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low platelets and aids progression but no treatment.
Jun 20, 2005

2 years ago I had a bone marrow biopsy because of low platelets.When I went back to get the results at my next check up months later my consultant did not know I had had the test and asked me why it had been done. I live 300 km from my treatment centre and I had to travel over night for the test. I never got a conclusive result. I had another low platelet result but no treatment. I changed to a new treatment centre near my town when it opened and missed a check up as my son was ill. Now I have got an aids diagnosis and I am still not on treatment although I have been under the care of a consultant for 7 years. Can you tell me how low a platelet count has to be to warrant a bone marrow biopsy (spine) and what is the normal treatment response if continues low. I read at the time that it was a possible indicator for progression to aids.My cd4 was 350 ish .Now it is 150 and I have had a herpes infection - they think as it was diagnosed over the phone without examination . I thought it was an allergy as I have had many skin rashes from sanitary towels and had been having problems due to long menstrual cycle ( anything from 8 - 18 days). I have to wait for a month to get app with consultant again to start treatment as she is going on holiday next week.They are going to give me prophylax they said for pcp - ceptrin. I read quite a bit about treatments and so on but I feel that I should have got treatment sooner and I should not have to wait so long to get it now. I have had no other contact with clinic only every 3 months except missed app. gap. But when I had biopsy done I felt I should have started treatment then and cant understand why they did it if my consultant did not order it or why so little follow up. I have been very very fatigued drained forgetful light headed and recurring diarrohea stomach cramps headaches and fluey symptoms all year and still not even a vitamin pill. I feel very mistrustful of whole experience with health provider but willing to be reassured that I have nothing to worry about. Should I wait a month to get started on treatment or insist I am seen now?

uncertain what to do.

Response from Dr. Wohl

It sounds like you have not been receiving optimal care but whether you better options available to you is unclear. Low platelets can occur during HIV infection. Many times it is not a problem with the bone marrow but with the platelets getting destroyed by an abnormal immune system response and/or trapped by the spleen.

You certaibly need HIV therapy and should try to get on treatment right away. This may or many not help your platelets. IF it does not, some reports suggest Dapsone as a PCP prophylaxis may increase platelet counts. Prednisone has also been used but has many side effects. The goal should be for the platelets to be above 20,000 without increased bleeding (including during menses).

DW



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