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Tired and can't get help
Oct 13, 2003

I have been on androgel for about one year for the past six months i have been on two packs a day. The doctor tells me that i am the low normal range.When i first started with the two packs it helped. My depression went away and my sex drive came back. Now i can;t say i am as depressed as before but it's back and my sex drive is down. On 2-17-03 my viral load was 11.000 on 6-4-03 it went up to 30.000 and on 8-27-03 it was 67.000 and my Tcell has lowered to 22.At the time my doctor said he wanted me to start on meds in a few weeks. Since i have been dropped from ryan white i have no doctor and am concerned that my labs are dropping fast. Is it critical that i get to another doctor or can i waite and see if ryan white will be reinstated? Thank you W

Response from Dr. Frascino

Hello W,

At this point, AndroGel should not be your first priority. I am very concerned about your low T-cell count, rising viral load, and lack of access to medications. I'm not sure where you are writing from, but I urge you to contact your local AIDS service organization and inform them of your situation. Since you mention Ryan White Funds, I assume you are writing from somewhere in the USA. Most states have alternative emergency funds or state programs, which you may be able to access for your prescription medications and other healthcare costs. If your T-cell count has dropped to 22, you are at considerable risk for opportunistic infections PCP, CMV, MAC, and others. You should be started on prophylaxis to help prevent these infections immediately. HAART (highly active antiretroviral therapy) would also be strongly recommended due to your severe immunodeficiency (CD4=22) and rising viral load. I'm not sure why your doctor wanted to wait "a few weeks." You need these therapies now. In fact, optimally you would have started on HAART when your T-cells fell into the 300-350 range, and started on PCP prophylaxis when the T-cells fell below 200.

As a secondary issue, your hypogonadism can be treated by adjusting your dose of AndroGel. Your dose could be adjusted to raise your serum testosterone level into the mid to upper-normal range.

Bottom line: Do I think you can or should wait to see if Ryan White Funds come through? No. Absolutely not. Get on the phone and call your local ASO (AIDS service organization) now. Yes, I mean now. Turn off the computer and make the call.

Dr. Bob


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