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Change treatment??
Nov 7, 2004

Hi doc, here is my short treatment history. diagnosed in oct 2000..started on nevirapine, lamivudine, stavudine-30 and continuing till date with 98 % adherence. Lab reports are 1. VL-RTPCR 31000(cd4 243)in oct 2000, 2. 24000(620) in july 2001, 3. <20(340)in oct-2004. IN all these years I have not had any infection requiring hospitalization, though skin abscess has occured once and few loose motions 2 or 3 times in these four years. My present biochem report is all within range but triglicerides are 323 mg/dL. Also I have lost fat from everywhere and weight loss in four years has been 5 kilograms.My questions are 1) should I change my treatment and 2) can I take yellow fever vaccination as I might travel. with warm regards and thanks.

Response from Dr. Lee

Looks like your current regimen is working to control the virus. So, the question is related to the side effects. A Triglyceride level of 323 without having fasted for several hours prior to the lab draw is probably not real concerning. However, the weight loss, especially fat loss will accumulate and cause significant changes in your appearance. It has been found that stavudine is one of the nucs that has the most significant effect on fat redistribution and so changing to another regimen with different nucs may reduce these effects.

This is from the CDC website concerning yellow fever vaccine: Yellow fever vaccine generally has few side effects; fewer than 5% of vaccinees develop mild headache, muscle pain, or other minor symptoms 5 to 10 days after vaccination. Under almost all circumstances, there are four groups of people who should not receive the vaccine unless the risk of yellow fever disease exceeds the small risk associated with the vaccine. These people should obtain either a waiver letter prior to travel or delay travel to an area with active yellow fever transmission: Yellow fever vaccine should never be given to infants under 6 months of age due to a risk of viral encephalitis developing in the child. In most cases, vaccination should be deferred until the child is 9 to 12 months of age. Pregnant women should not be vaccinated because of a theoretical risk that the developing fetus may become infected from the vaccine. Persons hypersensitive to eggs should not receive the vaccine because it is prepared in embryonated eggs. If vaccination of a traveler with a questionable history of egg hypersensitivity is considered essential, an intradermal test dose may be administered under close medical supervision. (Notify your doctor prior to vaccination if you think that you may be allergic to the vaccine or to egg products.) Persons with an immunosuppressed condition associated with AIDS or HIV infection, or those whose immune system has been altered by either diseases such as leukemia and lymphoma or through drugs and radiation should not receive the vaccine. People with asymptomatic HIV infection may be vaccinated if exposure to yellow fever cannot be avoided.

Be well.



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