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Pain without meds
Dec 28, 2003

Dear Dr. Frascino:

I wanted to let you know that I read the post everyday. I hope one day I will be able to manage my HIV much like you have. Right now I am a college student in Maryland. I have been HIV positive for 1 year. I learned of my condition the day before I was to begin college on full-scholarship. Talk about anger! My question is that recenlty, I have been having severe pain on my left and right side; as well as; shortness of breath. I have consulted a doctor, but he disregards the pain. I am not currently on medication. The last time I got checked my viral load was 22,000 and CD4 475. Is is possible that the pain might be sign of Hepatitis C? Also, I am considering beginning medication. Do you recommend I get tested to see exactly what meds I might have resistance towards. Thank you very much for your response. God bless you :0)

Larry

Response from Dr. Frascino

Hi Larry,

Sorry to hear about your positive test results last year. Yeah, the timing for finding out may not have been very good, but is there ever a good time for this kind of news? The important thing to realize is that it's always better knowing than not knowing.

Now, on to your question. Severe pain should never be "disregarded!" Are you seeing an HIV specialist? If not, you need to consult one. A thorough evaluation is warranted, particularly in light of your HIV status and other symptoms of "shortness of breath." Could it be your liver? Well, it's possible, but that wouldn't be on the top of my differential diagnosis list (list of possible conditions causing your problem). Further details about your discomfort and a physical examination are the next steps. Unfortunately, I can't do that over the internet.

Shortness of breath, likewise, has many potential causes. Some may be HIV-related; others, not. But everything from anemia, asthma, and bronchitis to heart disease and pneumonia need to be considered. If your current HIV specialist is not willing to work with you, it's time to consider finding one who will. If you need a list of HIV specialists in your area, try the American Academy of HIV Medicine web site www.aahivm.org.

Next, what about starting meds? Well, that's a very personal decision that must take many factors into consideration. You must balance the potential benefits against the potential risks. Again, your HIV specialist will need to discuss your specific situation with you and review all your potential options. Most guidelines now recommend deferring the start of therapy until the T-cell count is consistently in the 250-350 range. This is primarily to delay or avoid drug toxicities (both long and short-term).

Prior to starting therapy, do I recommend resistance testing? Yes, I do. The transmission of drug-resistance strains of virus has increased significantly over the years. Your first regimen should be your best shot at a convenient and effective regimen. Knowing that you may be resistant to one or more medications can be a critical piece of information in choosing your very best option.

Last, congratulations on your full scholarship! Ever consider medical school? The world needs more immunologists, and who knows, some day you could be on the other end of this advice line! Happy Holidays.

Dr. Bob


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