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Allergy Treatment and HIV
Feb 23, 2009

First off thank you for aIl your work helping people with hiv, you are greatly appreciated! I have two questions. I'm living in central Europe where resistence testing is not really done, I apprehensively started treatment one year ago with the Atriple combination without this test. It seems to be working very well. After 5 weeks my VL fell from 175000 to just 68 and I have been offically undetectable for the past 6 months. My CD4 count started at 200 and after one year is now 500. Do these results confirm that I did not have an initial resistance to any of the 3 drugs? Secondly I am allergic to ragweed and live in an area infested with it. I do not really like taking drugs to help this problem and especially now that I'm on haart. I wanted to start an "oral immunotherapy" LAIS(now available in Europe) Do you think it is a problem considering my hiv status and haart treatment. I'm supposing that it is ok considering that this treatment is really only the allergen derived from ragweed. My hiv doctor does not really have a strong opinion either way. Thank you!

Response from Dr. Frascino

Hi,

Your prompt response to Atripla both virologically (HIV plasma viral load of 175, 000 plunging to undetectable) and immunologically (CD4 count skyrocketing from 200 to 500) is excellent proof that your regimen is effective. Consequently we can assume you do not have resistance mutations significant enough to affect efficacy.

Regarding immunotherapy of ragweed, I'll make several comments:

1. There are some concerns that any type of allergen immunotherapy could be problematic because the treatment works by stimulating T cells. The activated T cells could in turn stimulate HIV production. This is all somewhat theoretical. However, I would caution against immunotherapy if someone's HIV disease was not under excellent control (undetectable HIV viral load, reasonable CD4 count).

2. Ragweed allergy is generally a reasonably short season, even though it can make the ragweed-allergic person quite miserable. In general I would advise symptomatic medications antihistamines and decongestants first. (I would avoid nasal steroids due to possible drug interactions and osteoporosis.) If symptomatic seasonal medications are not sufficient for control, immunotherapy could be considered. I do not have any personal experience with oral immunotherapy, as it is not yet approved in the U.S. Theoretically I tend to worry about putting ragweed antigen into the oropharynx because in highly sensitive individuals this could cause a local allergic reaction that could in turn compromise the oral airway. Immunotherapy by injection is less convenient; however, if your arm swells up after a shot, it's less dangerous than your throat swelling closed.

Good luck.

Dr. Bob


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