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Best treatment for toe-nails?
May 14, 2005

I am 50, positive for 5 years, on treatment for 10 months, undetectable but CD4 count reached only 450 before dropping steadily to current 320, liver-results good.

Nails of big toes have been deeply infected with a yellowing fungus for about three years. Was prescribed a thrice-daily cream but it did nothing. Was offered a pill to sort it out but was warned it is toxic and can damage the liver.

I avoid inspecting these two nails but they are now really frightful. One has developed a honeycomb underlayer nearly a quarter of an inch thick, and the other is a nicotine-yellow-brown and VERY bowed, contracting, (ingrown).

I live four hours from my nearest HIV doctor and my next appointment is in two months' time.

What should I do? What treatment would you recommend?

I am fearful of adding further toxic treatments to my HIV meds (EFV, 3TC, TDF).

Many thanks.

Response from Dr. Pierone

A fungal toe nail infection may appear quite frightening, but the medical consequences are minor so you can wait 2 months to see your doctor. There are several choices of effective oral anti-fungal medications (such as Diflucan, Sporanox, or Lamisil). All of these medications may cause liver toxicity, but the risk is low so we often offer treatment in order to clear up these infections.



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