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Will currnt symptoms affect viral load and cd4 count?
Sep 4, 2007

In have been on meds for 11 years. For the last several years I have been on the same regimine: Viread, Epivir (now Truvuda), and Viramune. My initial viral load was 10 and my viral load was >705,000. In June of 2007, my viral load was <50, as it has been for several years, and my cd-4 was 450.

In August I developed a fever and a plaque on my tonsils. I was treated with antibotics for tonsilitus, and I was tested for just about everything - std and otherwise. All of the labs came back normal, yet a month later I am still experiencing extreme nausea and fatigue. I have lost 10 lbs. My hiv doc wants to re-test for Lyme disease and is thinking about retesting for Epstein Barr.

I have two questions. First, is there anything you can think of that would cause prolonged nausea, fatigue and interrupted sleep? More importantly, will this recent illness affect my viral load and cd-4 count? Could a flu or something like that have triggered something in this hiv/immune condition?

I think the worst part of this is not knowing what is happening to me.

Response from Dr. Pierone

Hello, and thanks for posting.

Sometimes a viral-type infection can produce symptoms which persist for weeks. Epstein Barr is that prototype of a fatigue-producing infection, but most adults have already been infected with virus and it is rare for reactivation to occur with a good CD4+ lymphocyte count like yours. Lyme is a thought, but chronic nausea would be a somewhat unusual presentation. It your symptoms are starting to recede it will likely turn out to be a self-limited infection with post-infection fatigue. If your symptoms have not improved at all then further studies are in order.

When confronted with diagnostic uncertainty it often makes sense to repeat the original blood tests, because some conditions take a while to develop and show in the blood. It may be time for some imaging studies too and with chronic nausea an upper endoscopy may become necessary. The sequence of tempo of further testing depends on you and your doctor and how things evolve with time.

Sometimes an infection will produce a transient decrease in CD4+ lymphocyte count and sometimes a blip in the viral load. But rarely is the positive response to HAART is not compromised by a supervening infection.

Let us know how things turn with your condition and best of luck!

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