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Worried about my brother-in-law (many questions)
Mar 2, 2001

Dear Dr. Dezube, My brother in law was diagnosed with AIDS in July of last year.He almost died, but fortunately he beat the P.C.P. I went to the Dr. with him and his wife a few days ago, and I am concerned he is not getting proper treatment!She seemed concerned because his viral load went up from 1354 to 30667 in one month. He was on Combivir,and Viracept. Because of the jump she added Tizivir.She has not done a genotype test and has no plans to unless he doesn't respond to this new med.I have heard of Dr.'s retesting viral load to make sure there was no blip....well, we are still waiting on Dec. viral load test. He should know more on that Monday.That is my first concern. I had a step-son die of Leukemia almost two years ago. I am very worried that he might get some sort of Cancer and not know until it is too late.Is there something in his bloodwork I should look for to be on the safe side? That was my second concern!I had asked her about Hodgkins and non- Hodgkins and she laughed it off. My third concern is that she didn't seem to want to share his bloodwork with him, and she didn't even touch him like most Dr.'s do. I want the best for him!!We live in Nashville, Tennessee, if there is anyone here that you highly recommend, please let me know. He is going to see a new Dr. in the next couple of weeks to see if there is anything different he might do. His Dr. also told him that if his viral load was up in Dec. that this new drug, Trizivir will probably not work. That would leave one more regimen left, she says. I f that doesn't work then "we will be scrounging in the air for clinical trial med.s". I found that very frightening and I also felt like she shouldn't have told him that his viral load should be undetectable at six months, remember he just got out of hospital in September!I am probably rambling on and I am sorry, I am so scared for him and wish you or one of these better Dr.'s were taking care of him.. Thank You for listening!! Sincerely, Jennifer By the way his cd4 is 70(were 27 in hosp) and viral load is supposedly 30667(which she sd was 30,0667) cd4/cd8 ratio is .12 and cd4-pos. is 7.0

Response from Dr. Dezube

Dear Jennifer, I'm glad to hear about your concern for your brother-in-law. It sounds like his doctor will indeed be doing genotype testing. Genotype testing works best if your brother-in-law is on a stable regimen which has stopped working. He should stay on the regimen while he is being tested. I gather from your letter that this is the plan. As for your second question, there is no simple blood test for cancer. We all wish it was that simple, but no such test exists to test for all types of cancers. There are occasional tests (such as PSA, a prostate blood test used in men over the age of 50), but this is probably not the type of test you are referring to.

As for your third concern, that his doctor is not as warm and fuzzy as he would like, well that's always a hard concern to address. My first question is what does your brother-in-law feel? If he's happy, then nothing really needs to be done. If he's unhappy, then he could explore seeking an alternative provider. The first step, however, is that he should discuss his feelings with his provider (if he's able to). Often providers are very willing to modify their ways to enhance their sensitivities to a patient's needs. Obviously, this is not always the case. Good Luck


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