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Recently diagnosed with CMV

Jul 29, 2006

Hi Dr. Holodniy,

Thanks in advance for answering my question. I'm 28 and was diagnosed in Nov'05 with HIV. Up until now I haven't had any symptoms, am not on any medications and so far my labs have landed me on the borderline of taking meds vs not taking meds.

My first set of labs back in Nov were CD4 278, 19%, 17k VL followed by the following labs every 2 months - 325/19%/12k, 320/20%/7k, 402/23%/40k, 275/27%/18k (June '06).

For the first two weeks in July I was sick with high fevers, nightsweats etc followed by another week of very high fevers (103+), nightsweats etc due to an allergic reaction to the antibiotic Bactrim I was taking. I ended up in the hospital due to the reaction and despite running all sorts of tests, nothing was coming back.

Yesterday I got a call from my doctors and they told me that one of my tests came back positive for CMV (I'm not sure which one but I believe the receptionist said it was Mono CMV).

I've done some preliminary research on CMV but without knowing for sure which one it is, I haven't been able to narrow it down. Unfortunately I haven't been able to find very conclusive information as to what it is either.

Here are some of my questions:

1) Regarding my labs, can I still hold off on HIV meds? Should I just play the wait and see game?

2) Considering that I've been diagnosed with CMV, should I begin meds because of this? In the online info I've read it says that it's generally an OI in people with CD4's below 100 but as you can see from my labs, my numbers are above that.

3) Is CMV an STD? Bacterial?

4) Moving forward, how serious is CMV? Coupled with HIV does it significantly increase my chances of mortality?

Thanks so much for your feedback!

Best, J.

Response from Dr. Holodniy

1. I think you can hold off on meds for a while. Your CD4 percent is very good although your absolute count is a bit down and may reflect the allergic reaction or an acute infection. 2. Hard to know whether you truly had an acute infection with CMV or not. I would have to know what specific tests were done to confirm such a diagnosis. Most people are "infected" with CMV (a type of herpes virus) when they are children and retain the virus for life. People usually get reactive CMV disease when their immune system is profoundly depressed (I.e. AIDS, after organ transplant or cancer chemotherapy). A few people who were not infected as children can acquire the infection as adults and they can get very sick from that. Sometimes it is refered to as CMV mono. 3. See number 2. 4. With a relatively intact immune system, and if you had an acute CMV infection, you should have full recovery. But you now have the virus in you ,although it is not actively replicating. If your immune system were to decline and you were to fall into the AIDS category, then reactive CMV disease could develop.

Decreasing Viral Load
Initial Viral load score and life expectancy

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