Pseudo-AIDS--Often Even the Doctors Are Wrong

Some people diagnosed as having AIDS may not be stricken with the killer disease and probably are suffering from other illnesses misdiagnosed as the immune system disorder, a specialist reports.

“I call the phenomenon pseudo-AIDS, which refers to a group of very diverse medical conditions in high-risk group patients,” said Dr. Harry Hollander of the Adult Immunodeficiencies Clinic at the University of California, San Francisco.

“Not everybody at risk for AIDS actually has it,” Hollander said.

Pseudo-AIDS, he said, refers to such conditions as chest pain, swollen lymph nodes and certain cancers that may be mistaken as signs of the incurable immune system disease.

Can Be Misleading

“I think that awareness of AIDS is a good thing when taking care of people at risk, but (that awareness) can also blind physicians and caretakers to the possibilities of other illnesses,” he said.

In a study of cases referred to Hollander’s clinic by primary care physicians in San Francisco, 10% of those initially diagnosed with AIDS were found not to be victims of the disease.

The referrals, all homosexual men, the group at highest risk for AIDS, actually suffered from disorders ranging from swollen lymph nodes due to infections not related to AIDS to muscle strain.

Hollander said the problem of misdiagnosis is particularly acute in San Francisco, which has the second highest number of AIDS cases in the country.

The Centers for Disease Control in Atlanta estimates that 1,957 cases have been reported in San Francisco since 1981, ranking the city second only to New York City in the number of AIDS cases.

Leaping to Conclusions

“In a community that is sophisticated about signs of the disease, and when the medical community has seen many AIDS cases, there’s a tendency to leap to the conclusion that high-risk people actually have AIDS,” Hollander said.

Reporting in the Journal of Western Medicine, Hollander warned doctors “to use rigorous diagnostic criteria to avoid both traumatizing patients with news of terminal illness and delaying therapy for other diseases.”

“I don’t think there is a fear of AIDS among doctors,” Hollander said in an interview. “But there is an apparent prejudice that pigeonholes high-risk people into an AIDS category.

“Sometimes the possibility of AIDS makes the physician less objective when other diagnoses should be considered,” he said.

Hollander said part of the problem of misdiagnosis lies in the way medical evaluations are conducted.

“AIDS as a syndrome has many non-specific complaints. There are many diseases that mimic the things that AIDS can do,” he said of the swollen lymph nodes, dramatic weight loss and fatigue that also can occur in other illnesses.

He said many doctors do not conduct examinations to test for the presence of AIDS antibodies in the blood stream of patients suspected of having AIDS.

Instead, many physicians make a diagnosis of AIDS based on “complaints that might mimic AIDS,” Hollander said.

“Pseudo-AIDS should not be confused with ARC (AIDS-related complexes),” Hollander explained.

ARC, a pre-AIDS condition, is characterized by the presence of AIDS antibodies in the blood and usually results in a mature case of the disease within two years, the doctor said.