Apr 28, 2007
I was diagnosed HIV+ in Dec 2005. Started HAART in June 2006 as my platelets had dropped over a number on months to 20k. My CD4 and viral load at this point were 370 and 90,000 respectively. After starting treatment my platelts hovered between 9k and 40k. I was prescribed steriods which had no effect. Then I had a couple of sessions of IVIG. This worked really well in the short term but my platelets always dropped after a number of weeks. In january 2007 they were at 76k the highest since starting treatment. they have jumped up and down in the last few months and last week they were back to 24k. My recent CD4 is 570 and viral load undectable. I would have thought that if it was the HIV causing the low platelets then effective HAART would of sovled the problem. This doesnt seem to be the case. Its becoming very frustrating. My Heamoteologist said she is happy with my current platelet level as im not having any problems with bleeding etc, and wants to repeat bloods again in a month. On a seperate issue i have been suffering from peri-anal warts for about a year. I was percribed Aldara cream and initally it responded well but then stopped having any effect. I am now awaiting surgery to have them removed. Is it possible the warts are causing my low platelet count? I am unhappy that my Heamo is not trying to get to the bottom of the problem. I have asked for a bone marrow but was told it was unnecessary as my other blood counts are within the normal range. Is there anything else that you think should be done or will i have to live with low platelets indefinetly?
Response from Dr. Holodniy
I can appreciate your frustration, but it is unlikely that a bone marrow biopsy would yield any further information, particularly if your other blood counts are normal. It is likely you have idiopathic thrombocytopenia (ITP), and although some cases in HIV infected people resolve with HIV treatment some don't. People can also get this problem without being HIV infected. It looks like you have had some response to the usual treatments that are tried. Again, some times these work, with some people having sustained responses, and some times they don't. Although your platelet count is low, and of some concern, it is not dangerously low. It's good you are being followed by a hematologist.
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