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Fatigue and AnemiaFatigue and Anemia
           
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Sleeping in Lake Michigan
Mar 12, 2002

Dear Doctor Bob,

Greetings from the winter wonderland of Michigan. Here's my story, please forgive my futile attempts at sarcastic humor. I am a 31 year old attractive male, looking for romance....wait wrong column!

Seriously, though, the tail of woe is as follows: Possible exposure 7/8/01, 10 days later the usual "worried well primary hiv infection sydrome complex" begins. I'm sure it had nothing to do with the fact that I was guilt-ridden and surfing every single hiv web site! In any case, ELISA negative at 58 days, too much of a wuss to go back at 90 days for the retest.

Here's my issue. Since 2/21/02, I have had moderate fatigue and a low-grade fever between 99.2 and 101.8 EVERY day, just can't shake it. The only time my temp ever drops below my usual previously normal temp of 98.6 is during the night, when I wake up in a big pile of sweat and take my temp (always 97.7 at this point). No other symptoms, my doc did a thorough check for swollen nodes in my neck and armpits, as well probing my belly...nothing abnormal found. Had CBC done last week, everything was within normal limits. Liver enzyme test came back slightly elevated...92 and 62 respectively I think. My doc is thinking CMV, which scared the hell out of me, and got be back on the worried-well bandwagon.

Here's my question. Would it be likely for me to have complications of hiv disease based solely on my fever and night sweat symptoms? Or, is it likely that I'm seroconverting extremely late?

I see my GP again next week to get the results of the CMV test, as well as for another liver enzyme test.

He has already told me that if he can't figure out the fever and night sweats, he's going to pass me on to an infectious disease doc, which means more waiting games.

Any thoughts on my situation?

Response from Dr. Frascino

Hello,

What makes you think "31-year-old attractive male, looking for romance . . . " is the wrong column????

Thoughts on your situation? Sure. Which situation would you like me to comment on? "Attractive male looking for romance?" or "Guilt-ridden web surfing ELISA negative wuss?" or "Am I seroconverting?"

OK, time to hop off that WW bandwagon. Fatigue goes along with low-grade fevers. Exactly what's causing that I can't determine without additional information. Is your thermometer accurate? Your CBC is normal, and several liver function tests may be mildly elevated. Does this sound like HIV seroconversion due to a "possible exposure" 7 months ago? Nope! Do you have HIV-related CMV, a severe opportunistic infection that usually affects the eyes and gastrointestinal track? Nope! CMV is a very late complication of HIV. It occurs when your CD4 cells are almost completely wiped out. Your chances of having this type of CMV are zero, zip, zilch, Nada!

Repeating your liver function studies is a good idea. You may have some type of hepatitis. If your temperature is persistently above 101F and you are experiencing night sweats and fatigue, seeing an infectious diseases specialist is probably a good idea. If you can stop thinking about HIV, then stop "wussing" and get retested. It will be negative. At that point, you'll be able to concentrate on the really important things, like answering all the responses to your "looking for romance" ad.

Stay well,

Dr. Bob


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