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HIV with Pacemaker and infection
Apr 22, 2007

Dear Dr Holodniy,

I would really appreciate your assistance with this question. If you don't normally answer this type of question could you ask one of your colleagues. I am very much in need of some information.

A 77 yr old male with a pacemaker and HIV needs to have a new pacemaker put in. The current one is faulty. This will require surgery. The patient has developed an infection which has gone (from his arm) into his blood stream. The patient has been on IV antibiotic drip for days but his immune system has not been able to get rid of the infection. What can be done? How can he be given a strong enough antibiotic or get his immune systen functioning better?

Please assist and thank you for your dedication.

Response from Dr. Holodniy

There are several pieces missing to this complicated story. There may be several reasons why the infection is not clearing, which have nothing to do with HIV infection. There could be pockets of the infection that the antibiotics may not be reaching (like abscesses), or require several weeks of antibiotics to cure (like infections of the heart valves, endocarditis). The bacteria could also be resistant to the current antibiotics. HIV is not a contraindication for a new pacemaker to be placed. However, an ongoing blood stream infection would be, unless the heart rhythm problem is life-threatening and the pacemaker needs to be placed emergently.



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