Aug 12, 2008
Dear Dr.Frascino, This question may not be exactly about fatigue and anemia but i have chosen this forum because i like your responses and style. A bit of background; My partner(40) diagnosed HIV+ after he presented with PCP recently.( Up to this point no real signs of illness- just a few rashes etc).His CD4 count registered as 10(!!), VL 50,000. 3 weeks of septrin cleared the PCP after which he started ARV treatment.He has been on that now for a couple of weeks. Our consultant(we live in the UK) is 'top class' & great and are delighted with the care we are getting.
My question relates to the difference i have observed on this site v our UK experience regarding prophylaxis. My partner IS on prophylaxis for PCP(septrin-one a day)(of course, this can help with TOXO prevention as well) . I have noticed that the advice here(on this site) seems to be (almost universally) that people below 100 cells should also be on prophylaxis for MAC. The docs. here did a blood test and my partner has (at the moment)no signs of MAC,CMV or TOXO. The docs. here have made a balanced judgement (with my partners approval) not to prescribe MAC prophylaxis- but i just keep noticing that that this site is very PRO- MAC prophylaxis. However, the belief here in the UK seems to be that the evidence of benefit of MAC prophylaxis is less than conclusive and monitoring for signs of infection(and then intervention) may be better.
Whats your experience/ opinion Dr. Bob ???Your observations would be greatly appreciated.
Response from Dr. Frascino
I, too, would strongly recommend MAC prophylaxis for HIVers with absolute CD4 counts less than 50. Primary prophylaxis against disseminated mycobacterium avium complex (DMAC) can be discontinued in HIVers who respond to antiretroviral medication with a sustained increase in CD4 count to greater than 100 cells/microliter for at least three months.
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