetting.  However, it remains unlikely you have HIV.

You are correct that TB can be a sign of an underlying HIV infection.  However, TB also is common in people without HIV, especially in underdeveloped and developing countries like India.  You should be tested for HIV; I assume your doctor has recommended you do so and perhaps already sent the test.  However, based on the risk history you described in your questions on the forum several months ago, you can expect a negative result.  TB is usually a late complication of HIV, i.e. in people with longstanding infection and overt AIDS; it isn't something likely to show up only a few months after catching HIV.

I repeat that your HIV test probably will be negative.  If it's positive, it won't be from the safe sexual practices you described in your questions on the forum a few months ago.  You would have to go back to other, perhaps unrecognized risks for HIV infection.

Please return with a follow-up comment to let me know the result of your HIV test, as well as the final result of testing for tuberculosis.  In the meantime, concentrate on your tuberculosis.  TB itself is serious and sometimes life-threatening, so the important thing at this point is to confirm the diagnosis and, if confirmed, to be treated properly.  

Best wishes--  HHH, MD