I am a 46 year old female(UK). I was diagnosed 6 weeks ago after admission to hospital for PCP. I don't how long I've been positive, obviousy years. (Not surprisingly my husband tested positive at the same time, we have been together 8 years.)My CD4 is 114 and VL 95,000+. My HB is 10.6. I had a severe reaction to Septrin (rash and swollen ankles). I have not started on medication yet as the Dr. was waiting for my system to settle down and for my resistance results. I have no other viruses.

My questions are firstly, what would be the best treatment reqime for me, which will give me optimum health. The PCP esposide was scary. My Dr has also asked me to join a research trial for TCM 114 aimed at treatment naive people. This has kind of thrown a spanner in the works as I don't know what to do. Reports I have read about TCM 114 are very good with treatment experienced people.

Secondly, my husband has a CD4 62 and a VL 300,000+. He has been referred to a dermatologist for suspected Kaposi Sarcoma on his shin. What is the treatment for this? Is it curable?

Phew!

Thank you.

Dear Phew,

Sorry to hear about your and your husband's recent diagnoses. Both of you have rather advanced disease and I'd agree that starting treatment for HIV in the near future is indicated.

For you, it sounds like your doctors are well connected to the research community. TMC-114 is now approved for use here in the US, called darunavir (Prezista). There are ongoing and enrolling studies to look at the use of darunavir in therapy naive persons, like you. The initial studies of the drug in therapy-experienced patients is quite favorable, though certainly not as lengthy in follow up as other medications. Should you enroll in the study? I'd recommend a detailed discussion with your doctor about your on-study and off-study treatment options, then weight the pros and cons.

As for your hubby's condition, so long as the KS is limited to his skin (he could have multiple sites on the skin, but no suspected internal involement), then the usual treatment approach is to use antiretroviral medications (HAART). KS is indeed "curable" with an increase in CD4 cells, and without usual need for things like chemotherapy.

Let us know how your health improves and of your treatment decisions. Feel free to write us back with additional questions; best of luck to both of you. BY