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Fatigue and AnemiaFatigue and Anemia
           
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infected in may 02 + diagnosed in august 2002
Mar 3, 2003

Dear Dr R Franscino i was diagonosed in august 2002 HIV+ and HepB+ as a result of being drug raped.I have been fine up until now but for the last four weeks i have been waking up every night in sweats i dont think this is psychological.I have normal liver function tests and my body has cleared the HepB my last viral load and cd4 was 11000 copies and 590 cd4 in december 02, i am not on meds.I would also like to know being an agency nurse is it bad to be working on hospital wards being HIV+ for my health? would the possibility of working in such places put me at risk from becomming ill sooner? should i find another job? i am suffering with overwhelming fatigue as well how can i convince my doctor to prescribe me testosterone? could you also tell me what would be an average viral load set point? would taking one or two e tabs every two weeks on a weekend be a risk for substancial implications with regard to my cd4 count and viral load count? presently 11000VL and 590cd4 are my counts normal? for someone who has been infected in may02? i do have hiv specialist but i have problems in actually going to the clinic incase i am seen because of myoccupation and i also live in a small city in the UK where everyone seems to know everyone, i am worried about people and my family finding out, only i and one friend knows i cannot bring myself to hurt my family by telling them, i have decided never to say anything to anyone,i am only able to continue with my life by living a lie.I could not cope with looking like i had AIDs or ill and have decided that if i should look ill in the future then i would kill myself.I know this seems extreeme but its how i want it. thank you for yourtime and thanks for caring , messed up british guy xx (22)

Response from Dr. Frascino

Hey Messed Up British Guy XX (22),

You pose many questions. Let me try to reply to each:

1. Working as an agency nurse does not pose any significant increased risk for your health at this time. Your CD4 counts are quite good. If your counts were below 200, your risk of acquiring opportunistic infections increases, but with proper medical care, you should be able to avoid that for many, many years - perhaps forever. So, if you enjoy your job, there is no reason to change. 2. Testosterone can help with fatigue if you have hypogonadism. That means if your testosterone level is low, replacement therapy should be prescribed. How do you tell if it's low? You need to get a testosterone blood test. At age 22, your levels should be high in the normal range. If your levels are low and your doctor refuses to treat you, find another HIV specialist who knows what he is doing. Remember also that there are multiple other potential causes for fatigue, including anemia (hemoglobin less than 14 g/dL for men) and/or depression/anxiety. 3. There is no 'average" viral set point. It's completely different and specific for each individual and varies greatly from person to person. The viral set point is an equilibrium reached between your body's immune system and your HIV. There are many variables, including various strains of HIV; other medical conditions, like Hep C; general health; the efficacy of your immune response against HIV; etc. 4. Would a few "e" tabs hurt? Well, they won't help. We know ecstasy does interact with certain HIV meds, particularly protease inhibitors, causing toxicity, but you aren't on meds yet. "E's" effect on HIV hasn't been well studied, but some reports indicate it may increase viral replication. It also has been linked to rebound depression, unsafe sexual practices, and other potentially harmful conditions. I'd advise against it. 5. Are your counts "normal?" Well, not exactly. Normal viral load would be "none," i.e. not being infected. Normal CD4 count values vary from lab to lab, but yours are fairly good. It's important to check your CD4's every 3 months or so, and watch for trends. The CD4 count lets you know how your immune system is functioning and holding up to the HIV infection. The viral load test lets you know how active your particular virus is at any point in time. 6. An HIV specialist is critically important to maintaining your good health. If you have problems with your small city, perhaps you could drive to a neighboring, larger city, and establish your HIV care there. You'll probably only need to make the trip every 3 months or so. Ultimately, you may need to decide what's best for your health, even if it means telling friends and family. I fully realize how difficult that can be. Remember, I've had to do it myself, and there's no denying the fact it is emotionally gut wrenching. However, British Guy, I must tell you, it turned out to be an amazingly positive experience for me. Consider this: Would you be "hurt" if a family member told you their medical problem and looked to you for support and compassion, or would you love them all the more? Living life as a lie is incredibly burdensome and difficult. Isolating yourself is not the answer. Of course, only you can decide if and how to live with this virus. But please remember this, I contracted the virus in January 1991. The past 12 years of my life, although not the easiest, have been far and away the most rewarding and meaningful. Have I looked ill? My body has changed as a result of the chronic viral infection and the HIV meds. For instance, I had sunken cheeks due to lipoatrophy. I subsequently have had injections of New Fill to fill out those nooks and crannies. I've spent time at the gym and have muscled up. Like the guy in the late night infomercials says, "At 50, I've never looked better!"

Considering that you were drug raped, and were diagnosed with both HIV and Hep B in August 2002, I'm sure psychologically you are still trying to adjust to your new reality. Consider getting some counseling to help you sort out your feelings, fears, and frustrations. HIV is not the end of the road; it's just a different path, and in some ways, a new beginning. Please remember we are all in this together.

Write back anytime, OK? Things can and will get better for you.

Dr. Bob


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