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Jan 26, 2002

Good morning,

I was diagnosed with histoplasmosis.

One year ago with cd-4 of 48, I was hospitalized with high fevers of unknown origin. I was treated with antibiotics and released. I was tested and treated at that time for histo, but urine and blood test came back negative.

5 months ago the fevers came back with a vengance. 102-105 degree range, and a series of test could not determine the cause. Again, i tested negative for histo. My spleen became enlarged and was removed. THe byopsy showed granules on the spleen, and doctors were certain the granuals were now on my liver.

After 4 months on intensive antibiotics, the fevers are gone, liver functions ok, but finally tested positive for histoplasmosis.

I am origanally from the Ohio Valley area,( prone to histo)

My CD-4 droped from 84 to 54 the last 3 months, my doctor attributes this to the histo and Predisone taken for the liver.

What is the proper treatment and recovery time for Histoplasmosis? And do you think this is dragging my CD-4 down? And will it come up again after treatment?

I feel better than I have in months, But fatigue easily, Mu viral load is still undetectable.

thanks for all your help....

Response from Dr. Feinberg

Histoplasmosis can be an elusive diagnosis. Coming from the Ohio River Valley certainly puts you at high risk for this infection because it is common in this area (believe me, we see a fair amount of histo here in Cincinnati). I don't know how you were treated for histo, but if your Cd4 cell counts are still depressed, you should remain on histo "maintenance therapy" indefinitely (or at least until you CD4 cell count has been oabove 200 for 3-6 month s).

If when you were treated previously for histo and the treatment was stopped when you responded but you still had low CD4 cells, that would explain why you relapsed. In this situation, CD4 cells are more important than viral load-- what I mean by that is that it is certainly encouraging that your HIV is suppressed, but it is your immune system (specifically, in this case, your T cells) that wards off opportunistic disease. Some individuals have a discordant response to HIV therapy, where their viral load is fully suppress but their T cells are still low, or where their T cells go up considerably even though they have detectable virus. For such people, continued treatment for histo (or whatever OI they have) is important to stay healthy.

Antibiotic Use For Extended Time Period
both partners positive

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