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Fatigue and AnemiaFatigue and Anemia
           
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Re: Help
Jun 29, 2001

Dr Frascino,

Thank you for your thoughts. - meant that I am HIV negative this far. I wrote to inquire about my partner's fatigue and waking later. When he found time to be positive with school and work I don't know, and would rather not find out. Anyhow, we got the Viral Load and CD4 back and I was hoping you could help me. The VL is 30K and CD4 700. Would these conditions cause excessive fatigue? I know both are great numbers, no meds are required! How susceptible am I with unsafe sexual contact as the receptive partner one time with no semen for 30 secs? How does alcohol affect the immune system (he now drinks more frequently). Thank you so much for your insights!

P.S. I read your personal data and feel you are quite an inspiration for the rest of us! Keep up the great work, and sensational humor during these dark days.

Response from Dr. Frascino

Hi "negative this far,"

Welcome back to the forum! Your partner's CD4 count is excellent at 700, and the viral load is only mildly elevated at 30K. I agree that starting therapy at this point is not necessary! HIV-related fatigue is often a multifactorial process. Studies indicate that those of us with lower CD4 counts tend to have more fatigue. At 700, it's doubtful that's a problem for your partner. Friends and patients have told me that they feel worse when their viral loads go up, but this really hasn't been documented in clinical trials so far. Besides, 30K isn't very high. So, I would say that your partner's numbers probably don't explain his fatigue. What else could it be? There are many other potential causes:

1. Inadequate or poor diet 2. Inadequate exercise/physical activity 3. Alcohol, caffeine, nicotine, recreational drugs can all affect sleep cycles. 4. Anxiety/depression is very common and often under recognized as a cause of fatigue. 5. Medication side effects - he's not on antivirals, but what about any other new medications? 6. Anemia - often unrecognized and frequently under-treated as a cause of fatigue. A normal hemoglobin level for men is 14-18 gm/dL and 12-16 gm/dL for women. 7. Hormonal imbalances - low testosterone, thyroid, or adrenal hormones

This is only a partial list, but I would check these things out first. Go with your partner to his next appointment and specifically address these potential causes of his fatigue. Don't be dissuaded by his "good" numbers. Your partner's quality of life has changed and an evaluation of his fatigue is warranted.

As for your risk, well, the receptive partner has higher risk than the insertive partner, but the fact that the duration was short (30 secs.) and no semen was exchanged improves your chances somewhat. HIV is actually not all that easy to catch. The statistics are that infection occurs in approximately 1-4% of high-risk sexual episodes. The risk is lower if the viral load is undetectable. So, you have some risk, but it's probably quite low. I would still recommend getting tested. If negative, repeat the test again at 3 and 6 months to be absolutely sure of your negative status. Condoms are now essential for your continued good health. Talk this over with your partner. It might help you to know that my partner and I are also a discordant couple, and we have a wonderful and fulfilling relationship. I hope the best for you and your partner as well. Write back if you need additional information.

Thanks for your comments. I do believe that dark days can often be brightened by a smile.

Stay well.

Dr. Bob


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