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What should I expect
Nov 21, 2005

Dear Dr. Wohl: Please help me understand something. I would like to know the prognosis/mortality/and mindset of my husband who was diagnosed with HIV and HEPC 5 years ago. (last lab was: VL 3500 and CD4 was 360) He is 45 years old, 6 ft. tall, 240 pounds, drinks everyday (6-7 beers/day thru the week, and more than a case over the weekends, AND from time to time he will heavily use valium (50 to 120 mg at a time.) (He has never taken meds for either of his infections) He is a physically strong (as well as mentally strong) person who goes to work everyday and insists that he is fine and everything will be ok. What should I expect in the future from a medical stand point? Casey in KC

Response from Dr. Wohl

Dear KC-

I suspect your husband is also the kind of guy who hates to ask for directions, even when lost. The good news is that his HIV viral load is relatively low. That means that it is likely his CD4 cell count will drop slowly over time. The bad news is that it will drop and as it does drop he does become at increasing risk for opportunistic conditions such as cancers and infections. Most docs in the US would be getting their precription pads ready as a CD4 less than 350 typically leads to a recommendation to start HIV meds.

The HCV infection can complicate things and therapy for that, although no walk in the park, is better tolerated and more effective when the CD4 cell count is high. He would need to stop his drinking. Alcohol is going to hasten any HCV related liver disease. If he were willing and clean and sober, this would be a great time to start HCV therapy and get it out of the way before starting HIV therapy.

But, I gather the issue is what will happen if he is not interested in quitting drinking or starting any therapy for either infection. Again, as the CD4 cell count drops, he may get ill. His HCV can also flare causing liver failure. He is a walking time bomb and I suspect that it will take a major infection or other illness to snap him out of his head in the sand approach. At this rate everything will not be okay.

Nagging him won't help. Hopefully, his clinician cna help him see where the path he is following leads. A trusted friend or relative may also be recruited to help to get your husband to see the light. He also may be depressed. Not everyone with depression is sad. Some are angry or withdrawn.

Overall, it sounds like he needs help, if he will just allow it.

DW


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