I recently was diagnosed with Syphilis, HIV & Hep.C. The Syphilis was in the second stage from what the doctors could tell. I was started on Doxycycline before any of my blood work was done.After it was done my HIV CD4 was 394 & my HIV Viral Load was 611,000.They said that I did not have a choice to start HIV meds or not because of my high Viral Load. I started on them at once. Now I have read that other infections and medications could have an effect on CD4 and Viral Load counts. I have also read that you should always wait until two consecutive blood works before starting HIV meds based on viral load alone.Was this wise for me to start on the HIV meds? Now my HIV doctor wants to do a spinal tap to see if the Syphilis is in my nervous system. MY RPR test was at first 256 and the second test after treatment was 16.I am horrified of getting this Spinal Tap, is this really necessary? Should I be looking for a new doctor?

Hmmmm... Let's dissect the issues here. It is not unreasonable to perform a spinal tap (lumbar puncture) in HIV infected people whose syphilis tests are positive. People with HIV have an increased incidence of neurosyphilis and treatment is different and more prolonged if the spinal fluid tests indicate syphilis is in the central nervous system. This is usually done before syphilis treatment starts, as the test may not be interpretable after starting treatment, or if positive, the titer may have declined and we like to use this number in spinal fluid to gauge how well treatment has worked.

I like to get a couple of sets of numbers before starting HIV treatment to establish the consistency. Although your viral load was very high, it could have been elevated because of another active ongoing infection (i.e. syphilis). Your CD4 count was slightly decreased, but not in the danger zone. Thus, even with that elevated viral load you were not in immediate danger of developing opportunistic infections given a CD4 count of 394. However, assuming your viral load remained that high after successful treatment of syphilis, most experts would probably have started you on HIV treatment.