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Low Platelets; Time for Drugs?
Sep 21, 2003

I have been postive for twenty years. For the last fifteen years my t-cells have been in the 200s and my viral load under 15,000. In the last year my platelets have dropped. One month ago they were 80,000; recently 50,000. I have never had opportunitistic infections or been on antiretroviral therapy. My doctor thinks the platelet count is cause to go on antiretroviral therapy. I have resisted therapy because I am concerned about long term side effects. Will therapy improve the platelet count? Is the platelet count alone enough reason to begin therapy?

Response from Dr. Holodniy

A low platelet count in and of itself is usually not sufficient to start HIV therapy. HIV itself has been associated with low platelet counts and is thought to be due to its effects on the bone marrow. HIV treatment however, has been associated with increasing the platelet count. A platelet count of 50,000 is not a major concern, but bares watching. Major bleeding problems don't usually occur until the platelet count falls below 10,000. The current recommendation for starting treatment is a CD4 count < 350 and/or a viral load > 50,000. If you were walking into the clinic today, many experts would recommend starting treatment just given your CD4 count. Given your relatively stable history over the last 15-20 years, time is on your side.



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