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whole blood count results

Dec 15, 2013

Hii, I am an infectious disease doctor in Turkey. I would want to ask about my patient. She is 63 years old, with diabetes, osteopenia, HIV positive for 9 years, but started to take treatment for the first time before months. At the beginning of the treatment: CD4: 48, HIVRNA: 56000 kopy, wbc: 3,24, platelet:84.000, hgb:9. She had no any infection before treatment. We started zidovudine, lamuvudin and liponavir/rv. Because severe neutropenia occurred, we changed the treatment with tenofovir, embtricitabine and liponavir/rv. The treatment is given for 2 months. HIVRNA suppressed, but leukocyte, platelet and hemoglobin count are still low. The last results: wbc 1,7 (PNL %60), hgb 9, and platelet 70. The patient has also severe nutrional deficiency due to not to want to eat. What do you think and recommend? Thanks, Sincerely yours.

Response from Dr. Holodniy

The pancytopenia could all be consistent with advanced AIDS or poor nutrition, or it could be the result of an infiltrative process in the bone marrow such as an infection like MAC. In general, if it is only HIV related the counts should increase as the virus comes under control. If not already performed, I would do a bone marrow biopsy to determine what the precursor cell counts look like and to rule out any infection or malignancy that could be accounting for the pancytopenia.

Undetectable viral load but zero cd4 count - 3 years on
can aids pop up like 3 years later?

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