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HIV-ITP and initiating treatment?
Nov 4, 2003

My current CD4 count is 678 and my VL is 87,654. The of CD4 to CD8 is 22. I have no symptoms to speak of; no fatigue, no fevers, etc... My blood work looks good and all other cell markers are in the normal range. My testosterone level is in the upper ranges of normal. The only problem is I have a declining platelet count, diagnosed by my doctor as HIV-ITP. 6 months ago it was 178, 3 months ago 131, in early September it was 97, and last week it was 78. Obviously it is declining. My doctor recommends starting HAART (AZT shows good results in resolving ITP). But I've been trying to avoid that for as long as possible. I've been infected for about 2.5 years. Are there other options to boosting my platelet count without resorting to HAART? All other cell markers are good. Thanks

Response from Dr. Pierone

Hello, although there is a declining trend of your platelet count it might be worth repeating another level now to see if it has reached a plateau or is still going down. There is not that much difference between the last 2 readings of 78 and 97.

Antiretroviral treatment promptly takes care of HIV-related ITP in the great majority of people. There are other treatments and these include corticosteroids (prednisone), intravenous immumoglobulin (IVIG), and splenectomy for severe and refractory cases. These alternative treatments have major shortcomings and generally it makes more sense to treat with ART rather than these standard treatments for non-HIV-related ITP. It is unusual to develop bleeding complications with a platelet count of more than 50 -60 so you may not have to start ART immediately if you want to see if the ITP quiets down on its own. If you decide to wait on treatment you should have more frequent monitoring of the platelet count (every 2 weeks or so until the trend is clear). Good luck!



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