|where is the urgency?
Apr 21, 2002
hi doctors, Realising that you recieve alot of questions, i have also asked several both here and in other categories and forums, i am not begging per se but i hope you will answer this one because i am getting panicky. Due to other medical conditions i eventually found out about my hiv status. Choosing a ID doctor was hard for me since i did not know how to do it but through advice from other HIV patients and this forum i have decided to somewhat confidently settle on one. I will be going next week. I visited the office to get a feel for the place and spoke with a nurse and caregiver there to make sure my provider information was all set. Prior to that however, i was stressing and did make an appointment at a well regarded clinic and saw an ID doctor ten days ago. She was fine but i did not like the placeat all. I was given bactrim and had blood tests. During a two week period beginning twnty-one days ago my cd4 count was 151 and 374 (i don't have the viral load info yet). Now, I have intermittent fever and also night sweats, i think also thrush as i have seen photos of it and can identify my tounge in a similar way, somewhat grotesque. I also have low platelets. Just today i found out from my hospital records, which encompass several visits due to a kidney stone, plenamegoly, and other minor problems, that i have multiple low density lesions on my liver (about 15) and at least two appendicoliths at the tip of my appendix and what may be a small polyp in my gallbladder, as a stone has been ruled out. There are also other hopefully minor things but my questions are about beginning treatment. Since the conditions i have don't seem to be caused by AIDS, or maybe so and i am unaware of it, would you suggest treating all of the other things before starting on meds? I worrying alot about the seemingly non-urgent response by the medical professionals regarding my HIV, which when taken collectively, puts me oddly at ease knowing that alot of testing must be completed before starting meds. Along with learning more about what is going on with HIV i realise that i don't need meds yestarday, or am i wrong about that? Since my cd4 went so low i belive i should worry shouldn't I? Can you please put this into perspective for me? I would treally like to hear about it. thank you
| Response from Dr. Pavia
It sounds like you are having some HIV related symptoms, including thrush and unexplained fevers. Low platelets can often be a direct result of HIV infection. Splenomegaly (an enlarged spleen) can be a result of HIV, or can be related to the reason you have low platelets. The information on the lesions in your liver is too limited to know what they might be, but this needs to be worked out.
With symptoms and a low platelet count, you have several reasons to start therapy. Your two CD4 counts show just how much counts can bounce around, but if the real number is closer to 150, that is another clear reason to start treatment.
It does not have to be yesterday, but it is getting to be time to get going, in my opinion. You need to form a relationship with a doctor and work to select the right regimen. During the time you are getting ready to start, you should be able to figure out if there is another problem that accounts for the liver and spleen changes, or if it appears to all be the HIV.
It is a scary process to get started and to develop trust in a doctor and the team at the facility, but it will come together. It sounds like you need to make a decision and avoid any more doctor shopping in the short term.
Good luck ATP
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