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Should I tell our children
Sep 26, 2005

My husband was diagnosed with HCV & HIV in May 2005, with a CD4 count of 175, he started treated with Kaletra, Epivir, Ziduvina and Septrin. Last August he was diagnosed with severe Anemia and required a blood transfusion, apparently a side effect of Ziduvina, his treatment is now Kaletre, Epivir, tenofovir(his specialist is awaiting the arrival of a drug to our part of the country which I believe is Triduvir, which he says will replace the tenofivir. We have two children of 14 & 17, whom we have explained that their father has Hep C, but not HIV. According to the specialist the last blood test his viral loading was undetectable but the CD4 count wasnt valid because of the anemia. He has had Ecographs of the liver and a Radiomagnetic Eco also, which shows he has the left lobe of the liver and the bazo enlarged. My question is this, obviously I am extremely worried, my husband has a physical job do you think he will be able to continue working? Does he have a chance of living for a few years more, the HIV is worrying but the co infection with the hep C makes it worse, do you think I should prepare my teengage children now even though they are very young, we are a very close family and I would rather wait until they grow up, but Im worried that my husband outlook is not a good one and I may need to tell them now, I also need to think about changign my job as I work part time and will need to get a full time job to support the family...or do you think I am panicking??

Response from Dr. Frascino

Hello,

I'm sorry to hear about your husband's recent HIV and HCV diagnoses. Yes, the most likely cause of his severe anemia in August is zidovudine (AZT). Of note is the fact that some treatments for hepatitis C, particularly ribavirin, can also cause significant anemia.

Regarding prognosis, in general HCV-HIV coinfection causes more rapid progression of HCV. The effect of HCV infection on the rate of progression of concurrent HIV disease is controversial, but the largest analyses show no important effect. Consequently, if your husband is a candidate for HCV therapy, he should have a full HCV evaluation, including a qualitative HCV RNA PCR assay, genotype analysis and liver biopsy.

Is it possible your husband could be aggressively treated for HCV and HIV and do well for a number of years? Yes, that's possible. Once he has had a complete evaluation and a determination of whether his liver has been damaged, we'll be better able to provide you with an accurate prognosis.

Should you tell the children that Dad has HIV? Yes, I would encourage you to be open and honest with your kids. It's better they hear the news from you directly rather than finding out by accident. If you have difficulty responding to their questions, your husband's HIV specialist or the children's pediatrician could be a resource in helping to explain what's going on in terms they can comprehend.

Regarding employment and making ends meet, consider seeking the advice of an AIDS-knowledgeable benefits counselor. Your husband's HIV specialist should be able to give you a referral to someone specializing in this field. They will explain everything from disability to various state and federal assistance programs that may be of benefit to you and your family.

Don't panic, but do get informed.

Good luck to you, your husband and your family.

Dr. Bob


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