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CD4 =350 abd now have CMV
Nov 24, 2003

Dear Doctor Thank you for your help. 2 months ago I had CD4 of 350 and VL of 16000. I started to feel unwell and found I had a new infection of CMV (unusual in a 35 y.o man?) It fixed itself up and my plan was to continue to monitor my health and decide when HAART was appropriate.

Anyway I now have had a week of feeling like I have a disease closer to Parkinsons disease. I cannot stand up, I am shaking uncontrolably and I have all the other sumptomps I had with the initial CMV. My doctor is awaiting my liver function tests to see if the CMV has re-activated.

Would you suggest I start HAART immediately? Could starting HAART damaged my liver further in the shortterm. I am desperate for help and I am concerned my doctor wants mee to sit it out. Are there any known cases of other serious CMV disease withg a CD4 count of mine?

Thank you for your great work

Response from Dr. Wohl

Hi

I am unsure what you mean when you say you had "CMV". CMV is a virus that many people with HIV have (almost all HIV+ gay men have evidence of CMV infection). CMV, like its cousins herpes simplex and the chicken pox virus, never leaves the body but lives in some of our cells from where, with a drop in immune function, it can reactivate. In the US, among HIV uninfected people age is generally the odds of having had CMV infection (i.e. if you are 50 years old, you have about a 50% chance of having CMV infection). It is not rare.

In HIV, CMV usually causes an infection of the back of the eye. This happens when the CD4 cell count is generally less than 50.

I suspect, your doctor thinks you caught CMV virus for the first time ever recently. This can cause a monnucleosis like illness (fatigue, elevated liver tests, etc). This is not all that uncommon and in adults is often sexually transmitted.

Your cuurent symptoms sound concerning. I would make sure you get a CT or MRI of your brain and see a neurologist. DW



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