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CMV before HIV?
Apr 1, 2002

Dr. Bob, I just read a response to another person and you said "CMV is a late complication..." Well, what if I was infected with CMV before I ever had HIV? Am I more likely to experience optical and/or gastrointestinal complications related to CMV because I am now HIV infected. BTW, for informational purposes, when I was diagnosed last year I had an extremely low CD4 count and a very high VL. I was placed on meds almost immediately after diagnosis. After several months of treatment, my VL is now undetectable and my CD4 has finally crept above 200, but opportunistic infections scare the hell out of me. I had thrush for almost a year before I found out (negative testing every six months as well) and then PCP, which is how they initially diagnosed me. I actually think I spend more energy worrying about the possibilities (toxo, crypto, Kaposi's and everything else under the sun) than worrying about being infected. Please clear this up for me. I'll be sleepless until you do! Second question: You have guys beating a path to your door..I can't even get a date! How do you do it?! (Single, heterosexual mom...scared to interact because of status). How do you learn to function in a relationship again and is it alright for two HIV+ people to have unprotected sex together? (Not that I actually know anyone who is HIV positive other than myself and, of course, my ex-hubby who infected me). Thanks so much for who you are and all you do. PC

Response from Dr. Frascino

Hello PC,

CMV is an extremely common infection. Lots of us have been exposed to that virus sometime during our lives. Our immune system has no difficulty controlling past infection, unless, of course, our immune system becomes so wiped out that the CMV reactivates. That's why we call it an "opportunistic" infection. It takes the opportunity of our immune system being deficient to cause trouble. Your PCP (pneumocystis carinii pneumonia) was an opportunistic infection, but PCP is not a reactivation infection. The germ pneumocystis carinii is essentially everywhere. It decided to bother you because your immune system couldn't fight it off. Hence it too is an opportunistic infection.

The good news is that our HIV meds are now potent enough to control HIV, allowing our immune systems to recover, at least partially. The higher your CD4 count, the more immune protection you have. We know from over 2 decades of dealing with HIV that the risk of PCP increases if your CD4 count falls below 200. The risk of CMV increases when your CD4s fall below the 50-100 cell count range. So, in your case, your having CD4 counts above 200 significantly decreases your risk. This applies for toxo, crypto, and almost all the other opportunistic germs. Kaposi sarcoma and opportunistic malignancies are a slightly different story, but the principal is the same. The more immune reconstitution, the better your chances of not having to battle these problems.

I should also mention that if your counts do drop down again, you should consider taking medication to help prevent getting opportunistic infections. Bactrim DS, for instance, is recommended as prophylaxis to prevent PCP, when CD4 counts are below 200. There are also prophylactic medications for other potential opportunistic infections, should your counts fall below the 50-100 range. So you can ease up on those worries. You've made it through the worrisome period. Hope this helps you get a good night's rest. If you're sleepless, you'll have bags under your eyes and then all those prospective hot dates will be scared off.

Should 2 HIV-positive people have unprotected sex together? I'd still recommend against it. There is always the possibility that one of you might have a different, more aggressive strain of HIV that might super-infect the other. There is also the possibility of transmitting other sexually transmitted diseases. Our poor overworked immune systems certainly don't need any additional challenges!

Can you learn to function in a relationship again? Sure. It's like riding a bicycle. You never really forget how. Love conquers all. My lover is HIV-negative and we have the most amazing life together.

So, heterosexual Mom, stop worrying, get some rest, and start dating again. Love what you do and do what you love.

Good luck.

Dr. Bob

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