Aug 9, 2009
My partner is deaf and was diagnosed positive in November. I was recently told his dr is a family care dr and not an HIV specialist. But she does handle many HIV patients. Im a little worried now about his medical care. He began medicaion on December 12th with EPZICOM, Reyataz, NOVIR has hasnt had any side effects. A month after he tested positive, we found out he had stage 1 kidney cancer. In February the lower 1/3 of the left kidney was removed. He has had a full recovery and no cancer detected as of 7/1. After the surgery he became undetectable and stated to have severe stomach pain. After 4 trips to the ER, his dr stopped the Reyataz & NOVIR and started Sustiva and remained undetectable for 2 months. His last test the CD4 has comedown from 480 to 184 and the viral load is at 135. He is having some nightmares from the Sustive, but he tends to enjoy them becase think its a alternate life. Wired.
I think his dr is taking good care of him but I would like another opinion. based on his lab work is he doing Should he look for a new dr that is focused on HIV with people who are deaf ? Heres his lab results since November:
7/28 HIV-1 RNA, QUANT. REAL-TIME PCR COPIES/ML 135 copies/mL LOGCOPIES/ML 2.13 Log copies/mL LYMPHOCYTE SUBSET PANEL 5 TOTAL LYMPHOCYTE COUNT 843 cells/uL CD4 % POS 22 % ABS. CD4 COUNT 184 cells/uL
05/28/09 COPIES/ML <48 NOT DETECTED LOGCOPIES/ML <1.68 NOT DETECTED
TOTAL LYMPHOCYTE COUNT 1950 cells/uL CD3 % POS 76 % CD3 ABS POS LYMPHOCYTES 1480 cells/uL CD4 % POS 25 % L ABS. CD4 COUNT 482 cells/uL CD8 % POS 49 % ABS. CD8 COUNT 958 cells/uL CD4/CD8 RATIO 0.50 Log copies/mL
3/17/09 HIV-1 RNA, QUANT. REAL-TIME PCR COPIES/ML <48 NOT DETECTED copies/mL Normal LOGCOPIES/ML <1.68 NOT DETECTED Log copies/mL Normal LYMPHOCYTE SUBSET PANEL 3 TOTAL LYMPHOCYTE COUNT 1710 cells/uL Normal CD3 % POS 77 % Normal CD3 ABS POS LYMPHOCYTES 1317 cells/uL Normal CD4 % POS 25 % Low ABS. CD4 COUNT 420 cells/uL Low CD8 % POS 50 % High ABS. CD8 COUNT 859 cells/uL Normal CD4/CD8 RATIO 0.49 Low
2/12/09 HIV-1 RNA, QUANT. REAL-TIME PCR COPIES/ML 435 copies/mL High LOGCOPIES/ML 2.64 Log copies/mL High LYMPHOCYTE SUBSET PANEL 5 TOTAL LYMPHOCYTE COUNT 1173 cells/uL Normal CD4 % POS 26 % Low ABS. CD4 COUNT 307 cells/uL Low
1/16/09 HIV-1 RNA, QUANT. REAL-TIME PCR COPIES/ML 174 copies/mL High LOGCOPIES/ML 2.24 Log copies/mL High
11/11/09 T-LYMPHOCYTE HELPER CELLS CD4 WHITE BLOOD COUNT 4.0 Thousand/uL Normal RED BLOOD COUNT 5.01 Million/uL Normal HEMOGLOBIN 14.4 g/dL Normal HEMATOCRIT 43.4 % Normal MCV 87 fL Normal MCH 28.7 pg Normal MCHC 33.1 g/dL Normal PLATELETS 191 Thousand/uL Normal RED CELL DIST. WIDTH 14.1 % Normal NEUTROPHILS 48 % Normal NEUT, (ABS VALUE) 1920 Cells/mcL Normal LYMPHOCYTES 43 % Normal LYMPHS, (ABS VALUE) 1720 Cells/mcL Normal MONOCYTES 8 % Normal MONOS (ABS VALUE) 320 Cells/mcL Normal EOSINOPHILS 1 % Normal EOS (ABS VALUE) 40 Cells/mcL Normal BASOPHILS 0 % Normal BASOS (ABS VALUE) 0 Cells/mcL Normal TOTAL LYMPHOCYTE CT 1720 cells/uL Normal ABS. CD4 COUNT 361 cells/uL Low CD4 % POS LYMPHOCYTES 21 % Low DIFFERENTIAL TYPE AUTO Normal RPR/REFLEX TPPA RPR NON-REACTIVE Normal HEPATIC FUNCTION PROTEIN, TOTAL 8.9 g/dL High ALBUMIN 4.0 g/dL Normal GLOBULIN 4.9 g/dL High A/G RATIO 0.8 ratio Low BILIRUBIN, TOTAL 0.5 mg/dL Normal BILIRUBIN, DIRECT 0.4 mg/dL High ALKALINE PHOSPHATASE 76 U/L Normal AST (SGOT) 20 U/L Normal ALT (SGPT) 16 U/L Normal BILIRUBIN, INDIRECT 0.1 mg/dL Low TSH, 3RD GENERATION TSH 1.16 mIU/L Normal TESTOSTERONE,TOTAL TESTOSTERONE, TOTAL 429 ng/dL Normal HIV-1 GENOTYPING (PRI AND RTI) RT GENE MUTATIONS DETECTED Normal PR GENE MUTATIONS DETECTED Normal TOXOPLASMA AB IgG TOXOPLASMA IgG Ab <0.91 index Normal HLA-B*5701 TYPING HLA-B*5701 Negative Normal RESULTS REVIEWED BY see note Normal HEPATITIS Be ANTIGEN HEP Be ANTIGEN NON-REACTIVE Normal HEPATITIS Be ANTIBODY HEP Be ANTIBODY NON-REACTIVE Normal HEPATITIS A Ab, IgM HEPATITIS A Ab IgM NON-REACTIVE Normal
11/4/08 CONFIDENTIAL HIV 1/2 Ab W/REFLEXES HIV 1/2 Ab REPEATEDLY REACTIVE Abnormal HIV ANTIBODY, HIV-1, WESTERN BLOT INTERPRETATION POSITIVE Normal P17/P18 REACTIVE Abnormal P31/P32 REACTIVE Abnormal P40 INDETERMINATE Normal GP160 REACTIVE Abnormal GP120 REACTIVE Abnormal P65 REACTIVE Abnormal P55 REACTIVE Abnormal P51 REACTIVE Abnormal GP41 REACTIVE Abnormal P24 INDETERMINATE Norma
Response from Dr. Holodniy
I don't detect anything wrong with the care or decisions that have been made. The sudden drop in CD4 count is also reflected in the drop in total lymphocyte count. What is somewhat assuring is the CD4 percent is relatively stable. This indicates to me that this fall is probably not significant. The viral load increase to 135 is likely a "blip", which is associated with assay variability and not with treatment failure.
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