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Kaletra & Truvada & Sulfamethazole
Oct 1, 2006

Diagnosed in Feb 2006, In March, CD4 26/6%, started meds immediately. Developed MAC, was hospitalized for 10 days, put on Amikacin IV for 3 weeks, Cipro, Ethambutol, Mycobutin, Azithromycin. Still taking all but the Amikacin. Now also on Procrit for extreme anemia, was 8, now 11. Still on all these meds except Amikacin. In June CD4 was 136/12%, in Aug CD4 was 167/26%. Is this a good result with these 2 drugs? I hear that some of the meds I've mentioned can actually slow my CD4 count and %. I have developed severe joint pain and am extremely tired all of the time. Please give me your advice. I really appreciate all that you do here!

Response from Dr. Wohl

I wish you had written what your viral load has been. I will assume it is undetectable given teh nice CD4 cell count increase you have had. To have gone from 26 to 167 in a few months is impressive and although, understandably, you want it to go even higher you must realize that dramatic CD4 cell count rises in people starting with very low counts is unsual. We are not sure why those who had low counts see muted CD4 increases and often seem to hit a ceiling but it may have to do with the burning out of certain CD4 cell count lines.

Your counts may yet still rise.

Sulfa meds can theoretically inhibit the bone marrow and CD4 cell production but I feel this is not that common. Sulfa meds definitely can cause anemia and I would consider a switch to atovaquone (Mepron) for PCP prophylaxis so as to avoid any contribution of this to your low red blood cell count.

You are on a lot of medications and some of your symptoms may be side effects of these drugs. It is unclear to me why you needed to be on 4 drugs for MAC and remain on 3. Cipro and Ethambutol alone should work and with your counts over 100 and rising, I would see discontinuation of MAC therapy a real possibility if blood cultures for MAC are negative there is no clinical evidence of this infection.

DW



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