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disease progression and life expectancy
Jan 10, 2007

I am one of the unfortunate infected that was not diagnosed until an aids defining infection occured while at a cd4 count of zero and a viral load near the million mark. I began HAART shortly after and have struggled with fatigue, abdominal problems, neuropathy, wasting, and continued immune suppression. At last lab my cd4 was 290 and I have been undetectable since my first 60 days of HAART which was 33 months ago. My question is how much damage has my body really taken? Will it ever recover? I try to remain optimistic but never the less, my health is poor, and I cannot hold a job. At this level of quality of life it just seems grim. Is recovery that slow of a start? Or is there too much damage to expect any serious turnaround in health? My doctor is no help as she chooses to shield me from bad news out of fear it will cause me to be more depressed. I just want to know what to expect so things can be in order. Any insight will help. Thanks.

Response from Dr. Frascino


None of us have an infallible crystal ball to accurately predict the future. However, what I can do is remark that if your CD4 count was zero, your viral load at the 1 million mark and you had an AIDS-defining opportunistic infection at the time of your diagnosis, you are on many levels lucky to be alive today almost three years later! Your HAART regimen has proven itself to be extremely effective, both virologically (driving viral load from 1 million to undetectable within 60 days) and immunologically (CD4 counts skyrocketing from 0 to 290). Despite these miraculous results, I have no doubt life for you has been challenging, due to fatigue, neuropathy, wasting, abdominal problems, etc. How much damage has your body sustained? I have no way of knowing over the Internet without the benefit of reviewing your laboratory values and performing a physical exam. What I can say is that your body has demonstrated excellent immune reconstitution. Many of the symptoms you complain of fatigue, abdominal problems, wasting and neuropathy may well be improved by searching for the underlying cause of these symptoms and then aggressively treating those specific problems. Take a read though the archives of this forum for a thorough discussion of the underlying causes of HIV-associated fatigue and how best to treat these conditions. In the archives, you'll also find specific information about neuropathy, wasting and a host of other HIV-associated conditions, many of which have effective treatments. Once you've reviewed this information, make a list of your ongoing complaints, potential causes and possible treatments. Bring this list with you to your next visit with your HIV specialist and together you can decide how best to evaluate your symptoms and improve your quality of life. Part of that plan may well include counseling to help you cope with any mental health issues. Instead of looking at life as "grim," feeling that your doctor is shielding you from bad news and "getting things in order" for your final farewell, you should, in my opinion, work on an attitude adjustment, drawing strength from the fact you have dramatically beaten the odds and, with the efficacy of your current therapy, can expect further improvement. There is no doubt in my mind that your glass should be considered half-full at the present time.

Good luck.

Dr. Bob

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