FACTITIOUS HIV-INFECTION - THE IMPORTANCE OF DOCUMENTING INFECTION

Objective: To examine possible causes for factitious human immunodefic iency virus (HIV) infection among patients in an HIV clinic. Design: R etrospective chart review, a case-control study, and a survey of local hospital practices for documenting HIV infection. Setting: Clinical a cquired immunodeficiency syndrome (AIDS) program at a municipal hospit al. Results: Seven patients with self-reported, undocumented HIV infec tion 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 pat ients was 740 cells/mm(3); 6 patients had a history of illicit narcoti c use and clinical symptoms consistent with HIV disease. Compared with 70 randomly selected controls from HIV clinics, patients with factiti ous HIV infection had higher CD4 counts (difference, 519 cells/mm(3); 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 (odd s ratio, 9.8; P = 0.02). Known cases of alleged HIV infection have occ urred at 8 of the 10 other local hospitals surveyed. However, only 1 o f the 10 hospitals routinely documented HIV infection in patients befo re 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 befo re medical care is started.