Adolescents with factitious HIV disease

To describe two cases of factitious HIV disease and their implications for clinical practice and research.

Review of medical records and literature search.

A 19-year-old female and 17-year-old male were referred to an adolescent HIV clinic for evaluation and treatment of HIV disease. The former reported having been tested at a primary care clinic because of her history of transfusions, although the likely route of infection was intravenous drug use. The 17-year-old claimed to have contracted HIV through unprotected vaginal intercourse. Both patients reported HIV-related symptoms and prior seropositive HIV antibody test results which could not be corroborated. Other important features were histories of mental health problems, lack of apparent distress regarding HIV infection, and extensive knowledge of HIV disease.

In both cases, the most likely diagnosis was Factitious Disorder with combined psychological and physical signs and symptoms, based on the feigning of seropositive HIV test results, report of physical symptoms undocumented by physical examination, the need to assume the sick role, and the absence of obvious secondary gain. This report serves to underscore the need to confirm the presence of HIV infection in young people who seek treatment for HIV disease, especially when clinical presentations resemble these cases.