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I need a good Dr., and Insurence.
Dec 20, 2004

I am a small business owner, 27 years old. I have known of my HIV+ status for 2.5 years, and believe I was infected 5 years ago. I have been going to a clinical trials unit every 6 months to get free & supposedly anonymous lab work done since that finding. I was laid off from work shortly after finding out I was positive (telecom crash of 2002), and had been on COBRA for the maximum allowable time (18 months). I opened a new 2 person insurance policy (my business partner and I are covered) this January not allowing anything to lapse trying to avoid our States (OHIO) pre-existing condition loopholes for the insurance companies. When I opened the policy I did not state that I was positive for HIV. My business partner (35 yrs. young), also my life partner, is negative & has no other known high risk conditions, he knows of my condition and advised not to disclose to this new policy as well we could not afford premiums that would have resulted, being a new small business, if they would have even opened a policy with me on it to begin with.

Since my first set of labs, my CD4 count has been above, but stayed right around 400 & viral load has climbed from an initial 15,000 to 230,000 (this spans 2 years, or four 6 month testing intervals) I recently received my last results approximately 1 1/2 months ago to find a CD4 count of 48, and viral load of 30,000. I was advised by a nurse at the clinical trials unit that CD4 counts hardly ever dropped more that 50 100 in a 6 month period, and when it was closer to 350 I would have plenty of time to find a Doctor, and start discussing an initial regimen. I have not been afforded that luxury. They were concerned with the low count, and advised a re-test. I re-tested a week later with a count of 120. So with a new baseline below 200 Im now full-blown, with no doctor & a minimal 6-week wait to get in to see one because I have no current primary care physician. I was given a prescription for a prophylaxis antibiotic, Bactrum, through a Doctor at the Clinical Trials to prevent PCP until I could get in to see a physician on my own.

I have 2 weeks until my Doctor Appointment; I have developed a sore throat, and swollen tonsils. The Doctors secretary/case manager will not schedule me in before my 2 week out appointment because Im not a pre-existing patient. I have gone to an Urgent Care facility to get a strep test, figuring I would need additional antibiotic help with my minimal immune system if this were a bacterial infection. Strep was negative, but I was given Azithromyacin to prevent secondary infection. Urgent Care does not know Im on Bactrum, or that Im positive. I have been told through a caseworker at another Doctors Office that there are no contraindications for Bactrum & Z-pac (though he said that he was not giving official medical advice).

It is now one week before my appointment. My sore throat is worsening; No fever, I believe it is viral pharyengitis because the antibiotics seem to have made no difference. I continue to gargle with warm salt water. Im not sure I can wait a week it feels like I have swallowed glass chards & my tonsils and nodes are huge I know I have to stay hydrated, but water burns when I drink. I take between 600 & 800 mg of Ibuprofen (Advil) twice a day about 45 minutes before meals so I can get the food down, and to help ease the pain a bit.

So, as for my questions if I only show my Doctor this years labs and say that I was found to be positive earlier this year by anonymous testing, will this preserve my insurance status I know I will see a rate hike, but maybe I will still have a policy?

Does it usually take this long to get in to see a Doctor? Even when your situation is critical?

I dont want to live my life according to financial and insurance needs dictated by this disease. Everyone tells me to get a job with a company that has good benefits, quit the business. I have put so much of my life into this dream, this business Its starting to pay off after 2 1/2 years I dont want to give up.

Tell me that there is hope - Any comments related to my situation would be appreciated. Thanks. Gargling Guy in Ohio.

Response from Dr. Pierone

Generally a sore throat like this is more likely to be related to oral thrush (Candida) rather than a viral infection. Usually with thrush there are white patches, but in cases the mucosa is simply red and very inflamed. Depending on where one lives and how busy the HIV specialists are it can sometimes be very difficult for a newly diagnosed person to get in to a practice.

The insurance issues are more challenging and this is not my area of expertise. You can go to this link for HIV in the workplace for discussion of insurance issues. Good luck.



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