Good morning doctor and thanks for your time. I'm trying to understand better the pro and cons of cortison (glucorticoids I guess you call them in US). I'm HIV+, female, 28, CD4 over 1500, VL floating from 2000 to 700 no meds ongoing. What led to the HIV diagnosys was a strong ITP (less than 4000 PLT) for which I've been hospitalized. I've been infected during a holiday in a non-developed country with a tetanus shot (ironic, isn't it?). However, I agreed with my doctors (I'm Italian and we have very good centers for HIV), to delay the theraphy thank to my good numbers. I just have to undergo periodically (especially after the flu or a very strong cold), to a glucorticoid teraphy, with prendisone (we call it cortison), starting from 75mg per day decreasing slowly for avoiding my body to be hurted while in the process. I'm pretty curious; I see that my total white cells count increases dramatically with cortison, and so do my CD4 (30%) which it's surely not bad, but I also know that cortison is not good for people immuno-comprimised becasue somehow damages the immune system. Could you clarify this point? What are the risk of a long prendisone cure? I know that the only other choice would be to take the cocktail but I still would like to wait. Also, do you have info of the effects of melatonin on platelet count? I read a study, related to Dr. Di Bella, where one of the first effect of melatonin was a strong increase of platelet number. As soon as I'll stop again the cortison I would like to try it but I would like to have more info. Cortison is working but some of it's side effect are bothering me a little (for instance in this moment, being evening I have a sweet moon face :-)

Thank you for the time you'll dedicate to clear my doubts. Anne

Ciao Anne

It sounds like your numbers are fine and delaying therapy makes sense. There are at least 4 ways to treat ITP in people with HIV. One is to use antiviral drugs. In days past, this might be AZT alone, but now would be some form of combination therapy. Another is to use courses of high dose corticosteroids (Prednisone, prednisolone, or hydrocortisone). Two more desparate measures are to use intravenous gammaglobulin or to remove the spleen.

There is a lot of interest in corticosteroids in HIV. There is some evidence that they decrease the activation of the immune system which may lead to lower viral loads. However,a recent abstract did not show a long term benefit. The risks of corticosteroids are pretty complex. They depend on how much and for how long. In the short term, they may cause changes in blood pressure, increased blood sugar, mood change, increased appetite. Over a slightly longer period, they can cause weight gain, "moon face" and facial hair. Over the long term, we worry about thinning of the bones, serious blood pressure problems, and immune suppression.

One bit of good news. It is very unlikely for a short course, say two weeks, to significantly reduce immune function, even in a person with HIV.

In many people with ITP early in infection, the ITP improves. Hopefully that is what will happen for you. If you continue to require steroids, you and your doctors may want to think about HIV therapy.

Tanti auguri ATP