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Dry Cough
Jan 17, 2002

Dr. Frascino,

My partner is HIV+ and has been for a little over a year and has never taken any medication since he has healthy numbers CD4 650 and VL 45K. He has a HORRIBLE dry cough that has occurred for the past 2+ months and is only getting worse. He says it is worse when he lies down or changes positions both when standing and when lying down. I hear it every night when we go to bed and it is extremely dry and very bad...it sounds like he is choking and I don't know what to do. I feel horrible when I hear it...it gets so bad his eyes water and I think he can't breathe. What do we do? What does this indicate? Why with good numbers is he having this bad cough? How do we make it go away! Thank you doctor

Coughing in Chicago

Response from Dr. Frascino

Dear Coughing in Chicago,

So every time your partner lies down in bed next to you, he starts violently coughing, choking, his eyes water, and he can't breath??? Hmmm, the answer is obvious: He's allergic to you. No? Oh, OK, let's see what else I can come up with. You are correct that your partner is doing well from an HIV perspective - low viral load and nice high CD4 count while never having taken any anti-HIV meds! So what could this be? Certainly not "a severe" opportunistic infection." Most likely, he has sinusitis - inflammation or infection of the sinus cavities. This is frequently associated with postnasal drip, throat clearing, and cough, especially when lying down or in a supine position. Another possibility is asthma, but this is usually associated with chest tightness and audible wheezing. However, there is a condition called cough-variant asthma that presents primarily with cough. But even this type occurs most often with a stimulus like exertion, cold air, allergies, etc. Other possibilities include low grad or chronic bronchitis and walking pneumonia. What to do about it? Well, you need to pin down the exact cause first in order to identify the most appropriate treatment. Your partner needs to see his doctor. They need to listen to his lungs and possibly get a chest x-ray or sinus CT scan. Sinusitis is the most common infection seen in those of us with HIV, and considering the odds and your partner's symptoms, I'd bet on this as the most likely cause. Treatment would consist of antibiotics, nasal steroid spray, and possibly mucolytic agents (mucous thinners). Cough suppressants can be used at night so that you both can get some rest.

Pleasant dreams!

Dr. Bob


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