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fatigue --> start meds?
Mar 8, 2010

Dr. Bob,

First allow me to compliment you on your blog. I have only read the first entry but your positive energy and presence is just fantastic. Thank you for that.

I've been poz for 12+ years, not on meds and my numbers are good (CD4 ~500, VL ~5000.) My major complaints are apthous ulcers (often by the dozens...recently counted 40+) and extreme fatigue. My docs have been diligent; I am on TRT. We've checked for anemia, apnea, talked about diet, rest, etc. The fatigue has been getting worse and my instincts are that it is the "hiv itself" category. So, my docs have suggested trying meds. Intellectually, I think I understand where they are coming from.

However, I'm having some sort of mental block on starting meds. I can sit down with my provider and/or therapist and talk each "concern" through but I'm not nailing it.

So, at the risk of venturing out of the scope of this forum, can you share any wisdom as to why I resist the idea of starting meds?

As always, your service is very much appreciated...


Response from Dr. Frascino

Hi Andrew,

You want me to explain why you are resistant to starting HIV medicaments? Hmm. That's an odd request Andrew. I really have no idea how your specific thought processes work or what unrecognized fears you may be harboring, consciously or unconsciously. You'll have to delve into those topics with your shrink, OK? What I can tell you is that in general some folks are reluctant to begin HIV medications for a number of reasons:

1. It's a milestone, like the day you received your positive HIV test result. Starting meds is another one of those red letter days.

2. Fear of side effects and/or toxicities.

3. Need for near perfect adherence to the regimen (to avoid resistance).

4. Cost.

5. The hassle factor of having to take drugs regularly for the rest of your life.

6. The constant reminder that the virus is not only part of you, but wants to plant you six feet under.

The list goes on and on, but this should at least give you a starting point form which to analyze your own resistance.

Good luck.

Dr. Bob

I am SO SORRY Dr. Bob if I have troubled you in any way... I didn't mean to bother... Do not have anyone to talk to, help me, reach out to...

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