Factitious HIV Infection: The Importance of Documenting Infection

15 November 1994 | Volume 121 Issue 10 | Pages 763-766

Objective: To examine possible causes for factitious human immunodeficiency virus (HIV) infection among patients in an HIV clinic.

Design: Retrospective chart review, a case–control study, and a survey of local hospital practices for documenting HIV infection.

Setting: Clinical acquired immunodeficiency syndrome (AIDS) program at a municipal hospital.

Results: Seven patients with self-reported, undocumented HIV infection were identified as HIV seronegative after a mean of 9.2 months of care in our clinical AIDS program. The median CD4 count for these patients was 740 cells/mm³; 6 patients had a history of illicit narcotic use and clinical symptoms consistent with HIV disease. Compared with 70 randomly selected controls from HIV clinics, patients with factitious HIV infection had higher CD4 counts (difference, 519 cells/mm³; P < 0.001) and were more likely to have an HIV-infected sexual partner (odds ratio, 15.0; P = 0.005) and a history of a suicide attempt (odds ratio, 9.8; P = 0.02). Known cases of alleged HIV infection have occurred at 8 of the 10 other local hospitals surveyed. However, only 1 of the 10 hospitals routinely documented HIV infection in patients before initiating care.

Conclusions: Limitations of the current serologic tests for HIV, the use of anonymous HIV testing, and recent reports of factitious HIV disease or immune deficiency syndromes that may mimic AIDS underscore the need for clear documentation of HIV infection before medical care is started.

Author and Article Information

From Boston University School of Medicine, Boston, Massachusetts.
Requests for Reprints: Donald E. Craven, MD, Boston City Hospital, Thorndike Building 303, Boston City Hospital, 818 Harrison Avenue, Boston, MA 02118.
Acknowledgments: The authors thank Drs. Timothy Cooley, Lisa Moths, Christopher Shanahan, Leann Canty, Mark Drewes, and Michael Karasic for providing data on their HIV-seronegative patients; Drs. Martin Spivack, Philip Carling, Davis Allen, Martin Hirsch, Steven Boswell, Harvey Makadon, Mark Drapkin, James Noble, Powel Kasajian, Richard Platt, Robert Duncan, and David Bor for participating in the survey of local hospital HIV testing policies; Ann Brena and Dr. Stephen Pelton for doing the p24 antigen assays; Roy Byington and Dr. Martin S. Hirsch for doing HIV culture and polymerase chain reaction tests; Steven Barrus for carrying out the data analysis; Maria Tetzaguic for assisting in manuscript preparation; and Kevin Sullivan for providing statistical consultation.