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Crohns Meds,HIV,CD4Cells,Viral Load
Mar 21, 2010

My son has been HIV pos for 22 years. In 2002 he was dx with Crohn's. Was put on 6MP, had bone marrow supresson, HCT 10 %, trans 5 units of blood. Taken off 6MP and HIV meds as his viral load was undetectable, did okay until 2008. Crohn's relapsed, small bowel resection, ilieum removed, more 6MP for abt. 3 months, CD4 cells down to 167, off 6MP permanently. In Sept 2009 CD4 cells back to 302. Viral Load is still undetectable. He has been on 40 mg. predisone daily since Oct 09,{another Chrohn's relapse), but has had shingles Sept 09 and pneumonia in Dec.09 and March 2010. My question: is there anything you can think of to boost his CD4 cells while having to take the predisone? Do you think the 6MP has damaged his immune system to the point that it will not recover, even though his VL stays down? Is there anything we can do to boost his CD4 cells? He is 49 years old and he did well until he got Crohn's. I have ulcerative colitis with many years remission.

A reply will be appreciated.

Response from Dr. Holodniy

His case as you are aware is very complicated. He has one illness where his immune system is in overdrive and you need to give meds that shut it down and another, HIV infection, which reduces immune function. It's hard to know whether the 6MP has permanently damaged his immune system. The shingles and pneumonia are most likely the result of steroids shutting down his immune system. I assume his gastroenterologist and HIV docs are talking to each other regarding the management plan. There is no right answer here and every case is needs to be individualized. I would favor restarting HIV meds, thus taking HIV out of the equation. The question is can he receive and/or tolerate some of the newer meds now being used for Crohn's (like monoclonal antibodies) which although have their own issues, and could allow him to taper or get off the prednisone.



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