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Start HAART or wait until syphilis treatment is over?
Jun 20, 2003

Dear Experts,

My close friend tested positive for HIV a while back and has not started HAART. This person's t-cells have decreased significantly recently (were 450 a couple months back and are now @ 150 with a viral load around 160,000). But, this person also found out that they have tertiary syphilis and is now hospitalized for IV penicillin infusion to treat the syphilis. The question is, can syphilis cause such a precipitous drop in t-cells (can the bacterium even attack t-cells?) and, if so, is it possible that the t-cells will increase again after the syph is gone (without starting HAART)? I would be grateful if you would respond -- this friend lives in another country right now and if the syphilis is probably not the cause of the t-cell plummet (i.e. if this is just a sign of the HIV infection picking up speed), I need to figure out how to bring them home and get them on HAART quickly.

THANK YOU in advance,

frantic best friend

Response from Dr. Young

I'd suspect that the syphillis (if truly tertiary) is not the cause of the drop in CD4 count, since it's been there for many years. Yes, there is an influence of simultaneous illnesses or infections on CD4s but probably not in this case.

As for starting therapy, I'd be in favor of reevaluation of the CD4 count, and if really below 200, starting therapy for HIV would be highly recommended. Furthermore, the resposne to syphillis therapy is probably going to be better if the immune system is healthier.

Good luck. BY

starting medications
rapid drop in cd4

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